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
2
Q
People with BMI < 35 have an increase in what 1 thing with regard to fat cells? (S)
A
size
3
Q
What is Broca’s Index (IBW) for:
- Men
- Women
A
- cm-100=IBW (kg)
2. cm-105=IBW (kg)
4
Q
What is IBW using English units for:
- Men
- Women
A
- 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)
5
Q
What is BMI formula using metric scale?
A
kg/m^2
6
Q
What is lean body weight formula?
A
IBW + 20% of actual body weight=LBW
7
Q
What is BMI for these obesity classifications?
- Underweight
- Normal weight
- Overweight
- Obesity class 1
- Obesity class 2
- Obesity class 3
- Super Obesity
A
- <18.5
- 18.5-24.9
- 25-29.9
- 30-34.9
- 35-39.9
- 40-49.9
- 50 and above
8
Q
What are the 3 ways to be classified as MORBID obesity?
A
- 100 lbs over IBW
- BMI of 40 or more
- BMI of 35 or more and experiencing obesity-related problems like HTN or DM2
9
Q
Apple shaped obesity has high incidence of what system?
A
Cardiovascular (LV)
10
Q
What 2 related reasons do apple shaped have cardiovascular dysfunction? (GI, DSHBLTITL)
A
- glucose intolerance
2. decrease sex hormone binding leading to increased testosterone levels
11
Q
Do apples or pears lose weight easier?
A
apples
12
Q
what 2 areas do apples have more fat?
A
abdominal wall and visceral mesentery
13
Q
what 2 areas do pears have more fat?
A
buttocks and legs
14
Q
Is fat more metabolically active in apples or pears?
A
apples
15
Q
Is fat distribution or absolute body fat mass a better determinant of morbidity and mortality?
A
fat distribution
16
Q
Waist to hip ratio is an effective way to examine what? (RFT)
A
regional fat distribution
17
Q
Waist to Hip Ratio health risk for men:
- High risk
- Moderate risk
- Low risk
A
- > 1.0
- .9-1.0
3.
18
Q
Waist to Hip Ratio health risk for women:
- High risk
- Moderate risk
- Low risk
A
- > .85
- .8-.85
3.
19
Q
What 4 anatomical airway changes are decreased in obese pts? (NF, NE, MO, M-SFPD)
A
- neck flexion
- neck extension
- mouth opening
- mandible-sternal fat pad distance
20
Q
In what 2 directions is the larynx appeared in obese pts? (H, A)
A
high and anterior
21
Q
Is the airway wider or narrower in obese pts?
A
narrower
22
Q
Do paralytics help or hurt the airway view?
A
hurt
23
Q
Is chest wall compliance increased or decreased?
A
decreased
24
Q
Decreased chest wall compliance is what type of lung disease? (R)
A
restrictive
25
Obesity cause what type of spinal movement to the thorax and what type of spinal movement to the lumbar? (K, L)
thoracic kyphosis and lumbar lordosis
26
thoracic kyphosis and lumbar lordosis cause a limited rib movement resulting in a relative fixation of what? (T)
The thorax
27
Does obesity elevated or depress the diaphragm?
elevate
28
What happens to lung compliance in obesity?
It is normal unless the lungs have coexisting disease
29
Kyphosis equals increased what "c" word?
concavity
30
Lordosis equals decreased what "c" word?
convexity
31
What respiratory pattern is related to obesity? (R,S)
rapid and shallow
32
What compliance is decreased in obesity? (CWC)
chest wall compliance
33
What respiratory system change is increased in obesity? (WOB)
work of breathing
34
What 2 respiratory system changes are double arrow down decreased in obesity?
functional residual capacity and expiratory reserve volume
35
Do all obese pts have a decreased tidal volume?
no
36
what type of obese pts have a decreased tidal volume? (P)
pickwickian
37
what respiratory measurements are single down arrowed in obesity? (IRV, VC, IC/TLC)
1. inspiratory reserve volume
2. vital capacity
3. inspiratory capacity/total lung capacity
38
when functional residual capacity is less than closing capacity, what start to close? (SA)
small airways
39
Obese pts have an increase in what 3 metabolic areas? (OC, CP, OM0
1. O2 consumption
2. CO2 production
3. overall metabolism
40
Do obese pts have an increased or decreased pulmonary perfusion?
increased
41
what is the most common cause of hypoxemia in obese pts?
V/Q mismatch
42
Do obese pts have an increased or decrease alveolar ventilation?
decreased
43
What causes pulmonary hypertension in obese pts? (HPV)
Hypoxic pulmonary vasoconstriction
44
What 2 measurements combined equals functional residual capacity? (ERV, RV)
expiratory reserve volume and residual volume
45
apean is the cessation of airflow for how many seconds despite continuous respiratory efforts?
10 seconds
46
A sleep study is needed if obstructive periods are 10 seconds for how many times per hour?
