Chapter 6: Radiographic Assessment Test Bank

Multiple Choice

1. What type of X-ray view is obtained when the radiographic plate is placed behind the patient’s back with the x, and the side up may better define ____________________. a. Anteroposterior view b. Posteroanterior view c. Lateral view d. Frontal view

ANS: A

Feedback: When the radiograph is performed at the patient bedside with mobile radiographic equipment, the image receptor is placed behind the patient's back and the X-ray tube is placed in front of the patient's chest. This obtains a frontal view in the anteroposterior (AP) projection, with the beam passing from anterior to posterior.

REF: p. 89

2. The lateral decubitus view is a frontal radiographic projection whereby the side down can be evaluated for presence of ____________________. a. Atelectasis; a pneumothorax b. A pleural effusion; a pneumothorax c. Consolidation; atelectasis d. A pleural effusion; consolidation

ANS: B

The lateral decubitus position is a frontal projection performed with the patient lying on either the right side (right lateral decubitus) or on the left side (left lateral decubitus). The down side can be evaluated for presence of fluid, such as a mobile pleural effusion, and the up side will demonstrate free air, such as in the case of a pneumothorax (air in the pleural cavity). Dechray tube in front of the patient’s chest?

REF: p. 89 b. The size of both lungs will decrease. c. The size of the affected lung will remain the same or the lung will be hyperexpanded. d. The size of the unaffected lung will increase.

3. The respiratory therapist is evaluating a child with suspected foreign body aspiration. The radiographer gently adds pressure to the abdomen during expiration to take the chest radiograph. If an obstruction is confirmed, what changes should the RT expect to see? a. The size of the affected lung will decrease.

ANS: C

Forced expiratory images are used in assessing the presence of a pneumothorax and to evaluate for foreign body aspiration in small children. When assessing foreign body aspiration in very young patients, the radiographer may gently add pressure to the abdomen during expiration. If an obstruction is present, the affected lung will not decrease in size but remain normal to hyper-expanded.

REF: p. 89 a. Lateral decubitus at full inspiration b. Posteroanterior view at full expiration c. Anteroposterior view d. Oblique view

4. Which of the following radiographic views would be the best suited for evaluating fractured ribs in a pediatric patient?

ANS: D

Oblique views are usually rotated 45 degrees from the frontal position. They are typically used in the evaluation for rib fractures and to better evaluate the entire heart borders.

REF: p. 89 a. Light colored b. Gray c. Black d. White

5. How will well-expanded, air-filled lungs appear on a chest radiograph?

ANS: C

The normal structures that are visualized on a chest radiograph are distinguishable because of differences in the absorption of the X-ray beam by the organs and tissues within the thoracic cavity. Bone and metallic orthopedic hardware appear bright white because of greater X-ray absorption and less exposure of the image receptor. In contrast, air has little beam absorption, and therefore well-expanded lungs appear relatively black. Soft tissue organs and fluid usually appear as shades of gray in between the white bones and black lungs.

REF: p. 90 b. Incorrect exposure of the image receptor may have happened. c. Although the patient looks better, the pneumonia is probably worse. d. This is a normal phenomenon.

6. A respiratory therapist is evaluating a chest radiograph of a patient taken 2 days after being admitted for significant respiratory distress right middle lobe pneumonia. Although the therapist notices a dramatic clinical improvement of the patient, the chest X-ray appears to be more radiopaque than the one on admission. What could explain this situation? a. The therapist is mistakenly looking at a different patient’s film.

ANS: B

Incorrect exposure of the image receptor may alter the normal gray scale. Digital radiographic images are automatically rescaled to allow proper image contrast and brightness, and the image can be manipulated by the clinician after it is processed.

