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68 Cards in this Set

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

-GERD, cholecystitis,pancreatitis, steatohepatitis, hepatic fibrosis, cirrhosis, hepatmegaly,
- all are GI diseases related to obesity
All of the following are what type of diseases/conditions related to obesity

-oligiomenorrhea, amenorrhea, menorrhagia, hirsutism, impotence, hypogonadism, and metabolic syndrome
- All are endocrine diseases related to obesity
All of the following are characteristics of what syndrome?

-Type 2 diabetes, dyslipidemia, hypertension, microalbuminuria, increased gluconeogenesis
- Metabolic syndrome
100 lbs of adipose adds how much more vasculature?
450,000 feet
1 kg of adipose tissue requires how much of an increase in CO?
100 ml/min
A normal resp quotient is: (choose 2)
A. .5
B. .8
C. 4/5
D. 5/10
B. C
The obese pt needs to do what to min. vent. to deliver enough O2 to tissues?
increase
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
A, B, C
Why is the obese pt at risk for arrythmias?
increased mineralocorticoids can lead to electrolyte disturbances
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
A, C
why will the obese pt decompensate more quickly after preoxygenation while intubating?
Lower FRC
The obese pt reaches closing capacity (more or less) quickly than a non-obese pt?
more
Why is closing capacity an important consideration in obesity?
Because pulseox decreases rapidly after closing capacity reached and obese pts reach closing capacity quicker.
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
H. Not type I. Type II is part of metabolic syndrome
T/F: Maternal Obesity is associated with an increased risk of difficulty airway.
True. 1 in 250 for urgent C-section
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
E is false. Often have macrosomia (large babies)
T/F: NMB drugs are calculated based on actual weight in the obese patient.
False. Calc on IBW
Statement: for the obese pt, Propofol (lipophilic) is dosed on a corrected body wt:
IBW + 0.4(TBW - IBW)
(PT wt - IBW) x 0.4 then add to IBW = corrected wt to dose propofol.
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@!
b, c
Adults become obese through

a. increase in fat-cell numbers

b. through hypertrophy of existing fat cells
b
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
a, b, c are all true
gynecoid (gluteal/femoral) obesity
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
abdominal visceral obesity
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
gluteal femoral obesity
Emergence and Extubation of Obese population:
>Return of ____________ function.
>Trial of _____________ respirations
>Level of ____________
>__________ on cart
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
T/F - Obesity decreases morbidity and mortality postoperatively
F - increases M&M
Most common cause of mortality postoperatively in obese patients?
thromboembolism
___ / ___ exacerbated for days postoperatively in obese pts.
OSA / OHA
_____________ of gluteal muscles can occur postoperatively in obese pts
Rhabdomyolysis
Preoxygenation considerations in Obese pts
>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
The least lipid soluble volatile anesthetics are:
Sevoflurane and Desflurane
Which volatile anesthetics is less irritating hence preferable with an LMA?
Sevoflurane
Which volatile anesthetic has least renal or hepatic toxicity but more resistant to hepatic degradation?
Desflurane
Which volatile anesthetic causes least decrease in SVR for given depth?
Desflurane
In morbid obese patients, transition from volatile anesthetic_________ to________is suggested after initial loading.
Sevoflurane to Desflurane.
True/False
There is a difference in incidence of difficult airway anatomy in the obese patient,
False - There is NO difference in incidence of difficult airway anatomy (notes)
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
All the above
"HELP" (Head elevated laryngoscopy position)
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
5. all the above
True/False
Obese patients should be considered a full stomach?
False,
According to Naglehout, research suggests that patients with BMI's >30 have no increase incidence of aspiration. Treat symptoms not obesity
Why would CPAP be useful for pre oxygenation of the obese patient?
pre oxygenation with CPAP for 3-5 minutes decreases atelectasis and improves oxygenation
General anesthesia causes what % decrease in FRC when compared to the non obese patient?
1. 20%
2. 30 %
3. 40%
4. 50%
4. 50% (Naglehout p 1038)
Non obese patients have a 20% reduction
Pre-anesthetic testing of morbid obese patients should include which four things?
1. Medications
2. laboratory evaluation
3. Cardiac assessment
4. CXR
Pre-anesthetic assessment of morbid obese patients should include which four things?
1. Tobacco abuse
2. Orthopnea
3. OSA/OHS
4. Surgical history
Which is true: In morbid obese individuals and the use of volatile anesthetics,
biotransformation is of minimal/major concern.
It is of minimal concern except in steatohepatitis, cirrhosis.
TAKE A DEEP BREATH!
ALL IS GOING TO BE WELL
BUT, REMEMBER TO KEEP YOUR EYE ON THE_________.
PRIZZZZZEEEEEEEEEEEEEEEEEE
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
2. 10-12 ml/kg (page 1038)
What are some considerations to think about when evaluating the obese patient's airway?
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
Would a pair of extra hands benefit you in the airway management of the obese patient?
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.
BMI for overweight
greater than or= to 25
_____% if Americans are overwieght
65%
_____% US adults are obese
30%
______% of US adults extremely obese
5%
Overwieght to increase by _____% by 2030
86%
Overwieight more common in women
T or F
True
The number of people worldwide who are starving equal those overwieght.
T or F
T 2,000,000,000
Healthcare cost r/t obesity
147,000,000,000 annually
Annual cost for healthcare for chronic disease r/t obesity
1,800,000,000,000
Name the 6 state that will be more than 50% BMI> 30 by 2018
Oklahoma, Mississippi, Maryland, Kentucky, Oho, South Dakota
BMI formula
wt(kg)/Height(meters squared) or pounds/inches squared x 703
Normal BMI
18.5-25 kg/m squared
Overwiehgt BMI
25-29
Obese BMI
30-39
Exremely obese BMI
40-49
Super Obese
50-59
Super super obese
>60kg/meters squared
What is the most common post op complication r/t obesity
PE
What is the maximum forward airspeed for rescue hatch movement?
60 KIAS; 30 knt sidewards
5-14