5 times
47
How many STOP-BANG "yes" to be a high risk of OSA?
3
48
How many STOP-BANG "yes" to be a low risk of OSA?
1 or 2
49
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
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
What does the apnea hypopnea index measure?
The number of times per hour a pt goes apneic or hypopneic.
51
What is the adult AHI per hour range of these OSA severities?
1. none/minimal
2. mild
3. moderate
4. severe
1. <5
2. 5-15
3. 16-30
4. >30
52
What are the two most important results from a sleep study?
1. AHI
| 2. lowest SpO2
53
What is the pediatric AHI per hour range of these OSA severities?
1. none/minimal
2. mild
3. moderate
4. severe
1. 0-1
2. 2-4
3. 5-9
4. 10 or more
54
What 2 procedures can be done to treat OSA?
1. Uvulopalatopharyngoplasty (UPPP)
| 2. Genioglossal advancement
55
What procedure is most often performed to treat OSA?
uvulopalatopharyngoplasty (UPPP)
56
The genioglossal advancement results in an anterior displacement of what?
the tongue
57
What are the 3 areas of OSA?
1. nasopharynx
2. oropharynx
3. hypopharynx
58
Does OSA surgery mean the pt has an easy airway?
no
59
What are the triad of symptoms for Pickwickian syndrome? (O, SDB, CHDW)
1. obesity
2. sleep disordered breathing
3. chronic hypercapnia during wakefulness
60
Why are Pickwickian patients hypersomnolent?
Nighttime sleep apnea with hypercapnia and hypoxia awaken the pt to return to normal respirations
61
Anesthetic agents can make OSA and OHS worse by decreasing what? (MT)
muscle tone
62
Is CO increased or decreased in obese pts?
increased
63
Is absolute blood volume increased or decreased in obese pts?
increased
64
CO increases how many liters per minute to perfuse each kg of added fat?
0.1 L/min
65
1 kg of fat adds how many meters of blood vessels?
3,000 meters
66
Hyperinsulinemia activates what system and causes retention of what?
SNS and sodium retention
67
What causes cardiomegaly and LV failure in obese pts? (H)
hypertension
68
Is obesity an independent risk factor for ischemic heart disease?
yes
69
What are 3 reasons dysrhythmias are increased in obese pts? (LVH, H, FIotCCS)
1. LV hypertrophy
2. hypoxemia
3. fatty infiltration of the cardiac conduction system
70
Liver fat increases in what % of obese pts?
90%
71
cholelithiasis is how many times more likely in obese pts?
3 times
72
Is cardiac reserve increased or decreased in obese pts?
decreased
73
Are obese pts at an increased or decreased risk of gastric aspiration?
increased
74
increased chance of gastric aspiration if pH is less than what?
2.5
75
increased chance of gastric aspiration if volume is greater than how many mLs or how many mL/kg?
>25 mLs or 0.4 mL/kg
76
what are the 4 steps of hyperinsulinemia in obesity leading to increased BP?
1. hyperinsulinemia
2. increased adrenergic activity
3. increased aldosterone levels
4. aldosterone increases BP and intravascular volume
77
what respiratory measurement decreases after a gastric bypass? (FRC)
functional residual capacity
78
what are 3 ways to manage atelectasis in obese pts? (P, AVS, RM)
1. PEEP
2. appropriate vent settings
3. recruitment maneuvers
79
Vital capacity maneuver to recruit alveoli: inflate the lungs up to how many cm H2O for what range of seconds?
40 cm H2O for 15-26 seconds
80
Too small BP cuff underestimates or overestimates BP?
overestimates
81
too large BP cuff underestimates or overestimates BP?
underestimates
82
Succ dose of 1mg/kg is based on what body weight?
actual body weight
83
initial dose of non-depolarizing muscle relaxant is based on what body weight?
lean body weight
84
how does the Vd of hydrophilic drugs compare in obese pts as with non-obese pts?
same Vd
85
how does lipophilic drugs' Vd compare in obese pts with non-obese pts?
larger Vd in obese pts
86
Obese pts have increase GFR leading to an increase clearance of what two drugs? (A, C)
1. aminoglycosides
| 2. cimetidine
87
what are the 4 groups that accumulate VAs in order?
1. vessel rich
2. muscle
3. fat
4. vessel poor
88
Does increased cardiac output increase or decrease IV induction?
increases
89
Does increased cardiac output increase or decrease inhalation induction?
decreases
90
what is increased alveolar ventilation effect on IV induction?
no effect
91
Does increased alveolar ventilation increase or decrease inhalation induction?
increases
92
Does a decreased FRC increase or decrease the rate of rise in alveolar concentration?
increase
93
avoid what 3 drugs d/t prolonged actions? (M, P, V)
morphine, pancuronium, valium
94
Subarachnoid (spinal) blocks and epidurals decrease dose requirement what % in obese pts?
20%