REF: p. 90

7. A therapist is viewing a chest X-ray of a pediatric patient who recently emerged from general anesthesia after upper abdominal surgery. The right hemidiaphragm is elevated, and atelectasis is seen as a long, thick horizontal line within the right lower lobe. Which of the following terms describes this type of atelectasis? a. Discoid b. Lobar atelectasis c. Silhouette sign d. Plate

ANS: D

When an X-ray beam passes through the chest, the densities of all the structures it encounters are summated. Thus a flat object such as platelike atelectasis (collapse of all or part of the lung) may add little to the opacity of the chest in one projection but may appear opaque when viewed on edge in another projection.

REF: p. 90

8. A pediatric patient with pneumonia has an infiltrate in the lower half of the right lung. The right heart border is obliterated. In which lobe(s) of the right lung is the infiltrate located? a. Right upper lobe b. Right middle lobe c. Right lower lobe d. Right middle and lower lobes

ANS: B

Differences in tissue density allow the viewer to discriminate between different structures. The heart, which is composed of soft tissue of muscle density, is clearly demarcated by a distinct edge from the adjacent air-filled lung. However, if the lung becomes denser from loss of air, as in atelectasis, or if the alveoli become filled with pus, as in pneumonia, the sharp edge between the heart and the lung is no longer apparent. The sign caused when two normal structures lose their distinct edge and blend imperceptibly is widely known as the silhouette sign. If the right heart border is visible next to the infiltrate, the pneumonia is located in the right lower lobe. If the right heart border is obliterated, the infiltrate must be located in the right middle lobe, which resides immediately next to and in the same plane as the right side of the heart. Because the right lower lobe does not lie in the same plane as the right heart border, the two structures remain distinct on a chest radiograph.

REF: p. 90

9. Which of the following structures on a chest radiograph projects to the left, causes a prominent bulge of the superior mediastinum, and creates a mild indentation on the trachea? a. Left hemidiaphragm b. Apex of the heart c. Aortic arch d. Hilum

ANS: C

In normal anatomy the aortic arch is on the left and causes a prominent bulge of the superior mediastinum and a mild indentation on the trachea.

REF: p. 90 a. Thymus b. Right heart border c. Aortic notch d. Lymph node in the hilar region on the right

10. A therapist is examining an AP chest radiograph of a neonate and notices a structure projecting away from the mediastinum toward the right upper lung. This structure looks like a sail with a sharp inferior margin and lateral margins with wavy contours. Which of the following structures is the therapist observing?

ANS: A

The mediastinum is composed of the heart, aorta, main pulmonary artery and proximal branches, origins of the great vessels from the aorta, the superior vena cava, and thymus. Thymic tissue is usually prominent in the neonate and becomes less apparent with age because of regression of the thymus and growth of surrounding structures. Because it is an anterior mediastinal structure, the thymus in the small child fills the anterior clear space normally seen on the lateral projection of a teenager or adult. On the AP or PA projection it may only cause widening of the superior mediastinum. When the thymus projects away from the mediastinum, typically into the right upper lung, it appears as a "sail" with a sharp inferior margin. The lateral margins often have a characteristic wavy contour (see Figure 6-4 in the textbook). Unlike a pathologic mass such as lymphoma, the normal thymus does not exert mass effect on the trachea.

REF: pp. 90-91 a. An elevated right hemidiaphragm b. A mucous plug in the right mainstem bronchus c. A mass compressing the trachea d. A right-sided pneumothorax

11. While viewing the chest X-ray of an 18-month-old boy, a therapist notices that the trachea is truncated and that the right lung is collapsed. Which of the following situations or conditions may have caused this situation?

ANS: B

Truncation of the right mainstem bronchus is often the sign of a mucous plug when the right lung is collapsed. Although the right hemidiaphragm is usually slightly higher than the left because of the underlying liver, the position of the diaphragm may indicate hemidiaphragm paralysis or abdominal pathology.

REF: p. 92 a. Perform routine respiratory assessment in the morning and care for an intubated patient at this time. b. Withdraw the endotracheal tube a few millimeters. c. Advance the endotracheal tube a few millimeters. d. Remove the endotracheal tube and reinsert it because it is in the esophagus.

