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THORACIC TCAR EXAM LATEST 2025 EXAM QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRADE
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THORACIC TCAR EXAM LATEST 2025 EXAM QUESTIONS AND DETAILED CORRECT ANSWERS | A+ GRADE
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THORACIC TCAR EXAM LATEST 2025EXAM QUESTIONS AND DETAILED
CORRECT ANSWERS | A+ GRADE
What is post-pneumonectomy syndrome? Correct Answer
MC after R pneumonectomy
mediastinal shift causing main bronchial compression
How is post-pneumonectomy syndrome treated? Correct
Answer Silicone issue expanders on pneumonectomy side
to shift mediastinum back
What should be expected with hypotension, cyanosis,
tachycardia, and displaced heart on CXR after R
pneumnoectomy? Correct Answer Cardiac herniation
through pericardium
Treatment and prevention of cardiac herniation after R
pneumonectomy Correct Answer Pericarial Gortex patch
What should be expected with pooled secretions,
recurrent infection, or bronchial stump blowout after L
pneumonectomy? Correct Answer Long bronchial stump
syndrome
How is long bronchial stump syndrome treated? Correct
Answer Shorten bronchus and cover with flap
,Mortality with wedge? lobectomy? pneumonectomy?
Correct Answer wedge - 1%
lobectomy - 3%
pneumonectomy - 6% (R>L)
Treatment of persistent air leak in CT Correct Answer
Check system
2nd CT anteriorly
Bronch (foreign body, BPF, mucous plug)
CT chest
Wait 7 days then mechanical pleurodesis
Treatment of atelectasis resistant to usual measures
Correct Answer Bronch to look for mucous plugging
Increase TV if already vented
MCC of adult TEF Correct Answer Esophageal cancer
eroding into trachea
Treatment of adult TEF caused by esophageal cancer
erosion Correct Answer Stent esophagus
Treatment of postop adult TEF Correct Answer Repair
esophagus primarily
Close hole in trachea or bronchus
Interpose tissue so TEF won't come back (pericardial fat
pad or intercostal muscle)
Primary cause of ARDS picture after pneumonectomy
Correct Answer Inflammatory reaction (PMNs, O2
radicals, cytokines, vascular permeability)
,Increased perfusion to remaining lung
Tx like ARDS
MCC of empyema Correct Answer pneumonia with
subsequent infection of parapneumonic effusion
Symptoms of emypema Correct Answer pleuritic chest
pain, fever, cough, SOB
Pleural fluid in empyema Correct Answer WBC > 500
cells/cc
Bacteria
+ gram stain
3 stages of empyema Correct Answer Exudative
Fibrinopurulent
Organizing
Treatment of stage I - exudative empyema Correct Answer
CT + abx
Send cx for drainage and cytology
Treatment of stage II - fibrinopurulent empyema Correct
Answer CT + abx
send drainage from cultures and cytology
failure to re-expand lung - VATS deloculation
Treatment of stage III - organizing (chronic) empyema
Correct Answer Decortication +/- muscle flap
send fluid for cultures and cytology
abx
, nutrition
Eloesser flap if can't tolerate decort allowing direct
opening to external environment for drainage
MCC of early bronchopleural fistula Correct Answer
technical error
Treatment of early <7 days bronchopleural fistula Correct
Answer reoperation with intercostal muscle flap over
bronchus
Presentation of early bronchopleural fistula Correct
Answer massive air leak with respiratory compromise
collapsed lung and ptx on xray
MCC of late postop or non-surgical bronchopleural fistula
Correct Answer pressure from empyema makes hole in
bronchus
How do late postop or non surgical bronchopleural fistulas
present? Correct Answer abrupt serosanguinous or
purulent sputum production +/- respiratory distress
What is the key preventative measure for a late postop or
nonsurgical bronchopleural fistula? Correct Answer protect
the contralateral lung from aspiration of empyema fluid
What will be seen on CXR for a late postop or non-surgical
bronchopleural fistula? Correct Answer After lobectomy or
nonsurgical - fluid collection and PTX, thick rind if
empyema present
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