Thoracic – TCAR Exam Questions and Answers

Thoracic – TCAR Exam Questions and
Answers33

MC site of pulmonary AVMs - ANSWERS -lower lobes



Treatment of pulmonary AVMs - ANSWERS -embolization



What syndrome is associated with pulmonary AVMs? - ANSWERS -Osler-Weber-Rendu
syndrome (pulmonary AVMs + telangiectasias)



MC chest wall tumor - ANSWERS -Benign osteochondroma

Malignant chondrosarcoma



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



Blood supply lower 2/3 of trachea - ANSWERS -bronchial arteries



Blood supply lung parenchyma - ANSWERS -bronchial arteries



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



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

,Pathway of vagus nerve in thorax - ANSWERS -runs posterior to hilum



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

Minor separates upper from middle lobe



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



Accessory muscles of respiration - ANSWERS -SCM

Levators

Serratus posterior

Scalenes



Main surface active agent in surfactant - ANSWERS -phosphatidylcholine



Alveolar, arterial, and venous pressures in lung zones in upright person - ANSWERS -Zone I: PA >
Pa > Pv

Zone II: Pa > PA > Pv

Zone III: Pa > Pv > PA



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



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

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



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



What six things effect DLCO? - ANSWERS -Pulmonary capillary surface area

Hgb

Alveolar architecture

Dead space

Low CO

Pulmonary HTN



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



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



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



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



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



MC nerve injury after pulmonary resection - ANSWERS -brachial plexus injuries



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



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



MC resection resulting in atelectasis - ANSWERS -lobectomy



MC resection resulting in arrhythmias - ANSWERS -pneumonectomy (R MC)



MC resection resulting in postop TEF - ANSWERS -pneumonectomy (R MC)



MC resection resulting in postop bronchopleural fistula - ANSWERS -pneumonectomy (R MC)



MC resection resulting in mortality - ANSWERS -pneumonectomy (R MC)



What is post-pneumonectomy syndrome? - ANSWERS -MC after R pneumonectomy

mediastinal shift causing main bronchial compression