12. A therapist is viewing a frontal chest radiograph of a neonate who has just been endotracheally intubated. The tip of the endotracheal tube is located between the inferior clavicular border and the carina. What should the therapist do at this time?

ANS: A

The frontal chest radiograph can readily be used to assess the proper placement of the ET tube, which should be positioned in the midtracheal region between the inferior clavicular border and the carina. If the tip is located above the clavicular border, the ET tube is too shallow.

REF: p. 92

13. While viewing an anteroposterior view of a chest radiograph of a 24-month-old intubated child, a therapist notices that the endotracheal tube has now migrated right above the inferior clavicular border. What could explain this new location of the endotracheal tube? a. Flexion of the head b. Extension of the head c. Rotation of the head to the right d. Rotation of the head to the left

ANS: A

The position of the head, especially in a neonate, may result in a significant change in position of the endotracheal tube tip: the tip will advance toward the carina when the head is flexed.

REF: p. 92

14. Which of the following radiographic views provides the best perspective for ascertaining the position of an endotracheal tube in the patient’s esophagus? a. Anteroposterior view b. Left lateral decubitus c. Lateral view d. Oblique view

ANS: C

If a chest radiograph is obtained for suspected esophageal intubation, the stomach, small bowel, and esophagus will be distended with air while the lungs will be underinflated. Although usually not necessary, a lateral projection would demonstrate the endotracheal tube in the more posterior esophagus. The lateral projection may be more useful for showing adequate tracheal positioning and length in long-term placement of a tracheostomy tube.

REF: p. 92 a. Laryngotracheobronchitis b. Tracheomalacia c. Adenoidal enlargement d. Epiglottitis

15. A therapist is viewing frontal and lateral neck X-rays of a 12-month-old child and notices what is described as the “steeple” or “church steeple” sign: subglottic narrowing below the vocal cords, and an overdistended hypopharynx. Which of the following conditions does this child likely have?

ANS: A

Croup (laryngotracheobronchitis) is the most common cause of upper airway obstruction in children, with a peak incidence in infants and children 6 months to 5 years of age. Most cases are virally induced (parainfluenza) and cause inspiratory stridor with a barking cough. Frontal and lateral neck radiographs may show the characteristic subglottic narrowing below the vocal cords with loss of the normal "shouldering" of the airway and resultant "church steeple" appearance. The hypopharynx usually appears overdistended.

REF: p. 93 a. Bronchopulmonary dysplasia b. Esophageal fistula c. Croup d. Epiglottitis

16. While viewing a lateral view of a neck radiograph of an 18-month-old child, a therapist notices that the epiglottis is enlarged, the aryepiglottic folds are thickened, and the hypopharynx is overdistended. Which of the following conditions does this child likely have?

ANS: D

Whereas croup usually improves within a few days of supportive therapy, epiglottitis is a lifethreatening disease causing acute inspiratory stridor, fever, and dysphasia (speech impairment). The usual pathogen is Haemophilus influenzae, type B with the risk of infection now greatly reduced by routine immunization programs. The diagnosis should be made by physical examination or by direct visualization through a scope. If a lateral radiograph of the neck is obtained, the epiglottis is enlarged (referred to as the thumb sign) and the aryepiglottic folds are thickened with overdistention of the hypopharynx. The radiograph is performed upright in the position most comfortable for the patient to breathe. Because safety of the child is of primary concern, the radiograph should be performed portably in the emergency department, where intubation can be performed quickly if necessary.

REF: p. 93 a. Acute respiratory distress syndrome b. Pulmonary interstitial emphysema c. Meconium aspiration syndrome d. Transient tachypnea of the newborn

17. A mother has just given birth to a 42-week infant who is small for his gestational age. A chest radiograph of this neonate reveals coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation. Which of the following clinical disorders does this infant likely have?

