Question

32 Thoracic and Pulmonary Surgery Student's Name MATCHING Match the procedure with its definit An outpatient procedure in which lead sed to stage lymph which ultrasound guidance is guidance is Removal of thrombus in a pulmonary vessel Minimally invasive surgery to map and biopsy tumors in the peripheral tissues of the lang Removal of the entire lung Portions of the lung affected by pulmonary emphysema are removed A specific lobe of the lung is removed Bletromagnetie navigation bronchoscopy b. Poumonectomy c. Lung volume reduction d. Pulmonary thromboembolectomy e. Endobronchial ultrasound f. Mediastinoscopy EVATS h. Lobectomy Surgical treatment for empyema i. Decortication Minimally invasive thoracic surgery performed through ports in the chest wall Endoscopic surgery of the mediastinal space MULTIPLE CHOICE Select the best answer 10. An underwater closed chest seal drainage system is needed to: a. Restore positive pressure in the pleural space b. Remove exudate from the mediastinum c. Restore negative pressure in the pleural space d. All of the above 11. If the underwater chest drainage system is positioned higher than the chest: a. Fluid can fill the pleural space, preventing venti lation b. Fluid can spill out of the system and create a health hazard c. Air may enter the system, causing positive pres- sure in the pleural space d. The system may overflow, causing negative pres- sure in the pleural space 12During an open thoracotomy through a posterolateral incision, it is necessary to: a. Place a magnetic instrument pad near the surgical wound b. Wrap the ESU cord around a hemostat to keep it from dropping off the field c. Place the suction near the head of the patient d. Place a needle pad near the incision 13. During a thoracotomy, rib may be removed using: a. A rib approximator b. A kerrison rongeur c. Bethune shears d. A rib rasp Chapter 32 Thoracic and Pulmona pyright 2018. Elsevier Inc. All Rights Reserved.

Answer 1

Question number	Correct option
1.	e
2.	d
3.	a
4.	b
5.	c
6.	h
7.	i
8.	g
9.	f

Q. 10. Underwater closed chest drainage is used to :

Correct option is

Option C

In order to enter air inside thoracic cavity there should have negative pressure in chest cavity, means a pressure less the atmospheric pressure.

Chest drains are used for draining of the pleural spaces of air, blood or fluid, from lungs , they not from mediastinum

Chest drains restores negative pressure in the thoracic cavity by removing fluids, blood or air.

Only option C is correct regarding closed chest drainage system, option A and option B are incorrect.

Q. 11. If underwater closed chest drainage is positioned higher than chest :

Correct option is

Option A

Fluid will move from under water drainage system to lungs through chest tube, and fill the lung space interfering with ventilation.

B. Spilling of fluid from chest tube may occur from improper placement resulting in falling and breaking of bottles not from higher placement.

C. In an intact closed chest drainage system air can not enter from outside.

D. System will not work against gravity, hence it will not drain from lungs , but the direction will be reversed from drainage bottles to lungs , so there are no chances of overfilling and spilling from bottles.

Only option A is correct regarding closed chest drainage system, option B, C and option D are incorrect.

Q. 12. During an open thoracotomy through a posterior lateral incision it is necessary to:

Correct option is

Option A

A magnetic instrument pad is placed on the drapes below incision site to prevent instruments falling from the field in lateral thoracotomy

ESU cord should not be wrapped around haemostat to avoid direct contact between the active electrode and metal; heat from electrode may cause metal to become hot and cause tissue damage

Suction is placed downwards toward hip or foot end for easy drainage and to avoid hindrance in performing surgery

Needle pad is placed near back table or on mayo stand not near incision site.

Hence option B, C and D are incorrect.

Q. 13. During thoracotomy a rib may be removed using:

Correct option is

Option C

Bethune Rib Shears are used in cardiothoracic surgical procedures that necessitate clipping of ribs. They are slightly s-shaped and feature a very long handle with a smaller head for precise clipping of ribs.

Rib approximator is used to hold the ribs apart so as to suture the thoracotomy wound

A rongeur is used in oral maxillofacial surgery to remove bony fragments or soft tissue.

A rib rasp, is a coarse file type tool used for scrapping, filing or rubbing down ribs/ bone in thoracic surgery.

Hence option A, B and D are incorrect.