Obesity

Question 1

Adipose tissue is considered an organ–T/F?

Answer 1

True!

Question 2

What are (2) formulas that can be used to calculate BMI?

Answer 2

BMI = weight (kg) / height (m^2)

BMI = [weight (lbs) / height (in^2)] x 703

Question 3

BMI class (ASA)–overweight = ___-___

Answer 3

25-29.9

Question 4

BMI class (ASA)–obese class I = ___-___

Answer 4

30-34.9

Question 5

BMI class (ASA)–obese class II = ___-___

Answer 5

35-39.9

Question 6

BMI class (ASA)–obese class III/extreme obese = ___-___

Answer 6

40-44.9

Question 7

BMI class (ASA)–obese class IV/severe obesity = > ___

Answer 7

> 45

Question 8

How to calculate ideal body weight (IBW) for males and females using Broca’s index?

Answer 8

Male = height (cm) - 100

Female = height (cm) - 105

Question 9

How to calculate lean body weight (LBW)?

Answer 9

IBW x 1.3

Question 10

What type of fat distribution is central or abdominal visceral; patients are apple shaped?

Answer 10

Android

Question 11

What type of fat distribution is gluteal, femoral, or peripheral; patients are pear shaped?

Answer 11

Gynecoid

Question 12

Which type of obesity (android or gynecoid) is associated with more comorbidities?

Answer 12

Android

Question 13

What (5) things is android obesity associated with?

Answer 13

• Heart disease
• Diabetes mellitus
• Hypertension
• Dyslipidemia
• Death

Question 14

What (2) things is gynecoid obesity associated with?

Answer 14

• Varicose veins

- Joint disease

Question 15

There is a/an ___ (increased/decreased) metabolic demand from fat organs

Answer 15

There is an INCREASED metabolic demand from fat organs

Question 16

Increased cardiac output of ___ L/min for each kg of fat

Answer 16

Increased CO of 0.1 L/min for each kg of fat

Question 17

HTN in obesity is defined as SBP > ___, DBP > ___, or both

Answer 17

HTN in obesity is defined as SBP > 140, DBP > 90, or both

Question 18

Respiratory–obese patients have ___ (increased/decreased) lung compliance; why?

Answer 18

Obese patients have DECREASED lung compliance; d/t pressure from abdominal, diaphragmatic, and thoracic fat

Question 19

Obese patients have a ___ F/V loop pattern

Answer 19

Obese patients have a RESTRICTIVE F/V loop pattern

Question 20

Obese patients have ___ (increased/decreased) FRC, ERV, VC, TLC; ___ (increased/decreased) dead space; ___ (increased/decreased/no change) in RV, CC, FVC, and FEV1

Answer 20

Obese patients have DECREASED FRC, ERV, VC, TLC; increased dead space; no change in RV, CC, FVC, and FEV1

Question 21

Obese patients ___ventilate, which leads to ___carbia and ___osis

Answer 21

Obese patients HYPOventilate, which leads to HYPERcarbia and acidosis

Question 22

What volumes/capacities are decreased in obese patients?

Answer 22

Decreased

• FRC
• VC
• TLC
• ERV

Question 23

What volumes/capacities show no change in obese patients?

Answer 23

No change

• RV
• CC
• FVC
• FEV1

Question 24

OSA rates are directly proportional to ___

Answer 24

OSA rates are directly proportional to BMI

Question 25

Risk factors for OSA--BMI > ___, ___ fat distribution, large ___ girth

Answer 25

Risk factors for OSA--BMI > 35, abdominal fat distribution, large neck girth

Question 26

For BMI > 35, OSA occurs in 71-77% of patients--T/F?

Answer 26

True

Question 27

What is OSA defined as?