ANS: C

Although meconium staining of amniotic fluid occurs in 12% of deliveries, only 2% of these newborns develop meconium aspiration syndrome. Predisposing factors are postmaturity, intrauterine stress, and small size for gestational age. The aspirated meconium is produced by the bowel plugs’ bronchi and causes a chemical pneumonitis. The chest radiograph is characterized by coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation.

REF: pp. 95-96

18. A therapist is viewing frontal chest X-ray of a 12-year-old child and notices mediastinal shift towards the right hemithorax along with elevated hemidiaphragm and vascular crowding. Which of the following conditions does this child likely have? a. Atelectasis b. Pneumonia c. Pleural effusion d. ARDS

ANS: A

Segments, lobes, and entire lungs may be collapsed, or atelectatic. This loss of volume may shift fissures toward the area of atelectasis, cause mediastinal shift toward the affected side, and elevate the ipsilateral diaphragm. Crowding of the pulmonary vascular and interstitial markings in the affected region will occur. The other lung or adjacent lobes may become more lucent secondary to hyperexpansion.

REF: pp. 96-97

19. Which of the following are criteria to order a chest radiograph in a pediatric patient who does not have chest symptoms?

I. Fever

II. Oxygen saturation < 95%

III. White blood cell count > 20,000/mm3 IV. Creatinine > 2 mg/dL a. II and III only b. I and IV only c. I, II, and III only d. III only

ANS: C

Chest radiographs may also be appropriate for evaluation in a pediatric patient who does not have chest symptoms but does have a fever, oxygen saturation < 95%, and a white blood count >20,000/mm.

REF: p. 98

Chapter 7: Bronchoscopy

Test Bank

Multiple Choice

1. Which of the following clinical signs receives the highest diagnostic yield in the neonatal population for flexible bronchoscopy? a. Wheezing b. Stridor c. Discoid atelectasis on chest X-ray d. Increased airway secretions

ANS: B

Of all indications for diagnostic pediatric flexible bronchoscopy, stridor receives the highest diagnostic yield of the procedure, identifying specific lesions in more than 80% of patients.

REF: p. 103 a. It is the only way to deliver large foreign bodies through the subglottic area. b. It enables better ventilation of the patient while under general anesthesia. c. A lower fraction of inspired oxygen is required with rigid bronchoscopy, reducing the risk of oxygen toxicity. d. Less anesthesia is needed when rigid bronchoscopy is performed.

2. Why is rigid bronchoscopy preferred over flexible bronchoscopy for the removal of a foreign body from the tracheobronchial tree of a pediatric patient?

ANS: B

Although some authors believe that the flexible bronchoscope can be used for the therapeutic purpose of foreign body removal, rigid bronchoscopy is a better and safer approach in children. It allows better ventilation of the patient under general anesthesia and facilitates safer delivery of large foreign bodies through the subglottic area and the larynx compared with the flexible bronchoscope.

REF: p. 104 b. Flexible bronchoscopy can be effectively used to insert balloon catheters to tamponade the bleeding portion of the lung. c. The flexible bronchoscope can be effectively inserted to enable the deposition of bloodclotting medications into the lungs. d. Flexible bronchoscopy is usually inadequate in this type of situation.

3. A hospitalized patient with cystic fibrosis has developed massive hemoptysis. What is the utility of flexible fiberoptic bronchoscopy in this situation? a. It is useful for removing blood clots.

ANS: D

Bronchoscopy can be useful for therapeutic purposes: it can facilitate removal of blood clots and placement of single-lumen or double-lumen endotracheal tubes and balloon catheters to tamponade (i.e., to exert direct pressure on) a bleeding site in the airway. In situations with massive hemoptysis or brisk bleeding, however, the flexible bronchoscope is usually inadequate because of its limited visualization and suction capabilities compared with the rigid bronchoscope.

