Obesity

Question 1

BMI calculation

Answer 1

weight(kg) / height (m2)
———–or———-
[weight(lbs) / height (in2)] x 703

Question 2

Ideal body weight formula

Answer 2

male = height(cm) - 100

female = height(cm) - 105

Question 3

what’s the BMI for overweight

Answer 3

25-29.9

Question 4

what is the BMI for obese class 1

Answer 4

30-34.9

Question 5

what is the BMI for obese class 2

Answer 5

35-39.9

Question 6

what is the BMI for obese class III/ extreme obese

Answer 6

40-44.9

Question 7

what is the BMI for obese class IV/severe obesity?

Answer 7

> 45

Question 8

which type of fat distribution is more deadly

Answer 8

android - apple

Question 9

where is the fat located in android distribution

Answer 9

central or abdominal visceral

Question 10

where is the fat located in gynecoid

Answer 10

gluteal femoral or peripheral

Question 11

what disease processes does gynecoid fat lead to

Answer 11

vertices veins, joint disease

Question 12

T/F Gynecoid fat leads to an increased incidence of DM?

Answer 12

FALSE. reduced incidence

Question 13

what defines a pediatric patient as obese?

Answer 13

weight-height ratio >90%

BMI >95%

Question 14

T/F Maternal complication risk is increased after bariatric surgery.

Answer 14

TRUE

Question 15

what happens to total body water in the obese

Answer 15

DECREASES

Question 16

what happens to blood volume and VOD in the obese

Answer 16

INCREASE

Question 17

what happens to lean body weight in the obese

Answer 17

INCREASE

Question 18

what happens to the VOD for lipid soluble drugs

Answer 18

INCREASES

Question 19

if a drug has high lipophilicity, most of the time you should dose based off ___

Answer 19

TBW

Question 20

if a drug has low lipophilicity, most of the time you should dose off

Answer 20

IBW

Question 21

Cardiac output increases by ___ for each kg of fat

Answer 21

0.1L/min

Question 22

For every 13.5kg of fat = _____ of neovascularization

Answer 22

25mi

Question 23

increased volume, increased ____ activity —-> htn

Answer 23

RAAS

Question 24

what happens to the structure of the heart in obese patients

Answer 24

cardiomegaly, atrial and biventricular dilatation, hypertrophy

Question 25

T/F CAD is an independent factor with obesity?

Answer 25

TRUE - it appears with or without htn, DM, or sedentary lifestyle

Question 26

Define HTN.

Answer 26

SPB >140, DBP > 90, or both

Question 27

why do obese people have twice the normal risk of developing hypertension?

Answer 27

increased blood viscosity, hyperinsulinemia, increased mineralocorticoids, Na reabsorption, compression of kidneys, impaired NA excretion, RAA activation

Question 28

Which spirometry values decrease in the obese

Answer 28

FRC ERV VC TLC

Question 29

why does FRC decrease

Answer 29

because expiratory reserve volume is below closing capacity which creates a situation where distal airway collapse occurs during tidal breathing.

Question 30

Which flow volume loop pattern is best representative of the obese?

Answer 30

restrictive. looks like a small ice cream cone

Question 31

what is the gold standard test for OSA

Answer 31

polysomnography

Question 32

STOPBANG - BMI >?

Answer 32

35

Question 33

STOPBANG - Age > ?

Answer 33

50

Question 34

STOPBANG - neck circ >?

Answer 34

40cm

Question 35

someone is high risk for stop bang if they score a

Answer 35

3 or greater | according to nagel

Question 36

how is OSA defined in terms of apnea episodes

Answer 36

excessive episodes of apnea (10s) and hypopnea >5 episodes/hr or 30/night

Question 37

how is hypopnea defined? | not in ppt - taken from nagelhout

Answer 37

a 50% reduction in airflow for 10s that occurs 15 or more times/hr of sleep and is associated with snoring and a 4% decrease in O2 sat.

Question 38

Obese hypoventilation (pickwickian) syndrome - which lab values are suggestive?

