Restrictive Lung Disease

Front

Which of the following issues are typical for Restrictive Lung Disease?
Options:
Increase TLC
Increase RV
Increase FEV1/FVC
All of the above

Back

Increase FEV1/FVC

Answer explanation

Answer: C, increase TLC and RV is typical of obstructive lung disease and decrease in

FEV1/FVC. Increase in FEV1/FVC is typical of restrictive disease.

Front

A patient presents with acute fibrosis, dyspnea, cough, hypoxia, and vitamin E in the aspirates. There is an increase in FEV1/FVC with a decrease in TLC and RV. What disease does the diagnosis resemble?

Back

EVALI

Answer explanation

Answer: D, this patient is exhibiting signs and symptoms of restrictive lung disease. Since there was vitamin E found in the aspirate it singles for specifically EVALI.

Front

A 28-year-old woman develops acute SOB and hypoxemia shortly after extubation from a tonsillectomy. She is tachypneic, coughing pink frothy sputum, and her CXR shows bilateral opacities. She had a post extubation laryngospasm requiring vigorous inspiratory effort. Which is the most likely diagnosis?

Back

Negative pressure pulmonary edema.

Answer explanation

NPPE occurs when strong inspiratory efforts against an obstructed upper airway generate highly negative intrathoracic pressures, pulling fluid into alveoli. It shows up after extubation s/s of hypoxemia, tachypnea, and pink frothy sputum. CXR shows bilateral opacities.

→Aspiration pneumonitis presents after gastric content aspiration, often with chemical

pneumonitis and delayed findings on the CXR..

→ Cardiogenic pulmonary edema results from LV dysfunction or fluid overload, typically with

elevated filling pressures.

→ Anaphylaxis presents with hypotension, rash, bronchospasm, and airway edema.

Front

54-year-old man undergoing laparotomy for perforated diverticulitis aspirates gastric contents during intubation, later developing tachypnea, hypoxemia, and bronchospasm. CXR shows infiltrates appearing several hours later. What is the best initial management strategy?

Back

Provide oxygen, apply PEEP, and administer bronchodilators as needed; antibiotics only if symptomatic after 48 hours.

Answer explanation

Chemical pneumonitis from aspiration damages surfactant producing cells and pulmonary endothelium, causing pulmonary edema, bronchospasm,

and hypoxemia. Supportive management with oxygen, PEEP, and bronchodilators is

essential. Antibiotics are not indicated unless infection develops after 48 hours.

Front

Which of the following pulmonary function test (PFT) findings is most consistent with restrictive lung disease? Decreased Total Lung Capacity (TLC) and Forced Vital Capacity (FVC), Increased Residual Volume (RV) and Flattened Expiratory Flow Loop, Normal TLC and Decreased FEV1/FVC Ratio, Prolonged Expiratory Time with Scooped-Out Flow Loop

Back

Decreased Total Lung Capacity (TLC) and Forced Vital Capacity (FVC)

Answer explanation

Restrictive lung disease is defined by reduced lung compliance and volumes. Key PFT findings include decreased TLC, FVC, and often a preserved or increased FEV1/FVC ratio.

Front

A 55-year-old male with a history of idiopathic pulmonary fibrosis presents for elective hernia repair. Preoperative testing shows: • PFT: TLC 48% predicted, FVC 50% predicted, FEV1/FVC ratio 0.85 • ABG on room air: PaO₂ 60 mmHg, PaCO₂ 38 mmHg • Exam: Bibasilar crackles, SpO₂ 92%. Which of the following is the most important anesthetic management strategy for this patient? Options: Use high tidal volumes (10 mL/kg) to ensure adequate ventilation, Apply low tidal volumes (6 mL/kg) with moderate PEEP to optimize oxygenation, Liberal fluid administration to prevent intraoperative hypotension, Avoid preoxygenation to reduce risk of absorption atelectasis.

Back

Apply low tidal volumes (6 mL/kg) with moderate PEEP to optimize oxygenation.

Answer explanation

Patients with interstitial lung disease have decreased lung compliance and reduced

functional residual capacity (FRC), making them prone to hypoxemia during apneic

periods. Ventilation strategies include lung-protective low tidal volumes (6–8 mL/kg) and careful application of PEEP (5–15 cm H₂O) to prevent atelectrauma and maintain

oxygenation.

Front

A 25 yr old healthy male undergoes shoulder arthroscopy. Right after extubating, he develops acute upper airway obstruction due to laryngospasm. Less than 5 mins, he is hypoxemic with pink, frothy sputum. Chest X-ray results show bilateral pulmonary infiltrates. What is the most likely diagnosis?

Back

Negative pressure pulmonary edema

Answer explanation

Negative pressure pulmonary edema Caused by excessive inspiratory effort against an obstructed airway, usually a post-extubation complication, it presents acutely with hypoxemia and pink sputum.

Front

A 55 yr old woman with idiopathic pulmonary fibrosis is scheduled for elective abdominal surgery. Which ventilatory plan is the most appropriate to decrease the risk of barotrauma and hypoxemia?

Back

Low tidal volume ventilation with PEEP

Answer explanation

Low tidal volume ventilation with PEEP This approach improves oxygenation, minimizes

atelectasis, and reduces barotrauma risk in restrictive lung disease.

Front

Which of the following pulmonary function test (PFT) findings is most characteristic of restrictive lung disease? Reduced total lung capacity (TLC) with preserved or increased FEV1/FVC ratio, Increased total lung capacity (TLC) with reduced FEV1/FVC ratio, Increased residual volume with decreased FEV1/FVC ratio, Normal lung volumes with decreased FEV1/FVC ratio

Back

Reduced total lung capacity (TLC) with preserved or increased FEV1/FVC ratio

Answer explanation

Restrictive lung diseases are characterized by a reduction in lung volumes,

particularly total lung capacity (TLC) and vital capacity (VC). However, the

FEV1/FVC ratio is normal or increased because both FEV1 and FVC are

proportionally reduced. This pattern distinguishes restrictive from obstructive lung disease.

Front

62-year-old male with idiopathic pulmonary fibrosis presents for elective laparoscopic colectomy. Preoperative testing reveals: FVC 55% predicted, TLC 60% predicted, DLCO reduced. The patient requires general anesthesia. Which intraoperative ventilatory strategy is most appropriate for minimizing complications?

Back

Low tidal volumes (6 mL/kg) with moderate PEEP and higher respiratory rate

Answer explanation

In restrictive lung disease, particularly pulmonary fibrosis, patients are at risk of volutrauma and barotrauma due to stiff, non-compliant lungs. The best intraoperative strategy is lung-protective ventilation with low tidal volumes

(≈6 mL/kg of predicted body weight), moderate PEEP to prevent atelectasis, and

increased respiratory rate to maintain normocapnia.