Pulmonary/Thoracic Surgery

Question 1

Why may it be dangerous to give a patient with chronic COPD supplemental oxygen?

Answer 1

Patients with COPD use relative hypoxia for respiratory drive, and supplemental O2 may remove this drive.

Question 2

Optimally, when should patients who smoke stop smoking before scheduled surgery?

Answer 2

Optimally 8 weeks before scheduled surgery

Question 3

For elective surgery, patients with asthma should be free of wheezing and have a peak expiratory flow rate greater than _____ prior to surgery

Answer 3

Greater than 80% of predicted or their personal best

Question 4

For patients with respiratory disease that require endotrachial intubation, what should be administered 30 minutes prior to intubation?

Answer 4

Rapid-acting beta agonist (2-4 puffs)

Question 5

What respiratory infections are absolute contraindications to elective surgery?

Answer 5

Acute lower respiratory infections (tracheitis, bronchitis, and pneumonia)

Question 6

What is atelectasis?

What is the etiology?

Answer 6

Collapse of the alveoli

Inadequate alveolar expansion, high levels of inspired oxygen

Question 7

What is the most common cause of fever in the first two post-operative days?

Answer 7

Atelectasis

Question 8

What is the treatment of postoperative wheezing?

Answer 8

Albuterol nebulizer

Question 9

Why should you give supplemental oxygen to a patient with a pneumothorax?

Answer 9

Pneumothorax is almost completely nitrogen - thus increasing the oxygen in the alveoli increases the nitrogen gradient and results in faster absorption of the pneumothorax

Question 10

How do you figure out the PaO2 from an O2 saturation?

Answer 10

PaO2 of 40, 50, 60 roughly equals 70, 80, 90 in sats

Question 11

What pathogens are associated with ventilator-associated pneumonia (VAP)?

Answer 11

• Pseudomonas aeruginosa
• Methicillin-sensitive staph aureus
• MRSA

Question 12

A 68-year-old woman is two days post-colon resection due to colorectal cancer. She reports her left leg is painful and feels heavy. Physical exam reveals vitals within normal limits, and her left calf is erythematous, swollen, and tender to palpation. What is the initial imaging modality used to evaluate for the suspected diagnosis?

A) Compression ultrasound with Doppler
B) Computed tomography angiogram
C) Ventilation-perfusion scan
D) X-ray of the left leg

What is the gold standard to diagnose a DVT?

Answer 12

Compression ultrasound with Doppler

Venography