Thoracic – TCAR Exam 2024 | TCAR
Thoracic Exam 2024 Questions and
Correct Answers Rated A+
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)
Thoracic Exam 2024 Questions and
Correct Answers Rated A+
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)
