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APEX-Miscellaneous > MISC-obesity > Flashcards

MISC-obesity Flashcards

1
Q

How many calories does each gram of fat provide

A

9 calories of physiologically available energy

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2
Q

How many calories do each gram of CHO and protein provide

A

4 calories

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3
Q

What 2 medication classes can contribute to obesity

A
  1. steroid

2. antidepressants

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4
Q

What 5 diseases can contribute to obesity

A
  1. Cushing’s dz
  2. hypothyroidism
  3. depression
  4. eating disorders
  5. PCOS
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5
Q

What 2 genetic conditions can contribute to obesity

A
  1. Prader-Willi syndrome

2. Bardet-Biedl syndrome

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6
Q

When can adipose tissue become pathologic

A

When it releases significant quantities of free fatty acids and cytokines

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7
Q

Who is more prone to android obesity

A

men

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8
Q

What is the characterization of android obesity

A

Central or abdominal visceral fat accumulation

Men waist size > 40 inches
Women waist size >35 inches

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9
Q

With increased waist size comes increased risk for which 5 diseases

A
  1. ischemic heart disease
  2. HTN
  3. dyslipidemia
  4. insulin resistance
  5. death
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10
Q

Who is more prone to gynoid obesity

A

Women

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11
Q

What is the characterization of gynoid obesity

A

Gluteal and femoral fat accumulation

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12
Q

What complications are associated with gynecoid fat patterning

A
  1. joint disease

2. varicose veins

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13
Q

What is the CV risk % in pts with metabolic syndrome

A

50-60% greater than the general population

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14
Q

How is diagnosis of metabolic syndrome made

A

Must have at least 3 of the following:

  1. fasting glucose >110 mg/dl
  2. abdominal obesity (men>40 in, women > 35 in)
  3. serum triglycerides >150 mg/dl
  4. serum HDL<40 M, <50 F
  5. BP > 135/85 mmHg
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15
Q

Equation for BMI

A

kg / m^2

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16
Q

how does obesity-related morbidity relate to BMI

A

risk of morbidity increases in direct proportion to BMI

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17
Q

What is normal BMI

A

18.5-25 kg/m^2

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18
Q

What BMI is considered morbid obesity

A

BMI >40

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19
Q

What BMI range is considered overweight

A

25 - 30

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20
Q

What weight percentile are children considered obese

A

if weight falls in the 95-98th percentile

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21
Q

What is the equation for ideal body weight

A

Men kg = height(cm) - 100

Women kg = height(cm) - 105

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22
Q

What type of ventilatory defect is associated with obesity

A

restrictive

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23
Q

What pulmonary mechanics are altered

A

Lung volume is reduced

Compliance is reduced

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24
Q

What CV factor affects pulmonary compliance in the obese pt

A

increased pulmonary BF d/t increased CO, reduces compliance

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25
Q

How is the diaphragm affected by obesity

A

It is shifted cephalad and compresses the lungs

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26
Q

How is FRC related to BMI

A

it is inversely proportional

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27
Q

Why is FRC reduced in obesity

A

because ERV is reduced

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28
Q

How does FRC relate to closing capacity in obesity

A

FRC is reduced below CC

Causes airway collapse during tidal breathing

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29
Q

What is the result of an FRC that is below CC

A
  1. V/Q mismatch (deadspace)
  2. shunt
  3. hypoxemia
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30
Q

What 2 factors cause rapid desaturation in the obese pt during apnea

A
  1. higher O2 consumption

2. Smaller FRC

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31
Q

Which volumes or capacities are reduced in obesity

A
  1. FRC
  2. VC
  3. TLC
  4. ERV
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32
Q

Why is PaCO2 maintained even during apnea

A

b/c CO2 production is increased d/t the amount of fat that is metabolically active

