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APA3 levi 2019 S.Horvath > Obesity > Flashcards

Obesity Flashcards

1
Q

BMI calculation

A

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

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2
Q

Ideal body weight formula

A

male = height(cm) - 100

female = height(cm) - 105

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3
Q

what’s the BMI for overweight

A

25-29.9

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4
Q

what is the BMI for obese class 1

A

30-34.9

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5
Q

what is the BMI for obese class 2

A

35-39.9

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6
Q

what is the BMI for obese class III/ extreme obese

A

40-44.9

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7
Q

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

A

> 45

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8
Q

which type of fat distribution is more deadly

A

android - apple

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9
Q

where is the fat located in android distribution

A

central or abdominal visceral

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10
Q

where is the fat located in gynecoid

A

gluteal femoral or peripheral

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11
Q

what disease processes does gynecoid fat lead to

A

vertices veins, joint disease

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12
Q

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

A

FALSE. reduced incidence

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13
Q

what defines a pediatric patient as obese?

A

weight-height ratio >90%

BMI >95%

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14
Q

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

A

TRUE

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15
Q

what happens to total body water in the obese

A

DECREASES

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16
Q

what happens to blood volume and VOD in the obese

A

INCREASE

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17
Q

what happens to lean body weight in the obese

A

INCREASE

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18
Q

what happens to the VOD for lipid soluble drugs

A

INCREASES

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19
Q

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

A

TBW

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20
Q

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

A

IBW

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21
Q

Cardiac output increases by ___ for each kg of fat

A

0.1L/min

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22
Q

For every 13.5kg of fat = _____ of neovascularization

A

25mi

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23
Q

increased volume, increased ____ activity —-> htn

A

RAAS

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24
Q

what happens to the structure of the heart in obese patients

A

cardiomegaly, atrial and biventricular dilatation, hypertrophy

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25
Q

T/F CAD is an independent factor with obesity?

A

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

26
Q

Define HTN.

A

SPB >140, DBP > 90, or both

27
Q

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

A

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

28
Q

Which spirometry values decrease in the obese

A

FRC ERV VC TLC

29
Q

why does FRC decrease

A

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

30
Q

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

A

restrictive.

looks like a small ice cream cone

31
Q

what is the gold standard test for OSA

A

polysomnography

32
Q

STOPBANG - BMI >?

A

35

33
Q

STOPBANG - Age > ?

A

50

34
Q

STOPBANG - neck circ >?

A

40cm

35
Q

someone is high risk for stop bang if they score a

A

3 or greater

according to nagel

36
Q

how is OSA defined in terms of apnea episodes

A

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

37
Q

how is hypopnea defined?

not in ppt - taken from nagelhout

A

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.

38
Q

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

A

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

39
Q

what is the difference between simply obesity and OHS?

A

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.

40
Q

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

A

enlargement

41
Q

___% of NIDDM are also obese

A

80

42
Q

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
A

waist m>40in
waist f>35in

triglycerides >150

HDL <40men
HDL<50 women

BP 130/85

fasting glucose >100

43
Q

what should your tidal volumes be for an obese patient

A

6-10ml/kg

44
Q

what should you use for maint fluids multiplier?

A

45-55 ml/kg (prodigy)

45
Q

the maximum decrease in PAO2 occurs ____ post-op

A

2-3days (prodigy)

46
Q

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

A

thromboembolism (prodigy)

47
Q

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

A

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)

48
Q

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

A

FALSE - IBW

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

(prodigy)

49
Q

what is the most confirmatory test of pulmonary htn

A

tricuspid regurg on TEE

(prodigy)

50
Q

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

A

75

(prodigy)

51
Q

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

A

FALSE - overestimates

(prodigy)

52
Q

what are the risk factors for mendelsons syndrome

A

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)

53
Q

which 3 positions are least ideal for the obese

A

prone supine trend

(prodigy)

54
Q

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

A

TRUE

(prodigy)

55
Q

How should you do a recruitment maneuver?

A

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

prodigy

56
Q

Explain how PEEP can help or hurt the situation

A

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)

57
Q

what is the most senstive sign of leak in bariatric surgery

A

tachycardia.

most common - tachycardia, fever, and pain.

(prodigy)

58
Q

T/F Both fat mass and muscle mass increase.

A

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&raquo_space;> vd hydrophilic drugs, but both increase!

(apex)

59
Q

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

A

LBW
TBW

(apex)

60
Q

Sugammadex is dosed based on IBW LBW or TBW?

A

TBW

apex

APA3 levi 2019 S.Horvath (16 decks)

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