Test 2: Obesity (pt 1/3)

Question 1

The accepted measure of body habitus that describes adiposity normalized for height

Answer 1

Body Mass Index (BMI)

Question 2

How to calculate BMI?

Answer 2

Patient’s actual body weight in kg divided by the square of the height in m

Question 3

The risk of developing comorbid conditions ______ with higher BMIs.

Answer 3

Increases

Question 4

What is the BMI Range for Normal Weight?

Answer 4

20 - 24.9

Question 5

What is the BMI Range for Overweight?

Answer 5

25 - 29.9

Question 6

What is the BMI Range for Obese (Class 1)

Answer 6

30 - 34.9

Question 7

What is the BMI Range for Severely Obese (Class 2)?

Answer 7

35 - 39.9

Question 8

What is the BMI Range for Extremely Obese (Class 3)?

Answer 8

> 40

Question 9

What is the BMI Range for Super Obese?

Answer 9

> 50

Question 10

The measurement of height and body mass that exhibits the lowest M&M for a given population

Answer 10

Ideal Body Weight (IBW)

Question 11

Lean Body Weight (LBW) increases ____% with obesity secondary to increased muscle mass required to carry extra weight

Answer 11

30%

Question 12

Formula for LBW based on IBW?

Answer 12

LBW = IBW x 1.3

Question 13

How to calculate IBW for men?

Answer 13

Height in cm - 100

Question 14

How to calculate IBW for women?

Answer 14

Height in cm - 105

Question 15

Why is adipose tissue considered an endocrine organ?

Answer 15

It provides a reservoir of readily convertible & usable energy, and maintains heat insulation.

Question 16

Obesity in childhood results in an increased ____ of fat cells

Answer 16

Number

Question 17

Obesity in adulthood results in an increased ____ of fat cells

Answer 17

Size (hypertrophy of existing fat cells)

Question 18

When does the number of fat cells stabilize?

Answer 18

Adolescence

Question 19

Which type of obesity is associated with a higher risk of comorbidities?

Answer 19

Android (Apple Shape) aka Central aka Abdominal

Question 20

Patients with Android obesity are at a higher risk of what comorbid conditions compared to those with Gynecoid obesity?

Answer 20

-Ischemic Heart Dz
-DM
-HTN
-HLD
-Death
-Higher risk of difficult airway and intubation

Question 21

Patients with ____ obesity are at a higher risk of difficult airway and intubation

Answer 21

Android

Question 22

Waist circumference >____ in males and >____ in females denotes an increased risk for comorbid conditions, higher risk for difficult airway and intubation, and establishes abdominal obesity.

Answer 22

> 40 in men and >35 in women

Question 23

Which type of obesity is associated with an increased risk of varicose veins and joint disease?

Answer 23

Gynecoid (Pear Shape) aka Peripheral Gynecoid aka Gluteal Femoral Obesity

Question 24

Which type of obesity has the most overall risk?

Answer 24

Android Obesity

Question 25

Genetic predisposition, a primary factor in the development of obesity, explains ____% of the variance in body mass.

Answer 25

40%

Question 26

What are factors that have led to the significant increase in the prevalence of obesity?

Answer 26

-Genetic -Environmental (inc caloric intake and reduced physical activity) -Inflammation (elevation of inflammatory mediators such as Angiotensinogen, TNF alpha, IL6, etc in morbidly obese patients)

Question 27

In obese patients, compression of fat on the abdominal, diaphragmatic, and thoracic structures leads to a ________.

Answer 27

compromise of respiratory function.

Question 28

In obese patients, chest wall, lung parenchyma, and pulmonary compliance are reduced to ____% of predicted values.

Answer 28

35%

Question 29

Obese patients have premature airway closing, which causes what?

Answer 29

-Increased dead space (Vd) -CO2 retention -V/Q mismatch (Shunting) -Hypoxemia

Question 30

The rapid and shallow breathing pattern is characteristic of ____ Lung Disease

Answer 30

Restrictive

Question 31

Why do obese patients have increased myocardial O2 consumption?

Answer 31

The metabolic needs of the fat organ and the greater mechanical work of breathing stimulate increased myocardial O2 consumption.