REF: p. 104 a. Prepare the insertion tube for attachment to the flexible bronchoscope. b. Replace the 3.0-mm insertion tube with one that is 4.0 mm in diameter. c. Substitute the 3.0-mm–diameter insertion tube with a 2.0-mm–diameter insertion tube. d. Recommend that the physician perform rigid bronchoscopy.

4. The therapist selects a 3.0-mm–diameter insertion tube to be used for flexible bronchoscopy on a neonate who requires surfactant therapy. What should the therapist do with this insertion tube at this time?

ANS: A

The insertion tube is the flexible portion of the bronchoscope that is inserted into the patient's airways. These tubes have the same working length of 55 cm, but they vary in outer diameter from less than 2.0 mm to 6.3 mm. The instruments most often used in pediatric patients are 2.2-mm–diameter scopes for neonates, 2.8- to 3.7-mm scopes for older children, and 4.7- to 4.9-mm scopes for adolescents.

REF: p. 105 a. I only b. I and II only c. I, II, and III only d. I, II, and IV only

5. Which of the following features characterize insertion tubes of bronchoscopes described as “spaghetti scopes”?

I. They lack cables necessary to direct the distal tip, causing it to flex and distend.

II. They are less than 2 mm in diameter.

III. They are used for patients who are not intubated.

IV. Their use is limited to visualization of an airway via insertion down an endotracheal tube.

ANS: D

The insertion tubes of the thinnest bronchoscopes, those less than 2.0 mm in diameter, contain only light and image bundles. They are nondirectable because they lack the cables necessary to direct the distal section of the scope. Appropriately, they have been nicknamed “spaghetti scopes,” and their use is limited to visualization of an airway via insertion down an endotracheal tube.

REF: p. 106 a. Has a suction channel b. Provides recording of the procedure c. Is more rigid d. Produces less heat

6. Which of the following features are consistent with a large flexible bronchoscope compared with a smaller one?

ANS: A

Larger, flexible bronchoscopes have two control cables aligned 180 degrees from each other that connect a hinged bending section at the distal tip of the tube to a control lever at the head of the scope. These cables allow the operator to flex and extend the distal tip of the bronchoscope in order to direct the passage of the scope through the airways. The 2.2-mm scopes have this directable capability, but they lack the third major component of the insertion tube, a suction channel. The larger scopes contain suction channels, varying in diameter from 1.2 mm in the 2.8- to 3.7-mm scopes to 3.2 mm in the 4.5-mm scopes. These suction channels allow for the suction of airway secretions, the instillation of lavage fluids or medications into the airway, and the passage of brushes and biopsy forceps for obtaining airway cytology and pathology specimens. The channel, direction cables, and fiberoptic bundles are enmeshed in a woven metal sheath and then enclosed in a nonlatex flexible plastic membrane.

REF: p. 106 a. Less than 1% lidocaine b. 1% to 2% lidocaine c. 3% to 4% lidocaine d. 5% to 6% lidocaine

7. What percent lidocaine spray is used for neonatal flexible bronchoscopy?

ANS: B

Equipment, such as 1% to 2% lidocaine spray, 2% lidocaine jelly, syringes containing aliquots of 1% to 2% lidocaine, a Lukens trap, 10-mL normal saline aliquots for lavage, and clean gauzes, may be placed on top of the cart for easy access.

REF: p. 107

8. Which of the following drug class combinations is often used to induce conscious sedation in a neonate undergoing flexible bronchoscopy? a. Benzodiazepine and opioid narcotic b. Cephalosporin and opioid narcotic c. Mucolytic and bronchodilator d. Atropine and epinephrine

ANS: A

During the procedure, nearly all pediatric patients require some type of sedation. The most common approach is conscious sedation. Intravenous drugs are preferable to intramuscular medications because of their quicker onset, shorter duration, and titratable dosage for optimal effects. Although various sedative agents are available, the combination of a benzodiazepine (e.g., midazolam) and a narcotic (e.g., fentanyl or morphine) is widely accepted. In addition to sedative effects, the narcotic provides analgesic and antitussive effects, and the benzodiazepine offers anxiolytic effects and antegrade amnesia. The most common side effect of this combination is respiratory depression. On occasion, benzodiazepines can induce cardiovascular depression, and narcotics can elicit muscular rigidity and impaired liver and kidney functions. Fortunately, if these complications occur, specific reversal agents, naloxone (0.01 mg/kg per dose) and flumazenil (0.2 mg/kg per dose), can be given to restore the patient’s respiratory status. These antagonists, along with atropine and epinephrine for adverse cardiac events, should be immediately available.

