Adv Principles Week 1 - Morbid Obesity

Front 1

All of the following are what types of diseases related to obesity:

-GERD, cholecystitis,pancreatitis, steatohepatitis, hepatic fibrosis, cirrhosis, hepatmegaly,

Back 1

- all are GI diseases related to obesity

Front 2

All of the following are what type of diseases/conditions related to obesity

-oligiomenorrhea, amenorrhea, menorrhagia, hirsutism, impotence, hypogonadism, and metabolic syndrome

Back 2

- All are endocrine diseases related to obesity

Front 3

All of the following are characteristics of what syndrome?

-Type 2 diabetes, dyslipidemia, hypertension, microalbuminuria, increased gluconeogenesis

Back 3

- Metabolic syndrome

Front 4

100 lbs of adipose adds how much more vasculature?

Back 4

450,000 feet

Front 5

1 kg of adipose tissue requires how much of an increase in CO?

Back 5

100 ml/min

Front 6

A normal resp quotient is: (choose 2)
A. .5
B. .8
C. 4/5
D. 5/10

Back 6

B. C

Front 7

The obese pt needs to do what to min. vent. to deliver enough O2 to tissues?

Back 7

increase

Front 8

Obese pts have which of the following CV complications?

A. increased L heart pressures
B. increased blood viscosity
C. non-ischemic cardiomyopathy
D. Aortic insufficiency

Back 8

A, B, C

Front 9

Why is the obese pt at risk for arrythmias?

Back 9

increased mineralocorticoids can lead to electrolyte disturbances

Front 10

Alterations in resp. physiology that occur with obesity include: (choose all that apply)

A. hypercarbia/acidosis
B. increased FRC
C. blunting of CNS response to hypoxia
D. reduced shunting and reduced VQ mismatch

Back 10

A, C

Front 11

why will the obese pt decompensate more quickly after preoxygenation while intubating?

Back 11

Lower FRC

Front 12

The obese pt reaches closing capacity (more or less) quickly than a non-obese pt?

Back 12

more

Front 13

Why is closing capacity an important consideration in obesity?

Back 13

Because pulseox decreases rapidly after closing capacity reached and obese pts reach closing capacity quicker.

Front 14

Obesity is assoc with all of the following endocrine defects except:
a. oligomenorrhea
b. amenorrhea
c. menorrhagia
d. hirsutism
e. impotence
f. hypogonadism
g. metabolic syndome
h. Type I Diabetes

Back 14

H. Not type I. Type II is part of metabolic syndrome

Front 15

T/F: Maternal Obesity is associated with an increased risk of difficulty airway.

Back 15

True. 1 in 250 for urgent C-section

Front 16

Maternal obesity is assoc with all of the following except:
a. gestational HTN
b. gestational diabetes
c. preeclampsia
d. preterm labor
e. low birth wt baby

Back 16

E is false. Often have macrosomia (large babies)

Front 17

T/F: NMB drugs are calculated based on actual weight in the obese patient.

Back 17

False. Calc on IBW

Front 18

Statement: for the obese pt, Propofol (lipophilic) is dosed on a corrected body wt:
IBW + 0.4(TBW - IBW)

Back 18

(PT wt - IBW) x 0.4 then add to IBW = corrected wt to dose propofol.

Front 19

The major function of Adipose tissue (as an "organ") are to:

a. decrease risk of CAD

b. provide a reservoir for readily convertible and usable energy

c. thermoregulation and insulation

d. increase sex appeal@!

Back 19

b, c

Front 20

Adults become obese through

a. increase in fat-cell numbers

b. through hypertrophy of existing fat cells

Back 20

b

Front 21

A form of obesity that is perceived as a malignant form of fat accumulation

a. central obesity
b. android obesity
c. abdominal visceral obestiy
d. peripheral gynecoid obesity

Back 21

a, b, c are all true

Front 22

Back 22

gynecoid (gluteal/femoral) obesity

Front 23

The following describe which type of obesity?

-waist hip ratio > 0.85
-Metabolically active
-free fatty acid production
-hepatic synthesis VLDLs and LDSs
-Increased gluconeogenesis
-inhibition of insulin uptake
-CAD & Cerebrovascular diesease

Back 23

abdominal visceral obesity

Front 24

The following describe which type of Obesity:

-waist hip ratio < 0.76
-varicose vein/venous insufficiency
-osteoarthritis/degenerative joint disease
-metabolically inactive
-energy depot for pregnancy and lactation

Back 24

gluteal femoral obesity

Front 25

Emergence and Extubation of Obese population:
>Return of ____________ function.
>Trial of _____________ respirations
>Level of ____________
>__________ on cart

Back 25

Emergence and Extubation of Obese population:
>Return of neuromuscular function.
>Trial of spontaneous respirations
>Level of Consciousness
>Positioning on cart - sit up to increase FRC as far above closing capacity as possible

Front 26

T/F - Obesity decreases morbidity and mortality postoperatively

Back 26

F - increases M&M

Front 27

Most common cause of mortality postoperatively in obese patients?