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33
Q

What FiO2 settings can help decrease atelectasis in obese pts

A

Keeping FiO2 <80% can prevent absorption atelectasis

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34
Q

What is a lung protective strategy employed with ventilation of the obese pt

A

Vt 6-8 mL of IDEAL body weight

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35
Q

How should PaCO2 be managed in the obese pt

A

by adjusting RR not increasing Vt

36
Q

When is postoperative hypoxemia most likely to occur in the obese pt

A

immediately after extubation and up to 2-5 days following surgery

37
Q

5 strategies to maximize postop oxygenation in the obese pt

A
  1. CPAP or BiPAP after extubation
  2. Elevate HOB>30 degrees
  3. Early ambulation
  4. Control pain w/ non-opioid analgesics and RA
  5. Incentive spirometry
38
Q

How does obesity affect the CV system

A
  1. Increased blood volume
  2. increased CO
  3. increased SV (HR doesn’t change)
  4. increased VR
  5. diastolic dysfunction
39
Q

Why are obese pts less tolerant of excess fluid

A

D/t increased VR and reduced ventricular compliance and diastolic dysfunction

40
Q

How should fluid administration be dosed for the obese pt

A

Based on lean body weight

41
Q

What 5 changes in the obese pt can lead to HTN

A
  1. hyperinsulinemia
  2. SNS activation
  3. RAAS activation
  4. atherosclerosis
  5. elevated cytokine concentration
42
Q

What are 6 EKG changes that are common in the obese pt

A
  1. low voltage EKG
  2. left axis deviation
  3. right axis deviation
  4. QT prolongation
  5. Ischemia
  6. Dysrhythmias
43
Q

What causes low voltage EKG changes in the obese pt

A

D/t increased distance between the heart and the leads

44
Q

What are 2 causes of left axis deviation on EKG in the obese pt

A

The stomach pushing the heart up and left

LVH d/t volume overload and HTN

45
Q

What are 2 causes of right axis deviation on EKG in the obese pt

A

RVH from OSA

Volume overload

46
Q

What valvular pathology on TEE can confirm pulmonary HTN in the obese pt

A

Tricuspid regurg

47
Q

Loading dose is based on what pharmacological principle

A

Volume of distribution

48
Q

Dosing maintenance is based on what pharmacokinetic principle

A

clearance

49
Q

What are 4 factors that alter the volume of distribution in the obese pt

A
  1. increased blood volume
  2. increased CO
  3. altered plasma protein binding
  4. lipid solubility of the drug
50
Q

How is medication Vd altered by blood volume in the obese pt

A

The required dose to achieve a given plasma concentration is higher

51
Q

How is medication Vd altered by CO in the obese pt

A

Drugs are delivered faster to vessel rich groups

52
Q

How is medication Vd altered by altered plasma protein binding in the obese pt

A

Free fraction of available drug is altered

53
Q

How is medication Vd altered by drug lipid solubility

A

A larger fat mass increases the Vd for lipophilic drugs

54
Q

How does increased body fat alter Vd of lipophilic vs hydrophilic drugs

A

They are both increased, but Vd for lipophilic drugs increases more than hydrophilic

55
Q

How is lean body weight estimated

A

LBW = IBW x 1.3

56
Q

What type of volatile agents should be used in the obese population

A

Agents with the lowest blood:gas coefficients

57
Q

Which volatile agents provide faster emergence

A

Sevoflurane and desflurane

58
Q

How is MAC affected by obesity

A

it is unchanged

59
Q

Why is succinylcholine dose based on total body weight

A

The combination of increased blood volume (Vd) and increased pseudocholinesterase activity (clearance) requires increased dosing

60
Q

How is epidural LA volume administration affected by obesity

A

The dose should be reduced to 75% b/c epidural vein engorgement and increased epidural fat content cause greater spread of LA

61
Q

The opposing forces of which 2 upper airway factors maintain airway patency

A

pharyngeal dilator muscles oppose negative pressure of inspiration that promotes airway collapse

62
Q

How is the upper airway anatomy altered in the obese pt and what are 3 results of this change

A

Fat accumulation in the lateral walls of the pharynx

  1. narrows internal diameter
  2. decreases airflow
  3. increases tendency for collapse
63
Q

