SSM TCAR EXAM 2024 ACTUAL EXAM COMPLETE 250
QUESTIONS WITH DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
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
Treatment and prevention of cardiac herniation after R pneumonectomy - ANSWER:
Pericarial Gortex patch
What should be expected with pooled secretions, recurrent infection, or bronchial
stump blowout after L pneumonectomy? - ANSWER: Long bronchial stump syndrome
How is long bronchial stump syndrome treated? - ANSWER: Shorten bronchus and
cover with flap
Mortality with wedge? lobectomy? pneumonectomy? - ANSWER: wedge - 1%
lobectomy - 3%
pneumonectomy - 6% (R>L)
Treatment of persistent air leak in CT - ANSWER: Check system
2nd CT anteriorly
Bronch (foreign body, BPF, mucous plug)
CT chest
Wait 7 days then mechanical pleurodesis
Treatment of atelectasis resistant to usual measures - ANSWER: Bronch to look for
mucous plugging
Increase TV if already vented
MCC of adult TEF - ANSWER: Esophageal cancer eroding into trachea
Treatment of adult TEF caused by esophageal cancer erosion - ANSWER: Stent
esophagus
Treatment of postop adult TEF - ANSWER: Repair esophagus primarily
Close hole in trachea or bronchus
Interpose tissue so TEF won't come back (pericardial fat pad or intercostal muscle)
QUESTIONS WITH DETAILED VERIFIED ANSWERS (100%
CORRECT ANSWERS) /ALREADY GRADED A+
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
Treatment and prevention of cardiac herniation after R pneumonectomy - ANSWER:
Pericarial Gortex patch
What should be expected with pooled secretions, recurrent infection, or bronchial
stump blowout after L pneumonectomy? - ANSWER: Long bronchial stump syndrome
How is long bronchial stump syndrome treated? - ANSWER: Shorten bronchus and
cover with flap
Mortality with wedge? lobectomy? pneumonectomy? - ANSWER: wedge - 1%
lobectomy - 3%
pneumonectomy - 6% (R>L)
Treatment of persistent air leak in CT - ANSWER: Check system
2nd CT anteriorly
Bronch (foreign body, BPF, mucous plug)
CT chest
Wait 7 days then mechanical pleurodesis
Treatment of atelectasis resistant to usual measures - ANSWER: Bronch to look for
mucous plugging
Increase TV if already vented
MCC of adult TEF - ANSWER: Esophageal cancer eroding into trachea
Treatment of adult TEF caused by esophageal cancer erosion - ANSWER: Stent
esophagus
Treatment of postop adult TEF - ANSWER: Repair esophagus primarily
Close hole in trachea or bronchus
Interpose tissue so TEF won't come back (pericardial fat pad or intercostal muscle)