Answer 27

Excessive episodes of apnea (10 seconds) and hypopnea

Question 28

What exactly occurs during episodes of apnea?--obstruction leads to ___ia and ___carbia, surge of muscles to open airway, period of ___ventilation reverses ___carbia, ___ breathing, repeat

Answer 28

obstruction leads to hypoxia and hypercarbia, surge of muscles to open airway, period of hyperventilation reverses hypercarbia, normal breathing, repeat

Question 29

OSA includes > ___ episodes of apnea per hour or ___ per night

Answer 29

OSA includes > 5 episodes of apnea per hour or 30 per night

Question 30

OSA leads to ___ia, ___carbia, ___ and ___ hypertension, and cardiac ___

Answer 30

OSA leads to hypoxia, hypercarbia, systemic and pulmonary hypertension, and cardiac arrhythmias

Question 31

80-95% of patients who have OSA are undiagnosed--T/F?

Answer 31

True

Question 32

What is the gold standard test for OSA?

Answer 32

Polysomnography (PSG)

Question 33

What questionnaire can we use to evaluate patients for OSA and has up to 93% sensitivity?

Answer 33

STOP-BANG

Question 34

What does STOP-BANG stand for?

Answer 34

S-Snoring (Do you snore loudly?) T-Tiredness (Do you often feel tired, fatigued, or sleepy during the daytime?) O-Observed apnea (Has anyone observed that you stop breathing, or choke or gasp during your sleep?) P-high blood Pressure (Do you have or are you being treated for high blood pressure?) B-BMI (Is your body mass index more than 35 kg per m^2?) A-Age (Are you older than 50 years?) N-Neck circumference (Is your neck circumference greater than 40 cm [15.75 inches]?) G-Gender (Are you male?)

Question 35

What syndrome does this describe?--inappropriate and sudden somnolence, OSA, hypoxia, hypercapnia, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, right sided heart failure

Answer 35

Obese hypoventilation (Pickwickian) syndrome

Question 36

Obese hypoventilation (Pickwickian) syndrome can lead to what? How?

Answer 36

Right heart failure d/t hypoxic pulmonary vasoconstriction (AKA cor pulmonate)

Question 37

Pediatric obesity classifications--weight for height ratio > ___%, BMI > ___%

Answer 37

weight for height ratio > 90%, BMI > 95%

Question 38

Pharmacology in obese patients--___ (increased/decreased) volume of distribution; ___ (increased/decreased) blood volume; ___ (increased/decreased) total body water

Answer 38

increased volume of distribution; increased blood volume; decreased total body water

Question 39

IBW vs. TBW--for drugs with LOW lipophilicity, use ___

Answer 39

for drugs with LOW lipophilicity, use IBW

Question 40

IBW vs. TBW--for drugs with HIGH lipophilicity, use ___

Answer 40

for drugs with HIGH lipophilicity, use TBW (most of the time) i.e.: digoxin, remifentanil, procainamide You want to use their TBW because they have increased volume of distribution for lipid-soluble drugs (there's more area for the drug to be distributed to)

Question 41

Pharmacokinetic changes associated with obesity--___ (increased/decreased) fat mass; ___ (increased/decreased) cardiac output; ___ (increased/decreased) blood volume; ___ (increased/decreased) lean body weight; ___ (increased/decreased) total body water; ___ (increased/decreased) renal clearance; ___ (increased/decreased) volume of distribution of lipid-soluble drugs

Answer 41

increased fat mass; increased cardiac output; increased blood volume; increased lean body weight; decreased total body water; increased renal clearance; increased volume of distribution of lipid-soluble drugs

Question 42

Effects of general anesthesia--obese patients have __% reduction in FRC compared to ___% in non-obese patients

Answer 42

Obese patients have 50% reduction in FRC compared to 20% in non-obese patients

Question 43

Tidal volumes in obese patients--___-___ ml/kg of ___ (IBW or TBW) for volumes

Answer 43

6-10 ml/kg of IBW for volumes

Question 44

Volume replacement for obese patients--increased ___ volume, but proportionately decreased ___ volume

Answer 44

increased total body volume, but proportionately decreased estimated blood volume

Question 45

EBV in obese patients--use ___-___ ml/kg

Answer 45

use 45-55 ml/kg