Fellowship - thoracics Flashcards
Discuss the intraoperative considerations for a patient undergoing a pneumonectomy
A 60-year-old patient is scheduled for stenting of a tracheobronchial mass. Outline your perioperative management.
A 45-year-old woman with a large anterior mediastinal mass is scheduled for mediastinoscopy and biopsy. Discuss your preoperative assessment of this patient.
“A patient is anaesthetised for video-assisted thoracoscopic resection of the left upper lobe. At the completion of surgery, the double-lumen tube is in situ and the patient has persistent hypoxia. List the potential causes of hypoxia in this situation. (30%)
How will you manage this? (70%) “
You are asked to anaesthetise an adult patient for a left pneumonectomy. Describe the different methods for lung isolation in this patient, including the advantages and disadvantages of each.
You are asked to evaluate a 35-year-old patient who has been scheduled for mediastinoscopy to biopsy a symptomatic anterior mediastinal massa. Discuss the features specific to this condition that need to be considered when planning an anaesthetic for this patient. (50%)b. Describe how you may need to adapt your anaesthetic plan in response to each of these features. (50%)
a. Why can hypoxaemia occur after changing from two lung to one lung ventilation? 50% b. Describe the treatment of hypoxaemia in one lung ventilation (50%)
“A 25-year-old man with recurrent pneumothorax and persistent air leak is scheduled for video-assisted thoracoscopic pleurodesis.a. Outline the considerations involved in induction of anaesthesia in a patient with a persistent air leak (50%)b. Outline the
management of an intraoperative deterioration of oxygen saturation in this patient (50%)”
a. Describe the function of a three-chamber underwater seal chest drainage system. (a diagram may be useful) (50%)b. Evaluate the use of this system in the management of haemopneumothorax secondary to blunt chest trauma? (50%)
Draw a diagram illustrating the bronchial anatomy to the level of the lobar bronchi and describe how you would use a fibreoptic bronchoscope to corrrectly position a right sided DLT
A 60 year old man develops a large haemo/pneumothorax following attempted insertion of a haemodialysis catheter via the left subclavian route. Describe your technique of chest tube insertion to drain this and the features of the pleural drainage system you would connect to it.
A 65 year old man with a 40 pack a year history of smoking is scheduled for right pneumonectomy for carcinoma. Describe your preoperative evaluation of his respiratory system to decide his capacity to undergo this operation.
Evaluate the methods available to confirm correct placement of a double lumen endobronchial tube.
“A 57 yo man with a primary lung tumour is scheduled to have a thoracotomy for a left pneumonectomy. Justify your choice of airway device for this surgery and describe how it is placed.
Discuss the advantages and disadvantages of using a bronchoscope to check the position of the device.”
Outline your management of an oxygen saturation of 82% during one lung ventilation.
A 65 yo active man with a 40 yr pack history of smoking presents with 6 broken ribs and a small flail segment, soon after a fall from a ladder. He has no other significant injury. How would you manage his respiratory care in the first four days? Six hours after the injury, he develops ventricular ectopic beats. How would you diagnose the cause of these ectopic beats?
List the risk factors for the development of a bronchopleural fistula. (30%) Justify your airway management plan for a bronchopleural fistula repair. (70%)
A 64 year old man with a 40 pack year history of smoking is scheduled for a right pneumonectomy for lung adenocarcinoma. Describe your preoperative evaluation of his respiratory system to decide his capacity to undergo this operation.
Describe the segmental anatomy of the lobes of the lungs (60%).
What are the indications for and disadvantages of placing a right sided double lumen tube? (40%)
A 55 year old woman, 12 days after a right lower lobectomy presents to theatre for emergency management of a bronchopleural fistula. Discuss the anaesthetic issues related to this pathology and how you will manage these issues
