Exam (elaborations)
TCAR- Thoracic -ACTUAL EXAM (QUESTIONS AND ANSWERS) GRADED A+
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QUESTIONS AND ANSWERS
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TCAR- Thoracic -ACTUAL EXAM(QUESTIONS AND ANSWERS)
GRADED A+
Blood supply upper 2/3 of trachea
inferior thyroid arteries
Blood supply lower 2/3 of trachea
bronchial arteries
Blood supply lung parenchyma
bronchial arteries
Pathway of azygous vein in the thorax
runs along R side and dumps into superior vena cava
Pathway of thoracic duct in the chest
runs along R side, crosses midline at T4-T5, goes into L neck and dumps into L
subclavian vein at juncGon with LIJ
Pathway of phrenic nerve in thorax
runs anterior to hilum
Pathway of vagus nerve in thorax
runs posterior to hilum
What fissures exist in the lungs?
Major oblique separates RLL from middle and upper lobe
Minor separates upper from middle lobe
Muscle used in quiet respiraGon
Diaphragm 80%, intercostals 20%
Accessory muscles of respiraGon
,SCM
Levators
Serratus posterior
Scalenes
Main surface acGve agent in surfactant
phosphaGdylcholine
Alveolar, arterial, and venous pressures in lung zones in upright person
Zone I: PA > Pa > Pv
Zone II: Pa > PA > Pv
Zone III: Pa > Pv > PA
Normal pulmonary artery pressure
25/10 (mean 15)
What predicted value is needed for pulmonary resecGon?
Predicted postop FEV1 > 0.8L (>40% predicted)
What can be done if the predicted postop FEV1 is close to 0.8 (40% predicted)?
Obtain a V/Q scan and see how much that segment actually contributes
Single best predictor of being able to wean off venGlator ader pulmonary
resecGon
FEV1
Minimum DLCO for lung resecGon
>11-12 ml/min/mmHg CO (>50% predicted value)
What six things effect DLCO?
Pulmonary capillary surface area
Hgb
Alveolar architecture
Dead space
,Low CO
Pulmonary HTN
What pCO2 is necessary for lung resecGon?
<45 at rest
What pO2 is necessary for lung resecGon?
>60 at rest, not on O2
What VO2max is needed for lung resecGon?
>10 ml/kg/min (maximum o2 consumpGon)
Overall PFTs required for pulmonary resecGon
FEV1 >0.8L (>40% predicted)
DLCO >11-12 ml/min/mmHg CO (>50% predicted, or 40% postop)
pCO2 <45 at rest
pO2 >60 at rest, not on O2
VO2 >10 ml/kg/min
MCC of hypoxemia ader pulmonary resecGon
V/Q mismatch from atelectasis (shunt)
MCC of hypercarbia ader pulmonary resecGon
alveolar hypovenGlaGon (poor minute venGlaGon RR x TV)
MC nerve injury ader pulmonary resecGon
brachial plexus injuries
How can common peroneal nerve injuries be avoided durin pulmonary
resecGon?
flex dependent leg
Most common resecGon resulGng in persistent air leak
segmentectomy/wedge
MC resecGon resulGng in atelectasis
lobectomy
, MC resecGon resulGng in arrhythmias
pneumonectomy (R MC)
MC resecGon resulGng in postop TEF
pneumonectomy (R MC)
MC resecGon resulGng in postop bronchopleural fistula
pneumonectomy (R MC)
MC resecGon resulGng in mortality
pneumonectomy (R MC)
What is post-pneumonectomy syndrome?
MC ader R pneumonectomy
mediasGnal shid causing main bronchial compression
How is post-pneumonectomy syndrome treated?
Silicone issue expanders on pneumonectomy side to shid mediasGnum back
What should be expected with hypotension, cyanosis, tachycardia, and
displaced heart on CXR ader R pneumnoectomy?
Cardiac herniaGon through pericardium
Treatment and prevenGon of cardiac herniaGon ader R pneumonectomy
Pericarial Gortex patch
What should be expected with pooled secreGons, recurrent infecGon, or
bronchial stump blowout ader L pneumonectomy?
Long bronchial stump syndrome
How is long bronchial stump syndrome treated?
Shorten bronchus and cover with flap
Mortality with wedge? lobectomy? pneumonectomy?
wedge - 1%
lobectomy - 3%
pneumonectomy - 6% (R>L)
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