Obesity

Question 1

BMI 25-29.9

Answer 1

Overweight

Question 2

BMI 30-34.9

Answer 2

Obese Class I

Question 3

BMI 35-39.9

Answer 3

Obese Class II

Question 4

BMI 40-44.9

Answer 4

Obese Class III / Extremely Obese

Question 5

BMI > 45

Answer 5

Obese Class IV / Severe Obesity

Question 6

Surgery centers are not supposed to take care of patients with a BMI of ____ or greater

Answer 6

45

Question 7

IBW for male

Answer 7

Height (cm) - 100

Question 8

IBW for female

Answer 8

Height (cm) - 105

Question 9

LBW calculation

Answer 9

IBW x 1.3

Question 10

Major physiologic functions of adipose tissue

Answer 10

secrete proteins, endocrine progan that has readily convertble and usable energy, Liver fat metabolism

Question 11

Liver fat metabolism is extremetly important because all cells contain some ________ fats synthesized by the liver.

Answer 11

unsaturated

Question 12

Which type of obesity is associated with more comorbidities

Answer 12

android

Question 13

For each kg of fat there is an increased CO of ____

Answer 13

0.1L/min

Question 14

The effects of fat on the heart include increased CO, 02 consumption and _____ production

Answer 14

C02

Question 15

HTN in obesity is attributable to what?

Answer 15

increased blood viscosity, hyperinsulinemia, increased mineralcorticoids, sodium reabsorption, compression of the kidneys, impaired sodium excretion, RAA activation

Question 16

The effects of obesity on the respiratory system include ________ compliance, a __________ F/V loop pattern.

Answer 16

decreased / restrictive

Question 17

What is decresed with obesity in regards to the respiratory system?

Answer 17

FRC, ERV, VC, TLC

Question 18

What is increased with obesity in regards to the respiratory system?

Answer 18

Dead space

Question 19

What has no change in regards to obesity and the respiratory system?

Answer 19

RV, CC, FVC, FEV1

Question 20

OSA rates are directly proportional to ____.

Answer 20

BMI

Question 21

For BMI >35 OSA is present in ___ to ___%

Answer 21

71-77%

Question 22

Definition of OSA

Answer 22

excessive episodes of apnea (10 seconds) and hypopnea

Question 23

Describe episodes of apnea

Answer 23

Obstruction > hypoxia and hypercarbia > surge of muscles to open airway > period of hyperventilation > reverses hypercarbia> normal breathing > start all over

Question 24

Effects of OSA

Answer 24

hypoxia, hypercarbia, systemic and pulmonary hypertension, and cardiac dysrhythmias

Question 25

Gold standard test for OSA

Answer 25

polysomnography (PSG)

Question 26

STOP-BANG is easy and up to ____ sensitive

Answer 26

93%

Question 27

Obese hypoventilation (Pickwickian Syndrome) is characterized by inappropriate and sudden ______________, OSA, hypoxia, hypercapnia, arterial hypoxemia, cyanosis-induced polycythemia, respiratory acidosis, pulmonary hypertension, right sided heart failure

Answer 27

somnolence

Question 28

Why can Pickwickian syndrome lead to right sided heart failure

Answer 28

HPV, pulmonary hypertension leading to Cor Pulmonale

Question 29

With maternal obsesity, complications correlate more to pre-pregnancy ______. The risk for 1st 6 weeks miscarriage ________.

Answer 29

obsesity / doubles

Question 30

Is there an increased or decreased risk for maternal issues after bariatric surgery

Answer 30

increased

Question 31

What is increased with the obese in terms of body composition

Answer 31

Vd, blood volume

Question 32

Total body water is ________ in the obese

Answer 32

decreased

Question 33

T/F Obese people have alterations in protein binding and obesity can affect on lipophilicity of the drug

Answer 33

TRUE

Question 34

If a drug has a LOW lipophilicity how should it be dosed?

Answer 34

IBW

Question 35

If a drug hasa HIGH lipophilicity how should the drug be dosed?

Answer 35

TBW (most of the time) examples include digoxin, remifentanil, procainamide

Question 36

Review pharmacokinetic changes associated with obesity

Answer 36

slide 27

Question 37

Propofol induction dose is based on _____ while maintenance dose is based on _____

Answer 37

LBW / TBW

Question 38

Succinylcholine intubating dose is based on _____

Answer 38

TBW

Question 39

Rocuronium, vecuronium and cisatracurium doses are all on ______

Answer 39

IBW

Question 40

Fentanyl loading dose is based on ____ and maintenance doses are based on _____. (think it's opposite of propofol)

Answer 40

TBW / LBW

Question 41

Remifentanil infusion rates based on _____

Answer 41

IBW

Question 42

Sugammadex reversal doses are based on _______

Answer 42

TBW

Question 43

PEEP of < ____ cmH20 achieves improvement in FRC and arterial 02 tension but may decrease ___ and ____ delivery

Answer 43

15 / CO / 02

Question 44

tidal volumes should be __ to __ ml/kg of ____

Answer 44

6-10 / IBW

Question 45

Intermittent manual sighs may help ______

Answer 45

FRC

Question 46

Obese folks have an increased TBV but proportionally decreased EBV. What should you use for your calculation?

Answer 46

44-55ml/kg