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Thoracic - TCAR Exam Questions And 100% Correct Answers
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Thoracic - TCAR Exam Questions And 100% Correct AnswersBlood 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
Course of thoracic duct in thorax-Answer runs along R side, crosses midline at T4-T5,
goes into L neck and dumps into L subclavian vein at junction with LIJ
Course of phrenic nerve in thorax - Answer runs anterior to hilum
Course of vagus nerve in thorax - Answer runs posterior to hilum
What fissures are present 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 ppo 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 with mortality - Answer pneumonectomy (R MC)
Post-pneumonectomy syndrome - Answer MC post R pneumonectomy
mediastinal shift causing main bronchial compression
Treatment for post-pneumonectomy syndrome - Answer Silicone issue expanders on
pneumonectomy side to shift mediastinum back
What would one expect with hypotension, cyanosis, tachycardia, and displaced heart on
CXR status post R pneumnoectomy? - Answer Cardiac herniation through pericardium
Treatment and prevention of cardiac herniation after R pneumonectomy - Answer
Pericarial Gortex patch
What is the likely outcome w/ pooled secretions, recurrent infection, or bronchial stump
blowout following L pneumonectomy? - Answer Long bronchial stump syndrome
How is long bronchial stump syndrome treated? - Answer Shorten bronchus and cover
w/ flap
Mortality w/ wedge? lobectomy? pneumonectomy? - Answer wedge - 1%
lobectomy - 3%
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