REF: p. 107 a. 1-2 hours b. 3-4 hours c. 4-6 hours d. 8-12 hours

9. Because one of the major risks of flexible bronchoscopy is aspiration of gastric contents, infants under 6 months should not take anything by mouth how many hours before the procedure?

ANS: B

One of the major risks of flexible bronchoscopy is aspiration of gastric contents. Infants under 6 months should not take anything by mouth before the procedure for 3 to 4 hours, older infants and toddlers for 4 to 6 hours, and older children for 8 hours, to ensure an empty stomach.

REF: p. 107 a. Continue monitoring the patient as the procedure progresses. b. Provide supplemental oxygen to the patient until the SpO2 is 95%. c. If the patient’s SpO2 falls to 88%, administer oxygen to achieve an SpO2 of 90%. d. Stop the bronchoscopy procedure until the patient’s SpO2 returns to its preprocedure level.

10. During a bronchoscopy procedure on a pediatric patient, the therapist notices that a patient’s SpO2 (oxygen saturation as determined by pulse oximetry) is 90%. What should the therapist do at this time?

ANS: B

Ideally, oxygen saturation should be maintained above 95% at all times, with supplemental oxygen delivered to the patient if necessary.

REF: p. 109

11. When using normal saline for bronchoalveolar lavage, what is the maximum amount of normal saline per kg that should be used? a. 1 mL/kg per aliquot b. 1 mL/kg total c. 2 ml/kg per lung d. 2 mL/kg total

ANS: A

If bronchoalveolar lavage is performed, the bronchoscopist wedges the bronchoscope in the selected segmental or subsegmental bronchi and normal saline is instilled in three to five aliquots of up to 1 mL/kg per aliquot.

REF: p. 109

12. Which of the following medications is administered to the patient’s nasal mucosa for the purpose of reducing the risk of epistaxis during a bronchoscopy procedure? a. Lidocaine b. Hypertonic saline c. Phenylephrine d. Racemic epinephrine

ANS: C

The most common route for nonintubated pediatric patients is the transnasal approach. The flexible bronchoscope is lubricated with lidocaine jelly, or another sterile water–based lubricant, and then inserted through a nostril into the nasopharyngeal area. A topical decongestant (e.g., phenylephrine) may be administered to the nasal mucosa first to facilitate passage of the scope past edematous tissue and to reduce the risk of bleeding

REF: p. 109 b. Increase PEEP on the ventilator until the procedure is completed. c. Use a PEEP-Keep TM adaptor. d. Increase tidal volume to sustain lung recruitment during the procedure.

13. A flexible bronchoscopy has been ordered in a child undergoing mechanical ventilation for acute respiratory distress syndrome. After several events of desaturation and therapeutic recruitment maneuvers, the physician wants to rule out mucus plugging. What should the therapist suggest to avoid alveolar derecruitment in this patient? a Take the patient off and bag throughout the procedure.

ANS: C

A PEEP-KeepTM is used when performing flexible bronchoscopy in a patient through an endotracheal tube or LMA.

REF: p. 110 a. Weight less than 10 kg b. Upper airway pathology c. Lower airway pathology d. Preprocedure hypercapnia

14. Which of the following are considered common risk factors for children who undergo bronchoscopy?

ANS: A

Patient risk factors for adverse events include upper airway pathology, preprocedure hypoxemia, and weight less than 10 kg.