Question 32

Obese patients have _____ CO2 production and retention, and _____ ventilation.

Answer 32

Increased; Decreased

Question 33

True/False: Respiratory muscle dysfunction as well as the development of asthma-like symptoms are associated with obesity.

Answer 33

True (weight loss results in improvements in SOB)

Question 34

Obese patients are predisposed to _____ _____, even in the setting of mild pulmonary or systematic insults.

Answer 34

Respiratory Failure.

Question 35

Extreme obesity is associated with what alterations in spirometry values?

Answer 35

-Reduction in FRC -Reduction in Expiratory Reserve Volume (ERV) -Reduction in Total Lung Capacity (TLC)

Question 36

Obese patients have a reduction in FRC. What does this mean for your clinical practice?

Answer 36

-Patient will not tolerate periods of apnea/hypoventilation -Patient will desaturate quickly -Patient needs full 3 minutes of pre-oxygenation -Extubate them a little more awake than others

Question 37

Repetitive upper airway collapses leading to cessation of breathing during sleep lasting 10 seconds or more.

Answer 37

Obstructive Sleep Apnea

Question 38

What are symptoms that would make you suspect OSA?

Answer 38

Excessive daytime sleepiness, fatigue, and poor concentration.

Question 39

OSA negatively affects quality of life, and can lead to what other major health disorders?

Answer 39

-CAD -HTN -HF -CVA

Question 40

What is the most prevalent sleep-breathing disorder?

Answer 40

OSA - it affects 9-25% of the general population.

Question 41

Up to ____% of patients having bariatric surgery have OSA.

Answer 41

70%

Question 42

What are anesthesia implications r/t OSA?

Answer 42

-Difficult Airway -Increased sensitivity to anesthetic agents -Increased post op complications

Question 43

How do you diagnose OSA (officially)?

Answer 43

Polysomnography (PSG) using the Apnea-Hypopnea Index (AHI)

Question 44

What does the Apnea-Hypopnea Index (AHI) Measure?

Answer 44

The number of abnormal respiratory events per hour of sleep.

Question 45

What is the minimum diagnostic criteria for OSA?

Answer 45

An AHI of 10 + symptoms of excessive daytime sleepiness

Question 46

How does the American Academy of Sleep define Mild, Moderate, and Severe OSA?

Answer 46

Mild - AHI between 5-15 Moderate - AHI between 15-30 Severe - AHI >30

Question 47

Detail the STOP-BANG Questionnaire.

Answer 47

Snoring Tiredness Observed Apnea High Blood Pressure BMI (>35 kg/m2) Age (>50 years) Neck Circumference (>40 cm) Gender (male)

Question 48

What scores on the STOP-BANG questionnaire indicate intermediate and high risk for OSA?

Answer 48

Intermediate Risk: 3-4 High Risk: >5

Question 49

What is the intervention for OSA that reduces the AHI score and attenuates symptoms such as daytime sleepiness, fatigue, poor concentration, and memory loss?

Answer 49

Positive Airway Pressure (PAP)

Question 50

Long term use of PAP in patients with OSA is associated with a reduction in what comorbid condition?

Answer 50

CV morbidity and mortality

Question 51

What are some strategies to reduce postop complications in patients with OSA?

Answer 51

-Regional Anesthesia when appropriate, or combined technique to limit opioids (multimodal anesthesia) -Use of short-acting drugs -Postoperative monitoring (espec SpO2) and use of PAP in PACU!

Question 52

Approx. ____% of patients with Obesity Hypoventilation Syndrome (OHS) have OSA.

Answer 52

90%

Question 53

What are the characteristics of Obesity Hypoventilation Syndrome (OHS)? (Also called Pickwickian Syndrome)

Answer 53

-Obesity (BMI > 30 kg/m2) -OSA (90% have it) -Hypercapnia (Daytime hypoventilation with awake PCO2 > 45 mm Hg) -Respiratory Acidosis -Daytime hypersomnolence -Arterial Hypoxia (PaO2 < 70 mmHg) -Polycythemia -Pulmonary HTN -R sided HF -Sleep-disordered breathing in the absence of other causes of hypoventilation.