THORACIC – TCAR EXAM | QUESTIONS AND ANSWERS | VERIFIED ANSWERS (100% CORRECT) | LATEST EXAM UPDATE

THORACIC – TCAR EXAM | QUESTIONS AND ANSWERS | VERIFIED
ANSWERS (100% CORRECT) | LATEST EXAM UPDATE




Blood supply upper 2/3 of trachea - CORRECT ANSWER - inferior thyroid
arteries


Blood supply lower 2/3 of trachea - CORRECT ANSWER - bronchial arteries


Blood supply lung parenchyma - CORRECT ANSWER - bronchial arteries


Pathway of azygous vein in the thorax - CORRECT ANSWER - runs along R
side and dumps into superior vena cava


Pathway of thoracic duct in the chest - CORRECT 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 - CORRECT ANSWER - runs anterior to
hilum


Pathway of vagus nerve in thorax - CORRECT ANSWER - runs posterior to
hilum


What fissures exist in the lungs? - CORRECT ANSWER - Major oblique
separates RLL from middle and upper lobe
Minor separates upper from middle lobe

,Muscle used in quiet respiration - CORRECT ANSWER - Diaphragm 80%,
intercostals 20%


Accessory muscles of respiration - CORRECT ANSWER - SCM
Levators
Serratus posterior
Scalenes


Main surface active agent in surfactant - CORRECT ANSWER -
phosphatidylcholine


Alveolar, arterial, and venous pressures in lung zones in upright person -
CORRECT ANSWER - Zone I: PA > Pa > Pv
Zone II: Pa > PA > Pv
Zone III: Pa > Pv > PA


Normal pulmonary artery pressure - CORRECT ANSWER - 25/10 (mean 15)


What predicted value is needed for pulmonary resection? - CORRECT ANSWER
- Predicted postop FEV1 > 0.8L (>40% predicted)


What can be done if the predicted postop FEV1 is close to 0.8 (40% predicted)? -
CORRECT 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
- CORRECT ANSWER - FEV1


Minimum DLCO for lung resection - CORRECT ANSWER - >11-12
ml/min/mmHg CO (>50% predicted value)


What six things effect DLCO? - CORRECT ANSWER - Pulmonary capillary
surface area
Hgb
Alveolar architecture
Dead space
Low CO
Pulmonary HTN


What pCO2 is necessary for lung resection? - CORRECT ANSWER - <45 at rest


What pO2 is necessary for lung resection? - CORRECT ANSWER - >60 at rest,
not on O2


What VO2max is needed for lung resection? - CORRECT ANSWER - >10
ml/kg/min (maximum o2 consumption)


Overall PFTs required for pulmonary resection - CORRECT 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 - CORRECT ANSWER - V/Q
mismatch from atelectasis (shunt)


MCC of hypercarbia after pulmonary resection - CORRECT ANSWER - alveolar
hypoventilation (poor minute ventilation RR x TV)


MC nerve injury after pulmonary resection - CORRECT ANSWER - brachial
plexus injuries


How can common peroneal nerve injuries be avoided durin pulmonary resection? -
CORRECT ANSWER - flex dependent leg


Most common resection resulting in persistent air leak - CORRECT ANSWER -
segmentectomy/wedge


MC resection resulting in atelectasis - CORRECT ANSWER - lobectomy


MC resection resulting in arrhythmias - CORRECT ANSWER - pneumonectomy
(R MC)


MC resection resulting in postop TEF - CORRECT ANSWER - pneumonectomy
(R MC)