Obesity

Question 1

These are defined as foreign chemicals hypothesized to disrupt normal development and balance of lipid metabolism which can lead to obesity.

Answer 1

obesogens

Question 2

What are the 4 regulators of hunger?

Answer 2

• brain
• gut
• adipose tissue
• pancreas

Question 3

How do you calculate the excess BW?

Answer 3

current weight - IBW (weight if BMI were 25)

Question 4

What is the best documented risk factor for obstructive sleep apnea?

Answer 4

obesity

Question 5

A female patient presents with hirsutism, acne, obesity, and fatigue. She has had a difficult time getting pregnant. What is the diagnosis?

Answer 5

PCOS

Question 6

How is metabolic syndrome defined?

Answer 6

3+ of the following

• central obesity
• elevated glucose
• elevating fasting triglycerides
• low blood HDL
• HTN

Question 7

At a BMI of 25-30 what is the best treatment option?

a. surgery
b. pharmacotherapy
c. lifestyle modifications

Answer 7

c. lifestyle modifications

Question 8

At a BMI of 27+ with comorbidities or a BMI of 30-35 what is the best treatment option?

a. surgery
b. pharmacotherapy
c. lifestyle modifications

Answer 8

b. pharmacotherapy

Question 9

At a BMI of 35+ with comorbidities or a BMI of 40+ what is the best treatment option.

a. surgery
b. pharmacotherapy
c. lifestyle modifications

Answer 9

a. surgery

Question 10

Which of the following interventions will result in the greatest estimated excess body weight loss?

a. lifestyle/pharmacologic
b. laparoscopic adjustable banding
c. sleeve gastrectomy
d. gastric bypass

Answer 10

d. gastric bypass

• lifestyle/pharmacologic = 10-20%
• laparoscopic adjustable banding = 40%
• sleeve gastrectomy = 50-60%
• gastric bypass = 65-70%

Question 11

What medication can be used for hunger/appetite control?

Answer 11

• phentermine

Question 12

Any patient on an antipsychotic should be on this diabetes medication.

Answer 12

• metformin

Question 13

These 8 criteria must be met to be a surgical candidate.

Answer 13

• BMI >40 or >35 with comorbidity
• age 18+
• failed prior weight loss attempt
• patient understands surgery/risks
• acceptable operative risks
• stable psychosocial condition
• no nicotine/THC use
• minimal alcohol use

Question 14

Bariatric surgery decreases the risk of death over 5 years by what %?

Answer 14

89%

Question 15

What is the incidence of mortality with bariatric surgery?

Answer 15

0.13%

Question 16

What are the 2 non narcotic analgesia medication commonly prescribed post-op?

Answer 16

• IV tylenol

- IV ketorolac

Question 17

What are the 5 phases of post-bariatric diet progression?

Answer 17

• 1 = clear liquids
• 2 = full liquids
• 3 = pureed foods
• 4 = ground
• 5 = healthy bariatric diet

Question 18

What are the 3 items that should be a part of all post-bariatric diet phases?

Answer 18

• protein
• vitamins
• fluids

Question 19

What is the cause of weight regain after surgery?

Answer 19

multifactorial

• adhere to weight loss program, lack of exercise, poor eating habits

Question 20

Acanthosis nigricans and acrochordons are findings consistent with what diagnosis?

Answer 20

• insulin resistance/diabetes

Question 21

What is the number 1 late complication of gastric bypass?

Answer 21

• anastamotic ulcer

Question 22

A patient presents with bilious vomiting following a gastric bypass. On CT you see a mesenteric swirl sign. What is the diagnosis?

Answer 22

• internal hernia

MUST call a surgeon

Question 23

A patient presents with vague abdominal discomfort and intractable nausea following a gastric bypass 5 days ago. What is the diagnosis?

Answer 23

• portal venous thrombosis

Question 24

What are the 5 medical conditions that can occur after bariatric surgery?

Answer 24

• cholecystitis
• choledocholithiasis
• gallstone pancreatitis
• abdominal wall hernia
• SBO