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Principles2 > Obesity > Flashcards

Obesity Flashcards

1
Q

People with BMI >35 have an increase in what 2 things with regards to fat cells? (S, N)

A

size and number

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2
Q

People with BMI < 35 have an increase in what 1 thing with regard to fat cells? (S)

A

size

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3
Q

What is Broca’s Index (IBW) for:

  1. Men
  2. Women
A
  1. cm-100=IBW (kg)

2. cm-105=IBW (kg)

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4
Q

What is IBW using English units for:

  1. Men
  2. Women
A
  1. 106 lbs + 6 lbs for each inch over 5 ft= IBW (lbs)

2. 105 lbs + 5 lbs for each inch over 5 ft=IBW (lbs)

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5
Q

What is BMI formula using metric scale?

A

kg/m^2

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6
Q

What is lean body weight formula?

A

IBW + 20% of actual body weight=LBW

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7
Q

What is BMI for these obesity classifications?

  1. Underweight
  2. Normal weight
  3. Overweight
  4. Obesity class 1
  5. Obesity class 2
  6. Obesity class 3
  7. Super Obesity
A
  1. <18.5
  2. 18.5-24.9
  3. 25-29.9
  4. 30-34.9
  5. 35-39.9
  6. 40-49.9
  7. 50 and above
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8
Q

What are the 3 ways to be classified as MORBID obesity?

A
  1. 100 lbs over IBW
  2. BMI of 40 or more
  3. BMI of 35 or more and experiencing obesity-related problems like HTN or DM2
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9
Q

Apple shaped obesity has high incidence of what system?

A

Cardiovascular (LV)

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10
Q

What 2 related reasons do apple shaped have cardiovascular dysfunction? (GI, DSHBLTITL)

A
  1. glucose intolerance

2. decrease sex hormone binding leading to increased testosterone levels

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11
Q

Do apples or pears lose weight easier?

A

apples

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12
Q

what 2 areas do apples have more fat?

A

abdominal wall and visceral mesentery

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13
Q

what 2 areas do pears have more fat?

A

buttocks and legs

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14
Q

Is fat more metabolically active in apples or pears?

A

apples

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15
Q

Is fat distribution or absolute body fat mass a better determinant of morbidity and mortality?

A

fat distribution

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16
Q

Waist to hip ratio is an effective way to examine what? (RFT)

A

regional fat distribution

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17
Q

Waist to Hip Ratio health risk for men:

  1. High risk
  2. Moderate risk
  3. Low risk
A
  1. > 1.0
  2. .9-1.0
    3.
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18
Q

Waist to Hip Ratio health risk for women:

  1. High risk
  2. Moderate risk
  3. Low risk
A
  1. > .85
  2. .8-.85
    3.
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19
Q

What 4 anatomical airway changes are decreased in obese pts? (NF, NE, MO, M-SFPD)

A
  1. neck flexion
  2. neck extension
  3. mouth opening
  4. mandible-sternal fat pad distance
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20
Q

In what 2 directions is the larynx appeared in obese pts? (H, A)

A

high and anterior

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21
Q

Is the airway wider or narrower in obese pts?

A

narrower

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22
Q

Do paralytics help or hurt the airway view?

A

hurt

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23
Q

Is chest wall compliance increased or decreased?

A

decreased

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24
Q

Decreased chest wall compliance is what type of lung disease? (R)

A

restrictive

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25
Q

Obesity cause what type of spinal movement to the thorax and what type of spinal movement to the lumbar? (K, L)

A

thoracic kyphosis and lumbar lordosis

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26
Q

thoracic kyphosis and lumbar lordosis cause a limited rib movement resulting in a relative fixation of what? (T)

A

The thorax

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27
Q

Does obesity elevated or depress the diaphragm?

A

elevate

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28
Q

What happens to lung compliance in obesity?

A

It is normal unless the lungs have coexisting disease

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29
Q

Kyphosis equals increased what “c” word?

A

concavity

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30
Q

Lordosis equals decreased what “c” word?

A

convexity

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31
Q

What respiratory pattern is related to obesity? (R,S)

A

rapid and shallow

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32
Q

What compliance is decreased in obesity? (CWC)

A

chest wall compliance

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33
Q

What respiratory system change is increased in obesity? (WOB)

A

work of breathing

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34
Q

What 2 respiratory system changes are double arrow down decreased in obesity?

A

functional residual capacity and expiratory reserve volume

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35
Q

Do all obese pts have a decreased tidal volume?

A

no

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36
Q

what type of obese pts have a decreased tidal volume? (P)

A

pickwickian

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37
Q

what respiratory measurements are single down arrowed in obesity? (IRV, VC, IC/TLC)

A
  1. inspiratory reserve volume
  2. vital capacity
  3. inspiratory capacity/total lung capacity
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38
Q

when functional residual capacity is less than closing capacity, what start to close? (SA)

A

small airways

39
Q

Obese pts have an increase in what 3 metabolic areas? (OC, CP, OM0

A
  1. O2 consumption
  2. CO2 production
  3. overall metabolism
40
Q

Do obese pts have an increased or decreased pulmonary perfusion?

41
Q

what is the most common cause of hypoxemia in obese pts?

A

V/Q mismatch

42
Q

Do obese pts have an increased or decrease alveolar ventilation?

43
Q

What causes pulmonary hypertension in obese pts? (HPV)

A

Hypoxic pulmonary vasoconstriction

44
Q

What 2 measurements combined equals functional residual capacity? (ERV, RV)

A

expiratory reserve volume and residual volume

45
Q

apean is the cessation of airflow for how many seconds despite continuous respiratory efforts?

