Thoracic Anesthesia

A patient with a tumor located in the anterior mediastinum is scheduled for surgery. What is the primary anesthetic concern regarding this tumor's location?

During a mediastinoscopy, which anatomical structures are at greatest risk of injury, leading to significant complications?

The right mainstem bronchus has a larger diameter and a 25-degree angle of take-off from the trachea, whereas the left mainstem bronchus has a smaller diameter and a 45-degree angle of take-off. During intubation with a standard ETT, why is there is a risk of mainstem intubation?

What is the most critical factor in optimizing survival rates for patients diagnosed with lung cancer?

A patient presents with a lung tumor and is subsequently diagnosed with Small Cell Lung Cancer (SCLC). Which of the following characteristics is likely to be associated with this type of lung cancer? select all that apply

A patient is diagnosed with Large Cell Lung Cancer. Which of the following characteristics is most consistent with this diagnosis?

A patient presents with a lung tumor located at the apex of the lung, invading the brachial plexus and causing shoulder pain. Which type of lung cancer is most likely associated with this presentation?

Which of the following scenarios best illustrates the typical progression and characteristics of squamous cell carcinoma of the lung?

A patient with a history of heavy smoking is diagnosed with a centrally located lung tumor obstructing the mainstem bronchus. Which of the following complications is most likely to be directly caused by the tumor's location and characteristics? select 2

A patient is found to have a firm, marble-like tumor in the periphery of their lung, composed of normal tissue elements. Which of the following is the most likely diagnosis?

Which paraneoplastic syndrome is frequently observed in Small Cell Lung Cancer (SCLC) due to release of ADH from tumor?

A patient with small cell lung cancer presents with euvolemic hypo-osmolar hyponatremia. Which paraneoplastic syndrome is most likely the cause?

A patient with a history of squamous cell carcinoma develops hypercalcemia. Which mechanism is the most likely cause of this electrolyte imbalance?

A patient presents with miosis, ptosis, and anhidrosis on the right side of their face, along with shoulder pain. Imaging reveals a mass in the apex of the right lung. Which condition is most likely causing these signs and symptoms?

Which of the following anesthetic considerations is most critical for a patient diagnosed with Lambert-Eaton Myasthenic Syndrome (LEMS) secondary to lung cancer? select 2

What is the primary physiological consequence of chronic hypoxemia in COPD patients that leads to right ventricular dysfunction?

A patient with lung cancer develops Superior Vena Cava (SVC) syndrome. Which of the following clinical signs would be observed?

A patient with severe COPD is scheduled for a lung resection. Preoperative assessment reveals a significantly reduced FEV1. Which additional measurement would be MOST important in predicting postoperative respiratory complications?

A patient with a history of COPD is scheduled for a surgical procedure. Which of the following intraoperative ventilator strategies should be considered? select all that apply

Which of the following signs or symptoms is associated with lung cancer?

Which of the following best describes the utility of the 'reversibility test' in the context of FEV1 measurement for COPD patients?

What is the rationale behind avoiding nitrous oxide (N2O) in patients with significant bullous emphysema undergoing mechanical ventilation?

Which of the following paraneoplastic syndromes is associated with ectopic release of ACTH, leading to symptoms such as moon face, buffalo hump, and hypokalemia?

A patient with a carcinoid tumor experiences intraoperative hemodynamic instability and coronary artery spasm. Which of the following substances is most likely implicated in this crisis?

A patient presents with migratory thrombophlebitis. Which of the following conditions is most likely associated with this finding?

A patient is scheduled to undergo a major oncologic resection. Preoperative evaluation reveals usage of bleomycin and mitomycin. What specific perioperative concern should be anticipated in this patient?

During a left-sided thoracotomy with one-lung ventilation, the arterial oxygen saturation suddenly drops to 85%. Initial troubleshooting steps, including assessment of DLT position, have been unsuccessful. What is the MOST appropriate next step in managing this acute hypoxemia?

In a patient undergoing one-lung ventilation for a left lower lobectomy, you observe a progressive increase in the peak inspiratory pressure of the ventilated lung. Auscultation reveals decreased breath sounds on the right side. What is the MOST likely cause of this change?

