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Thoracic - TCAR Exam with complete solutions 2024_2025
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Thoracic - TCAR Exam with complete solutions 2024_2025
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Thoracic - TCAR Exam with completesolutions 2024/2025
Blood supply upper 2/3 of trachea - ANSWER-inferior thyroid arteries
Blood supply lower 2/3 of trachea - ANSWER-bronchial arteries
Blood supply lung parenchyma - ANSWER-bronchial arteries
Pathway of azygous vein in the thorax - ANSWER-runs along R side and dumps
into superior vena cava
Pathway of thoracic duct in the chest - ANSWER-runs along R side, crosses
midline at T4-T5, goes into L neck and dumps into L subclavian vein at junction
with LIJ
Pathway of phrenic nerve in thorax - ANSWER-runs anterior to hilum
Pathway of vagus nerve in thorax - ANSWER-runs posterior to hilum
What fissures exist in the lungs? - ANSWER-Major oblique separates RLL from
middle and upper lobe
Minor separates upper from middle lobe
Muscle used in quiet respiration - ANSWER-Diaphragm 80%, intercostals 20%
Accessory muscles of respiration - ANSWER-SCM
Levators
Serratus posterior
,Scalenes
Main surface active agent in surfactant - ANSWER-phosphatidylcholine
Alveolar, arterial, and venous pressures in lung zones in upright person -
ANSWER-Zone I: PA > Pa > Pv
Zone II: Pa > PA > Pv
Zone III: Pa > Pv > PA
Normal pulmonary artery pressure - ANSWER-25/10 (mean 15)
What predicted value is needed for pulmonary resection? - ANSWER-Predicted
postop FEV1 > 0.8L (>40% predicted)
What can be done if the predicted postop FEV1 is close to 0.8 (40% predicted)? -
ANSWER-Obtain a V/Q scan and see how much that segment actually contributes
Single best predictor of being able to wean off ventilator after pulmonary
resection - ANSWER-FEV1
Minimum DLCO for lung resection - ANSWER->11-12 ml/min/mmHg CO (>50%
predicted value)
What six things effect DLCO? - ANSWER-Pulmonary capillary surface area
Hgb
Alveolar architecture
Dead space
Low CO
Pulmonary HTN
What pCO2 is necessary for lung resection? - ANSWER-<45 at rest
What pO2 is necessary for lung resection? - ANSWER->60 at rest, not on O2
What VO2max is needed for lung resection? - ANSWER->10 ml/kg/min (maximum
o2 consumption)
, Overall PFTs required for pulmonary resection - ANSWER-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 after pulmonary resection - ANSWER-V/Q mismatch from
atelectasis (shunt)
MCC of hypercarbia after pulmonary resection - ANSWER-alveolar
hypoventilation (poor minute ventilation RR x TV)
MC nerve injury after pulmonary resection - ANSWER-brachial plexus injuries
How can common peroneal nerve injuries be avoided durin pulmonary resection?
- ANSWER-flex dependent leg
Most common resection resulting in persistent air leak - ANSWER-
segmentectomy/wedge
MC resection resulting in atelectasis - ANSWER-lobectomy
MC resection resulting in arrhythmias - ANSWER-pneumonectomy (R MC)
MC resection resulting in postop TEF - ANSWER-pneumonectomy (R MC)
MC resection resulting in postop bronchopleural fistula - ANSWER-
pneumonectomy (R MC)
MC resection resulting in mortality - ANSWER-pneumonectomy (R MC)
What is post-pneumonectomy syndrome? - ANSWER-MC after R pneumonectomy
mediastinal shift causing main bronchial compression
How is post-pneumonectomy syndrome treated? - ANSWER-Silicone issue
expanders on pneumonectomy side to shift mediastinum back
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