A

10 seconds

46
Q

A sleep study is needed if obstructive periods are 10 seconds for how many times per hour?

47
Q

How many STOP-BANG “yes” to be a high risk of OSA?

48
Q

How many STOP-BANG “yes” to be a low risk of OSA?

49
Q

What do each of the STOP-BANG letters represent?

  1. S
  2. T
  3. O
  4. P
  5. B
  6. A
  7. N
  8. G
A
  1. snoring
  2. tired during daytime
  3. Observed stop breathing
  4. Hi blood pressure
  5. BMI > 35
  6. age > 50
  7. neck > 15.75 cm
  8. male gender
50
Q

What does the apnea hypopnea index measure?

A

The number of times per hour a pt goes apneic or hypopneic.

51
Q

What is the adult AHI per hour range of these OSA severities?

  1. none/minimal
  2. mild
  3. moderate
  4. severe
A
  1. <5
  2. 5-15
  3. 16-30
  4. > 30
52
Q

What are the two most important results from a sleep study?

A
  1. AHI

2. lowest SpO2

53
Q

What is the pediatric AHI per hour range of these OSA severities?

  1. none/minimal
  2. mild
  3. moderate
  4. severe
A
  1. 0-1
  2. 2-4
  3. 5-9
  4. 10 or more
54
Q

What 2 procedures can be done to treat OSA?

A
  1. Uvulopalatopharyngoplasty (UPPP)

2. Genioglossal advancement

55
Q

What procedure is most often performed to treat OSA?

A

uvulopalatopharyngoplasty (UPPP)

56
Q

The genioglossal advancement results in an anterior displacement of what?

A

the tongue

57
Q

What are the 3 areas of OSA?

A
  1. nasopharynx
  2. oropharynx
  3. hypopharynx
58
Q

Does OSA surgery mean the pt has an easy airway?

59
Q

What are the triad of symptoms for Pickwickian syndrome? (O, SDB, CHDW)

A
  1. obesity
  2. sleep disordered breathing
  3. chronic hypercapnia during wakefulness
60
Q

Why are Pickwickian patients hypersomnolent?

A

Nighttime sleep apnea with hypercapnia and hypoxia awaken the pt to return to normal respirations

61
Q

Anesthetic agents can make OSA and OHS worse by decreasing what? (MT)

A

muscle tone

62
Q

Is CO increased or decreased in obese pts?

63
Q

Is absolute blood volume increased or decreased in obese pts?

64
Q

CO increases how many liters per minute to perfuse each kg of added fat?

65
Q

1 kg of fat adds how many meters of blood vessels?

A

3,000 meters

66
Q

Hyperinsulinemia activates what system and causes retention of what?

A

SNS and sodium retention

67
Q

What causes cardiomegaly and LV failure in obese pts? (H)

A

hypertension

68
Q

Is obesity an independent risk factor for ischemic heart disease?

69
Q

What are 3 reasons dysrhythmias are increased in obese pts? (LVH, H, FIotCCS)

A
  1. LV hypertrophy
  2. hypoxemia
  3. fatty infiltration of the cardiac conduction system
70
Q

Liver fat increases in what % of obese pts?

71
Q

cholelithiasis is how many times more likely in obese pts?

72
Q

Is cardiac reserve increased or decreased in obese pts?

73
Q

Are obese pts at an increased or decreased risk of gastric aspiration?

74
Q

increased chance of gastric aspiration if pH is less than what?

75
Q

increased chance of gastric aspiration if volume is greater than how many mLs or how many mL/kg?

A

> 25 mLs or 0.4 mL/kg

76
Q

what are the 4 steps of hyperinsulinemia in obesity leading to increased BP?

A
  1. hyperinsulinemia
  2. increased adrenergic activity
  3. increased aldosterone levels
  4. aldosterone increases BP and intravascular volume
77
Q

what respiratory measurement decreases after a gastric bypass? (FRC)

A

functional residual capacity

78
Q

what are 3 ways to manage atelectasis in obese pts? (P, AVS, RM)

A
  1. PEEP
  2. appropriate vent settings
  3. recruitment maneuvers
79
Q

Vital capacity maneuver to recruit alveoli: inflate the lungs up to how many cm H2O for what range of seconds?

A

40 cm H2O for 15-26 seconds

80
Q

Too small BP cuff underestimates or overestimates BP?

A

overestimates

81
Q

too large BP cuff underestimates or overestimates BP?

A

underestimates

82
Q

Succ dose of 1mg/kg is based on what body weight?

A

actual body weight

83
Q

initial dose of non-depolarizing muscle relaxant is based on what body weight?

A

lean body weight

84
Q

how does the Vd of hydrophilic drugs compare in obese pts as with non-obese pts?

85
Q

how does lipophilic drugs’ Vd compare in obese pts with non-obese pts?

A

larger Vd in obese pts

86
Q

Obese pts have increase GFR leading to an increase clearance of what two drugs? (A, C)

A
  1. aminoglycosides

2. cimetidine

87
Q

what are the 4 groups that accumulate VAs in order?

A
  1. vessel rich
  2. muscle
  3. fat
  4. vessel poor
88
Q

Does increased cardiac output increase or decrease IV induction?

89
Q

Does increased cardiac output increase or decrease inhalation induction?

90
Q

what is increased alveolar ventilation effect on IV induction?

91
Q

Does increased alveolar ventilation increase or decrease inhalation induction?

92
Q

Does a decreased FRC increase or decrease the rate of rise in alveolar concentration?

93
Q

avoid what 3 drugs d/t prolonged actions? (M, P, V)

A

morphine, pancuronium, valium

94
Q

Subarachnoid (spinal) blocks and epidurals decrease dose requirement what % in obese pts?

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