70 Questions
What is the most common cause of cancer-related death in both men and women in the United States?
Lung cancer
Which pulmonary resection procedure is considered to be a more extensive form of surgery?
Pneumonectomy
What is the primary purpose of evaluating pulmonary disease, cardiovascular disease, and comorbidities during preoperative assessment?
To assess the patient's ability to tolerate lung resection surgery
Which factor influences the need for advanced intraoperative monitoring during lung cancer surgery?
Histologic type of lung cancer
What is the primary purpose of one-lung ventilation (OLV) during lung surgery?
To separate the lungs for optimal surgical visualization
Which method can be used to achieve one-lung ventilation (OLV) during lung surgery?
Dual-lumen endobronchial tube (ETT)
What is the most common cause of cancer-related deaths in the United States, according to the text?
Lung cancer
Which type of lung carcinoma accounts for 25% of all lung cancer cases?
Oat-cell carcinoma
Why is surgery rarely involved in the treatment of small-cell lung carcinoma (SCLC), according to the text?
Metastases have frequently occurred upon initial evaluation
What is the second most common type of lung carcinoma after small-cell lung carcinoma (SCLC), based on the text?
Adenocarcinoma
What proportion of patients presenting with lung cancer are nonsmokers, according to the text?
Less than 10%
Which environmental exposure can often contribute to the development of lung cancer in nonsmokers?
Heavy metal exposure
Which surgical procedure involves making a posterolateral or lateral thoracotomy incision through the fifth intercostal space?
Extra pericardial pneumonectomy
What is the primary purpose of the surgeon performing a methodical biopsy of the thoracic lymph nodes during a pneumonectomy procedure?
To assess the extent of lymph node involvement
What is a potential disadvantage of performing a video-assisted thoracoscopic (VATS) approach for pneumonectomy compared to open thoracotomy?
Limited visualization and limited ability for the surgeon to manually compress the lung
What is the primary reason the surgical ligation of the hilar structures (pulmonary artery, pulmonary veins, and bronchus) is performed during a pneumonectomy?
To prevent unwarranted damage to major vascular and mediastinal structures
What is the primary advantage of using a double-lumen endotracheal tube (ETT) compared to a bronchial blocker during a VATS procedure?
Easier control of lung isolation
What is the primary reason that VATS can be performed using epidural anesthesia in the spontaneous breathing patient who is sedated?
To manage cases of severe pulmonary compromise
What is the purpose of performing surgical evaluation of the thoracic cavity, mediastinum, pulmonary parenchyma, and pleural surfaces during the extra pericardial pneumonectomy procedure?
To identify metastases and lymph node involvement
Why is partial or total rib resection sometimes necessary during extra pericardial pneumonectomy?
To facilitate visualization during the surgery
What determines whether a pneumonectomy is necessary or if a less dramatic pulmonary resection procedure can be performed in extra pericardial pneumonectomy?
The pathological findings of the patient
During extra pericardial pneumonectomy, what structures are surgically ligated at the pulmonary hilum?
Pulmonary artery, pulmonary veins, and bronchus
What would preclude a complete resection in extra pericardial pneumonectomy?
Metastases and mediastinal involvement
After the surgical ligation of hilar structures in extra pericardial pneumonectomy, what is the next step performed by the surgeon?
Extracting the affected lung through the thoracotomy incision
What is the primary purpose of preoperative bronchoscopy and mediastinoscopy examination in patients with bronchogenic carcinoma?
Obtaining biopsies from tracheobronchial pathology
What is a crucial factor in determining a patient's ability to tolerate pneumonectomy?
Cardiac function optimization
Why is preoperative optimization important for high-risk patients undergoing pneumonectomy?
To manage conditions that predispose patients to postoperative complications
What is a common manifestation of SCLC cells derived from neuroendocrine tissue?
Paraneoplastic neurologic syndromes
What is a significant aim of pulmonary optimization procedures before pneumonectomy?
Decreasing viscosity of secretions
What do right and/or left ventricular dysfunctions indicate in patients presenting for pneumonectomy?
The necessity for preoperative optimization
Which of the following is NOT a common structure found in the left and right pulmonary hila?
Azygos vein
Which of the following is NOT a potential advantage of performing a video-assisted thoracoscopic (VATS) approach for pneumonectomy compared to open thoracotomy?
Improved ability for the surgeon to manually compress the lung
Which of the following is NOT a potential risk associated with pneumonectomy due to the proximity of the pulmonary hila to major vascular and mediastinal structures?
Damage to the diaphragm
Which of the following preoperative tests is LEAST likely to provide accurate information regarding tumor size, location, density, and metabolic activity?
Chest radiograph
Which of the following statements is TRUE regarding the physiological impact of a right-sided pneumonectomy compared to a left-sided pneumonectomy?
A right-sided pneumonectomy results in a greater decrease in total lung area.
Which of the following statements regarding the use of epidural anesthesia for VATS procedures is INCORRECT?