What is the underlying mechanism by which chronic hypoxemia leads to right ventricular dysfunction in COPD patients?

Which statement accurately relates FEV1 results to the potential benefits of bronchodilator therapy in COPD patients?

A patient presents with a constellation of symptoms including proximal muscle weakness that improves with repeated exertion. Diagnostic workup reveals the presence of an underlying lung malignancy. Which specific paraneoplastic syndrome is most likely contributing to this patient's presentation?

A patient with COPD is scheduled for lung resection. Preoperative evaluation reveals treatment with cisplastin. What specific perioperative concern should be anticipated?

A 68-year-old male with a 50 pack-year smoking history is diagnosed with squamous cell carcinoma of the lung. Given the typical pathophysiology of this cancer type, which of the following complications is most likely to arise directly from the tumor's location and growth pattern?

A patient is diagnosed with a peripheral lung lesion and undergoes a biopsy revealing adenocarcinoma. Further molecular testing identifies a mutation associated with increased growth factor signaling. Which of the following subsequent clinical courses is most anticipated, given the characteristics of adenocarcinoma? select 2

What is the underlying mechanism to why patients with carcinoid syndrome can have intraoperative hemodynamic instability?

What is the purpose of a mediastinoscopy?

What complications are commonly associated with mediastinoscopy? (Select all that apply)

Which type of non-small cell carcinoma is considered the most aggressive?

Match the lung cancer to its appropriate description:

What type of tumor is typically a large space-occupying lesion that can be benign or malignant and is associated with mesothelioma?

Which type of tumors are typically benign and noted to cause pneumonia distal to the tumor?

What are the signs and symptoms of Horner's syndrome? (Select all that apply)

Why is Horner syndrome associated with lung cancer?

What are the signs and symptoms of Pancoast syndrome? (Select all that apply)

What is the cause of Pancoast syndrome?

What are the two most common paraneoplastic syndromes associated with lung cancer?

What is Trousseau syndrome?

What chemotherapy medication is associated with cardiac toxicity?

What are the three pillars that serve as predictors of postoperative pulmonary complications for patients undergoing pulmonary surgery?

What is FEV1?

Which pulmonary function test (PFT) helps determine obstructive vs restrictive disease?

What is the most valid single test for post-thoracotomy respiratory complications?

Which PPO FEV1 is associated with increased risk of post-thoracotomy respiratory complications?

Which preoperative FEV1 is associated with a high risk of post-thoracotomy respiratory complications?

Predicted post-op DLCO < 40% → Increased complications Predicted Postoperative FEV1 (ppoFEV1) <40% → Increased complications

What test correlates with the total functional surface of the alveolar-capillary interface?

Which lung function test can be adversely affected by preoperative chemotherapy?

Inability to climb 1 flight of stairs is indicative of a VO2 max of less than ___ ml/kg/min and is associated with an ____ risk of postoperative complications.

What is VO2 max?

Which of the following are associated with an increased risk of postoperative complications? (Select all that apply)

What does FVC stand for and what does it measure?

Why does the PaCO2-ETCO2 gradient increase with one-lung ventilation (OLV)?

Which arm is preferred to place an arterial line during a mediastinotomy?

Which side should the arterial line and pulse oximeter be placed on during a thoracotomy?

On which side should a central line be placed during a thoracotomy?

Why are central venous pressure (CVP) and pulmonary artery (PA) catheters not routinely used in thoracotomy?

Which of the following are poor predictors of One-Lung Ventilation (OLV) preoperatively? (Select all that apply)

Why is desaturation greater in right-sided thoracotomy? (Select all that apply)

What is the benefit of lower baseline perfusion of the operative lung? select 2

What is the goal for intraoperative fluids during a thoracotomy?

What are the nerve injuries associated with the lateral decubitus position? (Select all that apply)

What is lung compliance?

Why are alveoli in the lung bases better ventilated in a spontaneously breathing, upright patient?

Why are alveoli in the lung bases better perfused in a spontaneously breathing, upright patient?

Why are there higher ventilation-perfusion (V/Q) ratios towards the non-dependent portion/apex of the lung?

Why are there lower ventilation-perfusion (V/Q) ratios towards the dependent portion/base of the lung?