Back 27

thromboembolism

Front 28

___ / ___ exacerbated for days postoperatively in obese pts.

Back 28

OSA / OHA

Front 29

_____________ of gluteal muscles can occur postoperatively in obese pts

Back 29

Rhabdomyolysis

Front 30

Preoxygenation considerations in Obese pts

Back 30

>Experimental preox in normal BMI patients
>Composition of alveolar gas
>O2 consumption >220ml/min
>Resp quotient
>FRC vs. Closing capacity
>Postural effects
>Volume of O2 available
>Time to develop atelectasis/shunt
>Positioning for intubation
>Implications for emergence

Front 31

The least lipid soluble volatile anesthetics are:

Back 31

Sevoflurane and Desflurane

Front 32

Which volatile anesthetics is less irritating hence preferable with an LMA?

Back 32

Sevoflurane

Front 33

Which volatile anesthetic has least renal or hepatic toxicity but more resistant to hepatic degradation?

Back 33

Desflurane

Front 34

Which volatile anesthetic causes least decrease in SVR for given depth?

Back 34

Desflurane

Front 35

In morbid obese patients, transition from volatile anesthetic_________ to________is suggested after initial loading.

Back 35

Sevoflurane to Desflurane.

Front 36

True/False
There is a difference in incidence of difficult airway anatomy in the obese patient,

Back 36

False - There is NO difference in incidence of difficult airway anatomy (notes)

Front 37

Pick the important advantages of position in the morbidly obese.
1. Use of reverse trendelenburg
2. HELP
3. Sniffing position
4. "ramped" position
5. elevation of head, upper body, and shoulders significantly above the chest

Back 37

All the above
"HELP" (Head elevated laryngoscopy position)

Front 38

Intraoperative concerns to consider with the obese patient include which of the following?
1. decreased FRC
2. Trendelenberg positioning
3. brachial compression
4. positioning injuries
5. all the above

Back 38

5. all the above

Front 39

True/False
Obese patients should be considered a full stomach?

Back 39

False,
According to Naglehout, research suggests that patients with BMI's >30 have no increase incidence of aspiration. Treat symptoms not obesity

Front 40

Why would CPAP be useful for pre oxygenation of the obese patient?

Back 40

pre oxygenation with CPAP for 3-5 minutes decreases atelectasis and improves oxygenation

Front 41

General anesthesia causes what % decrease in FRC when compared to the non obese patient?
1. 20%
2. 30 %
3. 40%
4. 50%

Back 41

4. 50% (Naglehout p 1038)
Non obese patients have a 20% reduction

Front 42

Pre-anesthetic testing of morbid obese patients should include which four things?

Back 42

1. Medications
2. laboratory evaluation
3. Cardiac assessment
4. CXR

Front 43

Pre-anesthetic assessment of morbid obese patients should include which four things?

Back 43

1. Tobacco abuse
2. Orthopnea
3. OSA/OHS
4. Surgical history

Front 44

Which is true: In morbid obese individuals and the use of volatile anesthetics,
biotransformation is of minimal/major concern.

Back 44

It is of minimal concern except in steatohepatitis, cirrhosis.

Front 45

TAKE A DEEP BREATH!

Back 45

ALL IS GOING TO BE WELL

Front 46

BUT, REMEMBER TO KEEP YOUR EYE ON THE_________.

Back 46

PRIZZZZZEEEEEEEEEEEEEEEEEE

Front 47

According to Naglehout, recommended TV's to decrease barotrauma in the obese patient is?
1. 8-10 ml/kg
2. 10-12 ml/kg
3. 6-8 ml/kg

Back 47

2. 10-12 ml/kg (page 1038)

Front 48

What are some considerations to think about when evaluating the obese patient's airway?

Back 48

1. difficult positioning for intubation
2. difficult positioning for intubation
3. Reduced temporo mandibular joint movement
4. reduced atlant occipital joint movement
5. Facial hair
6. Thick neck
7. Pendulous breasts

Front 49

Would a pair of extra hands benefit you in the airway management of the obese patient?

Back 49

Yes, Muscle hypotenuse in the floor of the mouth, followed by rapid occurrence of soft-tissue obstruction and hypoxia requires one person to support the mask.

Front 50

BMI for overweight

Back 50

greater than or= to 25

Front 51

_____% if Americans are overwieght

Back 51

65%

Front 52

_____% US adults are obese

Back 52

30%

Front 53

______% of US adults extremely obese

Back 53

5%

Front 54

Overwieght to increase by _____% by 2030

Back 54

86%

Front 55

Overwieight more common in women
T or F

Back 55

True

Front 56

The number of people worldwide who are starving equal those overwieght.
T or F

Back 56

T 2,000,000,000

Front 57

Healthcare cost r/t obesity

Back 57

147,000,000,000 annually

Front 58

Annual cost for healthcare for chronic disease r/t obesity

Back 58

1,800,000,000,000

Front 59

Name the 6 state that will be more than 50% BMI> 30 by 2018

Back 59

Oklahoma, Mississippi, Maryland, Kentucky, Oho, South Dakota

Front 60

BMI formula

Back 60

wt(kg)/Height(meters squared) or pounds/inches squared x 703

Front 61

Normal BMI

Back 61

18.5-25 kg/m squared

Front 62

Overwiehgt BMI

Back 62

25-29

Front 63

Obese BMI

Back 63

30-39

Front 64

Exremely obese BMI

Back 64

40-49

Front 65

Super Obese

Back 65

50-59

Front 66

Super super obese

Back 66

>60kg/meters squared

Front 67

What is the most common post op complication r/t obesity

Back 67

PE

Front 68

What is the maximum forward airspeed for rescue hatch movement?

Back 68

60 KIAS; 30 knt sidewards

Hint 68

5-14