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AP 1 > Test 2: Obesity (pt 1/3) > Flashcards

Test 2: Obesity (pt 1/3) Flashcards

1
Q

The accepted measure of body habitus that describes adiposity normalized for height

A

Body Mass Index (BMI)

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2
Q

How to calculate BMI?

A

Patient’s actual body weight in kg divided by the square of the height in m

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3
Q

The risk of developing comorbid conditions ______ with higher BMIs.

A

Increases

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4
Q

What is the BMI Range for Normal Weight?

A

20 - 24.9

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5
Q

What is the BMI Range for Overweight?

A

25 - 29.9

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6
Q

What is the BMI Range for Obese (Class 1)

A

30 - 34.9

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7
Q

What is the BMI Range for Severely Obese (Class 2)?

A

35 - 39.9

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8
Q

What is the BMI Range for Extremely Obese (Class 3)?

A

> 40

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9
Q

What is the BMI Range for Super Obese?

A

> 50

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10
Q

The measurement of height and body mass that exhibits the lowest M&M for a given population

A

Ideal Body Weight (IBW)

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11
Q

Lean Body Weight (LBW) increases ____% with obesity secondary to increased muscle mass required to carry extra weight

A

30%

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12
Q

Formula for LBW based on IBW?

A

LBW = IBW x 1.3

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13
Q

How to calculate IBW for men?

A

Height in cm - 100

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14
Q

How to calculate IBW for women?

A

Height in cm - 105

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15
Q

Why is adipose tissue considered an endocrine organ?

A

It provides a reservoir of readily convertible & usable energy, and maintains heat insulation.

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16
Q

Obesity in childhood results in an increased ____ of fat cells

A

Number

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17
Q

Obesity in adulthood results in an increased ____ of fat cells

A

Size (hypertrophy of existing fat cells)

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18
Q

When does the number of fat cells stabilize?

A

Adolescence

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19
Q

Which type of obesity is associated with a higher risk of comorbidities?

A

Android (Apple Shape) aka Central aka Abdominal

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20
Q

Patients with Android obesity are at a higher risk of what comorbid conditions compared to those with Gynecoid obesity?

A

-Ischemic Heart Dz
-DM
-HTN
-HLD
-Death
-Higher risk of difficult airway and intubation

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21
Q

Patients with ____ obesity are at a higher risk of difficult airway and intubation

A

Android

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22
Q

Waist circumference >____ in males and >____ in females denotes an increased risk for comorbid conditions, higher risk for difficult airway and intubation, and establishes abdominal obesity.

A

> 40 in men and >35 in women

23
Q

Which type of obesity is associated with an increased risk of varicose veins and joint disease?

A

Gynecoid (Pear Shape) aka Peripheral Gynecoid aka Gluteal Femoral Obesity

24
Q

Which type of obesity has the most overall risk?

A

Android Obesity

25
Q

Genetic predisposition, a primary factor in the development of obesity, explains ____% of the variance in body mass.

A

40%

26
Q

What are factors that have led to the significant increase in the prevalence of obesity?

A

-Genetic
-Environmental (inc caloric intake and reduced physical activity)
-Inflammation (elevation of inflammatory mediators such as Angiotensinogen, TNF alpha, IL6, etc in morbidly obese patients)

27
Q

In obese patients, compression of fat on the abdominal, diaphragmatic, and thoracic structures leads to a ________.

A

compromise of respiratory function.

28
Q

In obese patients, chest wall, lung parenchyma, and pulmonary compliance are reduced to ____% of predicted values.

A

35%

29
Q

Obese patients have premature airway closing, which causes what?

A

-Increased dead space (Vd)
-CO2 retention
-V/Q mismatch (Shunting)
-Hypoxemia

30
Q

The rapid and shallow breathing pattern is characteristic of ____ Lung Disease

A

Restrictive

31
Q

Why do obese patients have increased myocardial O2 consumption?

A

The metabolic needs of the fat organ and the greater mechanical work of breathing stimulate increased myocardial O2 consumption.