What are 3 factors that increase the likelihood of OSA

A
  1. BMI >30 kg/m^2
  2. abdominal fat distribution
  3. large neck girth (>17 in M, >16 in F)
64
Q

OSA increases the risk for which 3 comorbidities

A
  1. HTN
  2. CV morbidity
  3. Death
65
Q

What are 5 results of hypoxemia and hypercarbia with OSA

A

ANS stimulation causing

  1. HTN
  2. dysrhythmias
  3. MI
  4. pulm htn
  5. heart failure
66
Q

What are the 3 pharyngeal dilator muscles

A
  1. tensor palatine
  2. genioglossus
  3. hyoid
67
Q

What do each of the following pharyngeal dilator muscles open
Tensor palatine=
genioglossus=
hyoid=

A

Tensor palatine= nasopharynx
genioglossus= oropharynx
hyoid= hypopharynx

68
Q

What are the pharyngeal dilator muscles associated with the following pharynx anatomy
Hypopharynx=
nasopharynx=
genioglossus=

A 
Hypopharynx= hyoid
nasopharynx= tensor palatine
genioglossus= genioglossus
69
Q

What measure is used to quantify the severity of OSA

A

The apnea-hypopnea index

(# times of apnea or hypopnea)/hours of sleep

70
Q

What is the corresponding score for the following apnea-hypopnea index grading:
mild=
moderate=
severe=

A 
mild= 5-15 episodes/hr
moderate= 15-30 episodes/hr
severe= >30 episodes/hr
71
Q

What 2 airway management difficulties are pts w/ OSA at increased risk for

A
  1. difficult mask ventilation

2. difficult intubation

72
Q

What is the classic triad for dysfunctional sleep

A
  1. apnea or snoring
  2. arousal from sleep
  3. daytime somnolence
73
Q

What is Pickwickian syndrome

A

obesity hypoventilation syndrome

74
Q

What is obesity hypoventilation syndrome

A

Long-term consequence of OSA

Respiratory center in medulla fails to respond to hypercarbia

75
Q

What are 3 diagnostic criteria for obesity hypoventilation syndrome

A
  1. BMI >30 kg/m^2
  2. awake PaCO2 >45 mmHg
  3. Dysfunctional breathing during sleep
76
Q

What hematologic consequence is the result of obesity hypoventilation syndrome

A

Polycythemia

77
Q

What are 2 restrictive types of bariatric surgeries

A
  1. gastric band

2. sleeve gastrectomy

78
Q

How do restrictive bariatric procedures lead to weight loss

A

limits quantity of food consumed

79
Q

What are the benefits of restrictive bariatric procedures

A
  1. least invasive
  2. small intestines remain intact allowing for nutrient absorption
  3. reduces gastric hormone secretion
80
Q

Name 3 bariatric procedures that cause malabsorption

A
  1. jejunoileal bypass
  2. biliopancreatic diversion
  3. duodenal switch
81
Q

What are 2 key draw backs of the malabsorption bariatric procedure

A
  1. gastric reduction and removal of portion of small intestines
  2. limits nutrient absorption
82
Q

What 4 nutrients are typically depleted in the pt that has undergone a malabsorptive bariatric procedure

A
  1. vit K
  2. Vit B12
  3. iron
  4. folate
83
Q

What type of bariatric procedure is the Roux-en-Y gastric bypass

A

Combination of malabsorption and restrictive procedure type

84
Q

What are the 3 most common signs of anastomotic leak following gastric bypass are (greatest to least)

A
  1. tachycardia
  2. fever
  3. abdominal pain
85
Q

What is the most sensitive sign of anastomotic leak

A

unexplained tachycardia

86
Q

What are 9 less common s/sx of anastomotic leak

A
  1. shoulder pain (left)
  2. pelvic pain
  3. substernal pressure
  4. dyspnea
  5. HoTN
  6. oliguria
  7. increased thirst
  8. restlessness
  9. hiccups

APEX-Miscellaneous (6 decks)

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