Thoracic – TCAR 2025 Update|Most
Tested Questions And Verified Solutions
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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
Tested Questions And Verified Solutions
(Already Graded A+)|Assured Success !!!
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