REF: p. 110

15. Which of the following complications of flexible bronchoscopy are considered most common?

I. Transient cough

II. Hypoxemia

III. Respiratory depressionIV. Bronchospasm a. I and II only b. III and IV only c. I, II, and IV only d. I, II, III, and IV

ANS: D

The most common complications include transient cough, respiratory depression, hypoxemia, hypercapnia, and bronchospasm during the procedure. Cough is almost universally seen during and after the procedure, but it is usually self-limited and resolves within 24 hours. Respiratory depression is usually associated with oversedation and sometimes requires reversal agents. Any bronchospasm is relieved promptly in most patients by bronchodilator aerosol treatments.

REF: p. 110 a. Intravenous infusion of lidocaine b. Application of topical epinephrine to the vocal cords c. Application of topical lidocaine to the vocal cords d. Prophylactic insertion of an endotracheal tube

16. A pediatric patient is brought to the bronchoscopy suite for a follow-up assessment of laryngomalacia. Last time the child developed a mild laryngospasm during the procedure. How should this complication be prevented?

ANS: C

A less common but potentially more serious complication is laryngospasm. This problem can be avoided by application of topical lidocaine to the vocal cords. If laryngospasm occurs, the bronchoscope must be withdrawn immediately and airway resuscitation initiated.

REF: p. 110 a. Staphylococcus b. Mycoplasma c. Pseudomonas d. Klebsiella

17. Which of the following organisms is often responsible for cross-contamination between bronchoscopies?

ANS: C

The organisms most often responsible for cross-contamination between bronchoscopies are Mycobacterium and Pseudomonas

REF: p. 110

18. The therapist has been asked to clean the bronchoscope after a procedure. Which of the following chemicals should be used as a high-level disinfectant? a. Vinegar b. Soapy water c. 5% chlorhexidine d. 2% alkaline glutaraldehyde

ANS: C

High-level disinfection is a cleaning method that inactivates all viruses, fungi, and vegetative microorganisms, but not necessarily all bacterial spores. The most common agent used is 2% alkaline glutaraldehyde. Immersion in glutaraldehyde for 20 minutes can destroy virtually all pathogens surviving on a well-cleaned bronchoscope.

REF: p. 111

19. The pulmonologist has called the RT department requesting equipment for a bronchoscopy in the next 30 minutes. Which of the following methods will allow the therapist to have the scope disinfected and ready to use in that time frame? a. Peracetic acid submersion b. Alcohol submersion c. Ethylene oxide d. 2% alkaline glutaraldehyde

ANS: A

Two highly effective methods against all types of microorganisms are ethylene oxide gas sterilization and peracetic acid submersion. Ethylene oxide is noncorrosive and able to penetrate all portions of the bronchoscope without requiring high pressures. However, a venting cap must be placed to equalize the pressure between the interior and the exterior of the bronchoscope. The major disadvantage of ethylene oxide sterilization is that it is time consuming, taking at least 12 to 16 hours to complete the process. An alternative method is the STERIS system (refer to Figure 7-3 in the textbook), an automated, microprocessorcontrolled device using a sterilant concentrate, peracetic acid, as the active biocidal agent. This chemical sterilization process requires only 25 minutes. Once the disinfection or sterilization process is completed, the bronchoscope is rinsed with tap water and may be wiped with alcohol before storage in a dry, clean cabinet.

REF: p. 111

20. Which of the following features are considered advantages of the rigid bronchoscope over the flexible bronchoscope?

I. Improved anatomic definition

II. Ability to provide better ventilation

III. Large internal diameter

IV. Ability to introduce larger instrumentsa. I and II only b. III and IV only c. I, III, and IV only d. I, II, III, and IV

ANS: D

The rigid bronchoscope has some advantages over flexible bronchoscopy, including its relatively large internal diameter, improved anatomic definition, the ability to provide ventilation during the procedure, and the ability to use larger instruments.

REF: p. 111