32
Q

Obese patients have _____ CO2 production and retention, and _____ ventilation.

A

Increased; Decreased

33
Q

True/False: Respiratory muscle dysfunction as well as the development of asthma-like symptoms are associated with obesity.

A

True (weight loss results in improvements in SOB)

34
Q

Obese patients are predisposed to _____ _____, even in the setting of mild pulmonary or systematic insults.

A

Respiratory Failure.

35
Q

Extreme obesity is associated with what alterations in spirometry values?

A

-Reduction in FRC
-Reduction in Expiratory Reserve Volume (ERV)
-Reduction in Total Lung Capacity (TLC)

36
Q

Obese patients have a reduction in FRC. What does this mean for your clinical practice?

A

-Patient will not tolerate periods of apnea/hypoventilation
-Patient will desaturate quickly
-Patient needs full 3 minutes of pre-oxygenation
-Extubate them a little more awake than others

37
Q

Repetitive upper airway collapses leading to cessation of breathing during sleep lasting 10 seconds or more.

A

Obstructive Sleep Apnea

38
Q

What are symptoms that would make you suspect OSA?

A

Excessive daytime sleepiness, fatigue, and poor concentration.

39
Q

OSA negatively affects quality of life, and can lead to what other major health disorders?

A

-CAD
-HTN
-HF
-CVA

40
Q

What is the most prevalent sleep-breathing disorder?

A

OSA - it affects 9-25% of the general population.

41
Q

Up to ____% of patients having bariatric surgery have OSA.

A

70%

42
Q

What are anesthesia implications r/t OSA?

A

-Difficult Airway
-Increased sensitivity to anesthetic agents
-Increased post op complications

43
Q

How do you diagnose OSA (officially)?

A

Polysomnography (PSG) using the Apnea-Hypopnea Index (AHI)

44
Q

What does the Apnea-Hypopnea Index (AHI) Measure?

A

The number of abnormal respiratory events per hour of sleep.

45
Q

What is the minimum diagnostic criteria for OSA?

A

An AHI of 10 + symptoms of excessive daytime sleepiness

46
Q

How does the American Academy of Sleep define Mild, Moderate, and Severe OSA?

A

Mild - AHI between 5-15
Moderate - AHI between 15-30
Severe - AHI >30

47
Q

Detail the STOP-BANG Questionnaire.

A

Snoring
Tiredness
Observed Apnea
High Blood Pressure
BMI (>35 kg/m2)
Age (>50 years)
Neck Circumference (>40 cm)
Gender (male)

48
Q

What scores on the STOP-BANG questionnaire indicate intermediate and high risk for OSA?

A

Intermediate Risk: 3-4
High Risk: >5

49
Q

What is the intervention for OSA that reduces the AHI score and attenuates symptoms such as daytime sleepiness, fatigue, poor concentration, and memory loss?

A

Positive Airway Pressure (PAP)

50
Q

Long term use of PAP in patients with OSA is associated with a reduction in what comorbid condition?

A

CV morbidity and mortality

51
Q

What are some strategies to reduce postop complications in patients with OSA?

A

-Regional Anesthesia when appropriate, or combined technique to limit opioids (multimodal anesthesia)
-Use of short-acting drugs
-Postoperative monitoring (espec SpO2) and use of PAP in PACU!

52
Q

Approx. ____% of patients with Obesity Hypoventilation Syndrome (OHS) have OSA.

A

90%

53
Q

What are the characteristics of Obesity Hypoventilation Syndrome (OHS)? (Also called Pickwickian Syndrome)

A

-Obesity (BMI > 30 kg/m2)
-OSA (90% have it)
-Hypercapnia (Daytime hypoventilation with awake PCO2 > 45 mm Hg)
-Respiratory Acidosis
-Daytime hypersomnolence
-Arterial Hypoxia (PaO2 < 70 mmHg)
-Polycythemia
-Pulmonary HTN
-R sided HF
-Sleep-disordered breathing in the absence of other causes of hypoventilation.

AP 1 (32 decks)

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