Thoracic – TCAR EXAM QUESTIONS
AND VERIFIED ANSWERS ACTUAL
EXAM
\.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
\.What should be expected with hypotension, cyanosis, tachycardia, and displaced heart on CXR
after R pneumnoectomy? - Answer- Cardiac herniation through pericardium
AND VERIFIED ANSWERS ACTUAL
EXAM
\.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
\.What should be expected with hypotension, cyanosis, tachycardia, and displaced heart on CXR
after R pneumnoectomy? - Answer- Cardiac herniation through pericardium
