simple 45- overweight

Question 1

medical conditions which might predispose patients to secondary obesity

Answer 1

Cushing’s
Hypothyroidism
Hypogonadism

Question 2

Ask about symptoms of medical conditions associated with obesity, including symptoms of cardiovascular disease.

Answer 2

Sleep apnea (snoring, fatigue, and morning HA)

Cardiovascular disease (chest pain or dyspnea)

Cerebrovascular disease (vision change, neuro deficits)

Peripheral vascular disease (claudication)

Question 3

xanthelasma

Answer 3

Plaques or nodules composed of lipid-laden histiocytes on eyelids

hypoercholestolemia

Question 4

Findings of vascular disease:

Answer 4

Carotid bruits
Diminished peripheral pulses
Hypertension
Increased abdominal aortic size

Question 5

the diameter of a normal abdominal aorta should be less than

Answer 5

2 cm

Question 6

retinal hemorrhages with pale centers, typically seen in bacterial endocarditis

Answer 6

roth spots

Question 7

Obesity Evaluation for Co-Existing Risk Factors

Answer 7

DM: HgbA1C or fasting blood glucose

Question 8

USPSTF strongly recommends screening for lipid disorders

Answer 8

men > 35 years old

women > 45 years old if they are at increased risk for coronary heart disease

Question 9

There are four groups of patients who are most likely to benefit from statin therapy:

Answer 9

Current ASCVD

LDL cholesterol > 190 mg/dL

Diabetes (type 1 or 2) age 40-75 years

Estimated 10-year ASCVD risk by Pooled Cohort Equations > 7.5%.

Question 10

Causes of Secondary Dyslipidemias

Answer 10

DM2: hypertriglyceridemia and low HDL cholesterol.

Cholestatic or obstructive liver disease, such as primary biliary cirrhosis: elevated total cholesterol levels.

Nephrotic syn: high serum total and LDL and triglyc.

Hypothyroidism: hypercholesterolemia and hypertriglyceridemia.

Acute hepatitis : hypertriglyceridemia.

Alcohol : hypertriglyceridemia.

Question 11

meds that can cause modest changes in lipids

Answer 11

Thiazide diuretics, beta blockers, and oral estrogens and protease inhibitors

Question 12

statin positive effects

Answer 12

stabilize existing plaques, decreasing the risk of plaque rupture and myocardial infarction
decrease CHD and all-cause mortality
decrease LDL by 18% to 55%
increase HDL by 5% to 15%
decrease triglycerides by 7% to 30%

Question 13

Bile acid sequestrants, such as cholestyramine effects

Answer 13

modest lower LDL and raise HDL

but raise triglycerides

GI distress, constipation

Question 14

Niacin effects

Answer 14

*increase HDL, modest LDL, tri decrease

flushing

Question 15

first-line therapy for reducing triglycerides

Answer 15

Fibric acid derivatives

Question 16

Ezetimibe MOA

Answer 16

inhibits absorption of cholesterol at the intestinal brush border and increases cholesterol clearance.

decreases LDL

Question 17

moderate vs high dose of statin difference

Answer 17

Moderate: lower LDL cholesterol by 30- < 50%

High: lower LDL cholesterol by > 50%

Question 18

High intensity therapy is recommended for:

Answer 18

patients ≤ 75 years of age with clinical ASCVD and no safety concerns

those with LDL cholesterol > 190 mg/dL

diabetics aged 40-75 with estimated 10-year ASCVD risk of > 7.5%

Question 19

Moderate intensity therapy is recommended for:

Answer 19

patients > 75 years of age with clinical ACSVD

diabetics aged 40-75 with estimated 10-year ASCVD risk of < 7.5%

patients for whom high-dose therapy would be recommended but who are not candidates for high-intensity statins.

Question 20

What caloric deficit is needed to lose one pound of body weight?

Answer 20

3500 calories

Question 21

Oral drug therapy for obesity indications

Answer 21

All weight loss medications approved by the FDA are indicated for patients with BMI > 30;

most are also indicated for patients with BMI > 27 with at least one obesity-related comorbidity such as hypertension or diabetes.

Question 22

Phentermine
Diethylpropion
Pendimetrazine
Benzphetamine

Answer 22

Noradrenergic appetite suppressant

Indicated for short-term (a few weeks) only

Question 23

Orlistat MOA

Answer 23

Gastrointestinal lipase inhibitor

Decreases fat absorption

Question 24

Lorcaserin MOA

Answer 24

Highly selective serotonergic receptor agonist appetite suppressant

Associated with hypoglycemia in diabetic patients

Question 25

Qsymia (combination of phentermine and topiramate) MOA

Answer 25

Acts via multiple pathways to suppress appetite

Question 26

Contrave (naltrexone/bupropion)

Answer 26

for obesity

Question 27

bariatric surgery indications

Answer 27

Patients with BMI > 40 or BMI ≥ 35 with associated severe health complications who have not succeeded in losing weight with other treatment methods.

Question 28

bariatric surgery options

Answer 28

Gastric bypass-partitioning of the stomach with attachment of the proximal stomach to the jejunum

Adjustable gastric banding-placement of an inflatable, adjustable band around the stomach

Vertical banded gastroplasty-partial partitioning of the proximal stomach with placement of a small, fixed-diameter gastric outlet stoma