Answer 38

PCO2 >45 during wakefulness with compensatory metabolic compensation and hypoxemia (PO2 <70)

Question 39

what is the difference between simply obesity and OHS?

Answer 39

With simple obesity, the PCO2, pH and pulmonary compliance are within normal ranges. Hypoxia may be present but no evidence of cardiac failures or differences in aterioalbeolar O2 exists. In contrast, OHS is diagnosed when the morbidly obese patient exhibits inappropriate and sudden somnolence, sleep apnea, hypoxia, and hypercapnia.

Question 40

Signs of OHS include cardiac ____, cyanosis, polycythemia, and twitching

Answer 40

enlargement

Question 41

___% of NIDDM are also obese

Answer 41

80

Question 42

metabolic syndrome - in order to be diagnosed, one must have at least 3: name the #'s ``` waist m/f triglycerides HDL m/f BP fasting glucose ```

Answer 42

waist m>40in waist f>35in triglycerides >150 HDL <40men HDL<50 women BP 130/85 fasting glucose >100

Question 43

what should your tidal volumes be for an obese patient

Answer 43

6-10ml/kg

Question 44

what should you use for maint fluids multiplier?

Answer 44

45-55 ml/kg (prodigy)

Question 45

the maximum decrease in PAO2 occurs ____ post-op

Answer 45

2-3days (prodigy)

Question 46

what is the most common cause of post-op mortality after bariatric surgery?

Answer 46

thromboembolism (prodigy)

Question 47

T/F Succs dose for intubation are given according to TBW to ensure excellent intubating conditions

Answer 47

TRUE the combination of an increased blood volume(increased Vd) and increased pseudocholinesterase activity (increased clearance) necessitates a TBW dose be given to ensure adequate paralysis. (prodigy)

Question 48

T/F NDNMB used for induction/ maintenance are given according to TBW.

Answer 48

FALSE - IBW hydrophilic drugs given according to IBW will ensure shorter duration and a more predictable recovery in the respiratory challenged population. (prodigy)

Question 49

what is the most confirmatory test of pulmonary htn

Answer 49

tricuspid regurg on TEE | (prodigy)

Question 50

BP cuffs with bladders that encircle a minimum of ___% of the upper arm circle should be used.

Answer 50

75 | (prodigy)

Question 51

T/F Forearm measurements with a standard cuff underestimates both systolic and diastolic BP in obese.

Answer 51

FALSE - overestimates | (prodigy)

Question 52

what are the risk factors for mendelsons syndrome

Answer 52

gastric pH <2.5, gastric volume >25mL If the gastric volume is less than 1.5ml/kg, the risk of aspiration can be considered low. (prodigy q)

Question 53

which 3 positions are least ideal for the obese

Answer 53

prone supine trend | (prodigy)

Question 54

T/F A vertical abdominal incision, as opposed to a horizontal (transverse) incision, prolongs post-op hypoxia.

Answer 54

TRUE | (prodigy)

Question 55

How should you do a recruitment maneuver?

Answer 55

sustained 8-10s pressure of 40cm H20 or greater | prodigy

Question 56

Explain how PEEP can help or hurt the situation

Answer 56

PEEP 10-12cmH20 - recruiting collapsed alveoli BUT may cause hotn or decreasing arterial oxygenation d/t a PEEP induced increase in pulmonary shunt function (prodigy)

Question 57

what is the most senstive sign of leak in bariatric surgery

Answer 57

tachycardia. most common - tachycardia, fever, and pain. (prodigy)

Question 58

T/F Both fat mass and muscle mass increase.

Answer 58

TRUE So the Vd for water soluble drugs will increase some because the plasma volume is larger, but the Vd for fat soluble drugs will increase a whole lot more because of the large fat mass. vd lipophilic drugs >>> vd hydrophilic drugs, but both increase! (apex)

Question 59

for propofol, give induction dose based on ___, and maintenance dose based on ___

Answer 59

LBW TBW (apex)

Question 60

Sugammadex is dosed based on IBW LBW or TBW?

Answer 60

TBW | apex