In the lateral decubitus position, which lung has better ventilation and which lung has better perfusion?

What occurs to the lungs of an anesthetized, paralyzed patient in the lateral decubitus position? (Select all that apply)

better compliance = better ventilation

At which specific point is Pulmonary Vascular Resistance (PVR) lowest in relation to Functional Residual Capacity (FRC)?

What are the effects of One Lung Ventilation (OLV) on ventilation and perfusion? (Select 3)

When is pulmonary vascular resistance (PVR) at its lowest?

Why does pulmonary vascular resistance (PVR) increase as functional residual capacity (FRC) decreases?

Why does pulmonary vascular resistance (PVR) increase when lung volume increases beyond total lung capacity (TLC)?

What is hypoxic pulmonary vasoconstriction (HPV)?

What is the strongest stimulus for hypoxic pulmonary vasoconstriction (HPV)?

Which of the following inhibits the hypoxic pulmonary vasoconstriction (HPV) response? (Select all that apply)

What is the onset time and peak duration of hypoxic pulmonary vasoconstriction? (Select all that apply)

What are the absolute indications for one-lung ventilation (OLV)? (Select all that apply)

Blood, pus, oxygen, water = BPOW = mnemonic to remember when OLV is indicated

What type of ventilation is required in the management of a thoracic aortic aneurysm?

Why are left-sided double-lumen tubes (DLTs) preferred over right-sided DLTs in thoracic anesthesia? select 2

How do you measure the depth of a double-lumen tube (DLT) for placement?

What is the normal depth range for a double-lumen tube (DLT)?

What is the normal double-lumen tube (DLT) size for men?

What is the normal double-lumen tube (DLT) size for women?

What are the disadvantages associated with a Double-Lumen Tube (DLT)? (Select all that apply)

What are the indications for using a right double-lumen tube (DLT)?

What is the blind double-lumen tube (DLT) placement technique?

What are the indications for using bronchial blockers for lung isolation? (Select all that apply)

Match the steps to verify DLT placement:

What are the disadvantages of using a bronchial blocker for one-lung ventilation (OLV)? (Select all that apply)

Which lung is ventilated when using a bronchial blocker?

How are standard endotracheal tubes (ETT) used for one-lung ventilation (OLV)?

What should occur prior to the collapse of the surgical lung?

What are the preferred ventilator settings during one-lung ventilation (OLV)?

When should recruitment maneuvers be preferred during One-Lung Ventilation (OLV)?

What is the goal for pulmonary vascular resistance (PVR) in the operative and non-operative lungs during one-lung ventilation (OLV)?

What gas increases the speed of collapse of the operative lung?

What is the goal peak airway pressure during one-lung ventilation (OLV)?

What is the goal respiratory rate during One Lung Ventilation (OLV)?

Why do we avoid hypocapnia and allow permissive hypercapnia during one-lung ventilation (OLV)?

Why do we use the lowest FiO2 to maintain SpO2 saturation?

Which lung volume is the goal to maintain in the non-operative lung during one-lung ventilation (OLV)?

What is the maximum 24-hour fluid balance for thoracic surgeries?

What is the peak incidence of ischemia following one-lung ventilation (OLV)?

What is the preferred prophylaxis for post-thoracotomy arrhythmias?

What is the most common arrhythmia that occurs after thoracotomy?

Why do arrhythmias occur post thoracotomy? (Select all that apply)

What specific thoracic procedure is associated with an increased risk of postoperative arrhythmias?

What risk factors increase the risk of developing a postoperative arrhythmia after a thoracotomy? (Select all that apply)

What should be your initial intervention if a patient becomes hypoxic during One Lung Ventilation (OLV)?

Your patient becomes hypoxic during one-lung ventilation (OLV). You've already increased FiO2 and verified the position of the tube. There are no physiological causes of hypoxia (bronchospasm, low cardiac output, etc.). What is the next appropriate intervention? select 3

If all other interventions (PEEP, CPAP, recruitment maneuvers, tube placement, physiological factors) have failed to address a patient's hypoxia during one-lung ventilation (OLV), which of the following options are available to manage hypoxia? (Select all that apply)

Which anesthetic condition results in the worst V/Q mismatch?