It requires sedation in addition to the epidural anesthesia
Which factor is NOT a consideration when choosing between a left-sided and right-sided double-lumen endotracheal tube (DLT) for a surgical procedure involving the mainstem bronchus?
Gender of the patient
What is a contraindication for using a right-sided double-lumen endotracheal tube (DLT)?
Anomalous right upper lobe orifice above the tracheal carina
When selecting the ideal size of a double-lumen endotracheal tube (DLT), what is NOT a consideration?
Length of the patient's neck
How is placement confirmed for a bronchial blocker?
Chest radiograph, clinical signs, and fiber-optic bronchoscopy
What can contribute to inadequate ventilation of the right upper lobe with a right-sided double-lumen endotracheal tube (DLT)?
Obstruction of the right mainstem bronchus
For confirming placement of a double-lumen endotracheal tube (DLT), which method has shown a significant incidence of mispositioning despite proper positioning based on clinical signs?
Fiber-optic bronchoscopy
What technique can be used during placement to ensure adequate ventilation of the right upper lobe with a right-sided double-lumen endotracheal tube (DLT)?
(4) Ventilation slot embedded in the endobronchial cuff
In what scenario should the choice between a left- and right-sided double-lumen endotracheal tube (DLT) be carefully considered?
(4) Surgical procedures involving the mainstem bronchus
Which of the following types of pneumonectomy involves the removal of the entire lung, ipsilateral pleura, hemopericardium, and hemidiaphragm?
Radical pneumonectomy (extrapleural pneumonectomy)
What is the primary purpose of performing a carinal pneumonectomy?
To remove the entire lung, ipsilateral mainstem bronchus, and carina
What is the primary factor that determines the type of pneumonectomy selected for a patient with lung carcinoma?
The type, stage, and location of the lung carcinoma
What is the primary reason for performing a completion pneumonectomy?
To remove the affected lung after a previous lung resection has experienced a recurrence of carcinoma
Which of the following statements accurately describes the difference between intrapericardial and extrapericardial pneumonectomy?
Intrapericardial and extrapericardial pneumonectomy refer to a standard pneumonectomy with the extent of surgical resection in relation to the cardiac pericardium
What is the primary purpose of performing one-lung ventilation (OLV) during lung surgery?
To improve surgical visibility by collapsing the operative lung
What does pulmonary compliance refer to?
The change in volume for a given change in pressure in lung tissue
What causes a mismatch of ventilation and perfusion in the dependent lung during a lateral decubitus position?
Decreased perfusion in the dependent lung
In the lateral decubitus position, why do the dependent lung regions function similarly to the inferior regions of the upright lung?
Due to a decrease in pulmonary compliance
How do regional differences in pleural pressure affect ventilation in the lung?
They result in increased ventilation in superior areas
What causes a relative increase in ventilation in the nondependent lung during controlled ventilation?
Decreased pulmonary compliance
How does regional differences in pleural pressure affect tidal volume distribution?
It decreases tidal volume in superior areas
Why is there a mismatch of ventilation and perfusion in the dependent lung during anesthesia?
Decreased pulmonary compliance
What happens to pulmonary compliance in the dependent lung during thoracotomy (open chest surgery)?
Decreases
What is the result of regional differences in pleural pressure on ventilation?
Increased tidal volume distribution towards inferior portions of the lungs compared to superior portions
What occurs when there is a relative increase in ventilation due to regional differences between the superior and inferior portions of the lungs?
Increased compliance leading to better gas exchange capacity
What is the primary purpose of hypoxic pulmonary vasoconstriction (HPV) during instances of hypoxia?
To decrease pulmonary vascular resistance
Which pharmacologic agent used in anesthesia has been implicated in inhibiting hypoxic pulmonary vasoconstriction (HPV)?
Inhalation anesthetics
Why is it important to avoid factors that inhibit hypoxic pulmonary vasoconstriction (HPV) during permissive atelectasis?
To maximize oxygenation
How does continuous positive airway pressure (CPAP) applied to the non-ventilated lung help during one-lung ventilation?
By minimizing alveolar hypoventilation
What is the primary benefit of a tidal volume set to approximately 4 to 6 mL/kg during one-lung ventilation?
Preventing atelectasis
What is a potential risk associated with applying positive-end expiratory pressure (PEEP) greater than 5 mm Hg during one-lung ventilation?
Raising pulmonary vascular resistance
Why should the amount of drug administered be considered during the use of pharmacologic agents that may inhibit hypoxic pulmonary vasoconstriction (HPV)?
To maximize oxygenation
What is a significant advantage of utilizing a high fraction of inspired oxygen (FiO2) during pneumonectomy?
Preventing absorption atelectasis
How can the application of continuous positive airway pressure (CPAP) be beneficial during one-lung ventilation?
Maintaining oxygenation by decreasing alveolar hypoventilation
What is a potential disadvantage of a high tidal volume during one-lung ventilation?
Leading to increases in airway pressure
Test your knowledge on the anatomy of the sacral plexus, a network of nerves located in the pelvis formed by the anterior rami of several sacral spinal nerves. Learn about the major nerves originating from the sacral plexus and their functions.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
