Portal Chunk 11

A) Apply 5 cmH2O CPAP to the collapsed right lung

B) Increase tidal volume to 10 mL/kg

C) Switch to pressure-controlled ventilation

D) Administer intravenous almitrine

A) Desflurane at 1.5 MAC

B) Sevoflurane at 1 MAC

C) Isoflurane at 1.5 MAC

D) Nitrous oxide at 50%

A) Patient height using standard nomograms

B) Measurement of left mainstem bronchus diameter on chest CT

C) Body weight alone

D) Gender with male 41 Fr and female 37 Fr universally

A) V/Q scintigraphy followed by calculation of predicted postoperative function

B) Proceed to surgery without further assessment

C) Echocardiography only

D) Spirometry repeated after bronchodilators

A) The DLT has been advanced too far, with bronchial cuff crossing the carina

B) The DLT is not advanced far enough, both lumens in trachea

C) The bronchial cuff is deflated

D) The patient has a right-sided aortic arch displacing the carina

A) Acute increase in pulmonary vascular resistance and right ventricular afterload

B) Decreased systemic vascular resistance

C) Acute LV failure due to increased preload

D) Bradycardia secondary to vagal activation

A) Awake fibreoptic intubation with left-sided DLT in the sitting or semi-recumbent position

B) Rapid sequence induction with succinylcholine followed by DLT placement

C) Standard inhalational induction with sevoflurane

D) Supraglottic airway device for spontaneous ventilation

A) 5 cmH2O PEEP titrated to maintain alveolar recruitment without overdistension

B) Zero end-expiratory pressure to maximise tidal volume delivery

C) 15 cmH2O PEEP to maximise FRC

D) PEEP equivalent to the patient’s intrinsic PEEP only

A) Inhibition of hypoxic pulmonary vasoconstriction in the collapsed lung

B) Direct bronchodilation reducing airway resistance

C) Increased cardiac output augmenting shunt fraction

D) Depression of respiratory drive increasing PaCO2

A) Disconnect the circuit and perform manual ventilation to assess compliance, check for tube obstruction

B) Increase the respiratory rate to compensate

C) Reduce the tidal volume to 2 mL/kg

D) Administer intravenous salbutamol

A) Atrial fibrillation

B) Ventricular fibrillation

C) Complete heart block

D) Junctional tachycardia

A) Left pneumonectomy where surgeon requires access to the left mainstem bronchus

B) Right upper lobectomy as routine first choice

C) Patients with left-sided thoracic aortic aneurysm compressing left mainstem bronchus

D) All paediatric thoracic cases

A) Predicted postoperative FEV1 (ppoFEV1)

B) Total lung capacity (TLC)

C) Forced vital capacity (FVC) alone

D) Residual volume to TLC ratio

A) Non-cardiogenic pulmonary oedema affecting the remaining lung, associated with high mortality and excessive intraoperative fluid administration

B) Cardiogenic pulmonary oedema due to acute LV failure after increased preload

C) Pulmonary oedema confined to the pneumonectomy space

D) Oedema resulting exclusively from lymphatic disruption

A) Increases risk that left-sided DLT bronchial cuff will herniate across the carina or obstruct left upper lobe bronchus

B) Necessitates use of a right-sided DLT in all cases

C) Contraindicates OLV entirely

D) Mandates high-frequency oscillatory ventilation

A) Continuation of pulmonary vasodilator therapy perioperatively to prevent acute RV decompensation during OLV

B) Discontinuation of vasodilators 12 hours preoperatively to reduce intraoperative hypotension

C) Avoidance of all PEEP to reduce RV afterload

D) Use of ketamine infusion as primary anaesthetic to increase pulmonary vascular tone

A) 4-6 mL/kg ideal body weight

B) 10-12 mL/kg ideal body weight

C) 8 mL/kg actual body weight

D) 6-8 mL/kg ideal body weight with no PEEP

A) The tracheal lumen vent has not been opened to atmosphere (remains connected to the breathing circuit)

B) The bronchial cuff is overinflated

C) The FiO2 is too high, preventing nitrogen-dependent atelectasis

D) The patient has significant bullous disease preventing collapse

A) Thoracic epidural analgesia at the T4-T6 level

B) Intercostal nerve blocks alone

C) Intrathecal opioid injection at lumbar level

D) IV patient-controlled analgesia with morphine as sole analgesic

A) Proportional contribution of each lung to total pulmonary function, derived from V/Q scintigraphy and used to calculate predicted postoperative FEV1 and DLCO

B) Ratio of tidal volume delivered to each lung separately during DLT ventilation

C) Differential PEEP applied to dependent versus non-dependent lungs

D) Spirometric values measured separately at bedside using spirometer attached to each DLT lumen