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Thoracic - TCAR QUESTIONS AND CORRECT ANSWERS GRADED A+ 2024/2025
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Thoracic - TCAR QUESTIONS AND CORRECT ANSWERS GRADED A+ 2024/2025
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Thoracic - TCARBlood supply upper 2/3 of trachea - ANSinferior thyroid arteries
Blood supply lower 2/three of trachea - ANSbronchial arteries
Blood supply lung parenchyma - ANSbronchial arteries
Pathway of azygous vein in the thorax - ANSruns along R aspect and dumps into advanced
vena cava
Pathway of thoracic duct inside the chest - ANSruns along R aspect, 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 - ANSruns anterior to hilum
Pathway of vagus nerve in thorax - ANSruns posterior to hilum
What fissures exist in the lungs? - ANSMajor indirect separates RLL from middle and higher
lobe
Minor separates higher from center lobe
Muscle utilized in quiet respiratory - ANSDiaphragm 80%, intercostals 20%
Accessory muscle mass of respiratory - ANSSCM
Levators
Serratus posterior
Scalenes
Main surface energetic agent in surfactant - ANSphosphatidylcholine
Alveolar, arterial, and venous pressures in lung zones in upright person - ANSZone I: PA >
Pa > Pv
Zone II: Pa > PA > Pv
Zone III: Pa > Pv > PA
Normal pulmonary artery stress - ANS25/10 (imply 15)
What expected price is wanted for pulmonary resection? - ANSPredicted postop FEV1 >
0.8L (>forty% expected)
What may be accomplished if the predicted postop FEV1 is close to 0.Eight (forty%
anticipated)? - ANSObtain a V/Q experiment and see how tons that segment simply
contributes
,Single first-rate predictor of being capable of wean off ventilator after pulmonary resection -
ANSFEV1
Minimum DLCO for lung resection - ANS>eleven-12 ml/min/mmHg CO (>50% expected
price)
What six matters impact DLCO? - ANSPulmonary capillary surface area
Hgb
Alveolar architecture
Dead space
Low CO
Pulmonary HTN
What pCO2 is vital for lung resection? - ANS<45 at rest
What pO2 is necessary for lung resection? - ANS>60 at rest, no longer on O2
What VO2max is needed for lung resection? - ANS>10 ml/kg/min (maximum o2
consumption)
Overall PFTs required for pulmonary resection - ANSFEV1 >0.8L (>forty% predicted)
DLCO >eleven-12 ml/min/mmHg CO (>50% predicted, or forty% postop)
pCO2 <45 at rest
pO2 >60 at rest, now not on O2
VO2 >10 ml/kg/min
MCC of hypoxemia after pulmonary resection - ANSV/Q mismatch from atelectasis (shunt)
MCC of hypercarbia after pulmonary resection - ANSalveolar hypoventilation (negative
minute ventilation RR x TV)
MC nerve damage after pulmonary resection - ANSbrachial plexus accidents
How can not unusual peroneal nerve injuries be avoided durin pulmonary resection? -
ANSflex established leg
Most not unusual resection resulting in persistent air leak - ANSsegmentectomy/wedge
MC resection ensuing in atelectasis - ANSlobectomy
MC resection ensuing in arrhythmias - ANSpneumonectomy (R MC)
MC resection resulting in postop TEF - ANSpneumonectomy (R MC)
MC resection resulting in postop bronchopleural fistula - ANSpneumonectomy (R MC)
MC resection resulting in mortality - ANSpneumonectomy (R MC)
, What is put up-pneumonectomy syndrome? - ANSMC after R pneumonectomy
mediastinal shift causing primary bronchial compression
How is submit-pneumonectomy syndrome handled? - ANSSilicone problem expanders on
pneumonectomy side to shift mediastinum lower back
What ought to be anticipated with hypotension, cyanosis, tachycardia, and displaced heart
on CXR after R pneumnoectomy? - ANSCardiac herniation through pericardium
Treatment and prevention of cardiac herniation after R pneumonectomy - ANSPericarial
Gortex patch
What need to be predicted with pooled secretions, recurrent contamination, or bronchial
stump blowout after L pneumonectomy? - ANSLong bronchial stump syndrome
How is lengthy bronchial stump syndrome dealt with? - ANSShorten bronchus and cowl with
flap
Mortality with wedge? Lobectomy? Pneumonectomy? - ANSwedge - 1%
lobectomy - 3%
pneumonectomy - 6% (R>L)
Treatment of chronic air leak in CT - ANSCheck machine
2d CT anteriorly
Bronch (foreign body, BPF, mucous plug)
CT chest
Wait 7 days then mechanical pleurodesis
Treatment of atelectasis proof against normal measures - ANSBronch to look for mucous
plugging
Increase TV if already vented
MCC of adult TEF - ANSEsophageal cancer eroding into trachea
Treatment of adult TEF caused by esophageal cancer erosion - ANSStent esophagus
Treatment of postop adult TEF - ANSRepair esophagus in general
Close hole in trachea or bronchus
Interpose tissue so TEF might not come lower back (pericardial fats pad or intercostal
muscle)
Primary reason of ARDS image after pneumonectomy - ANSInflammatory reaction (PMNs,
O2 radicals, cytokines, vascular permeability)
Increased perfusion to closing lung
Tx like ARDS
MCC of empyema - ANSpneumonia with next infection of parapneumonic effusion
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