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Considerations for the cardiovascular effects of morbid obesity include? (Select 2)
A. Tachycardia
B. Increased ECG voltage
C. Diastolic dysfunction
D. Increased venous return
C & D
Increased CO and intravascular blood volume lead to a myriad of CV issues in obese patients
ECG voltage decreased, no tachycardia
Which of the following pulmonary conditions is not associated with obesity?
A. Restrictive lung disease
B. Hypoventilation syndrome
C. COPD
D. Obstructive sleep apnea
C
Obesity is associated with restrictive lung diseases, not obstructive like COPD
A patient with a BMI of 35 is presenting for a nephrectomy, what classification of overweight and obese would you assign?
A. Normal
B. Overweight
C. Obesity Class 1
D. Obesity Class 2
D. Class 2 is BMI 35-39.9
What is the optimal tidal volume for the patient with class 3 obesity?
A. 6-8ml/kg of total body weight
B. 6-8ml/kg of ideal body weight
C. 8-10ml/kg of total body weight
D. 8-10ml/kg of ideal body weight
B
Your patient is a 55 year old female with a PMH of DM, HTN, arthritis, and a BMI of 41. What two factors that increase do you need to take into account while dosing the medications in your anesthetic care plan?
A. MAC
B. Circulation time
C. Volume of distribution of lipophilic drugs
D. Volume of distribution of hyrdophilic drugs
C. increased due to increased fat mass
D. increased due to larger muscle mass and blood volume
- High CO shortens circulation time
- MAC unchanged
Pickwickian syndrome is characterized by which of the following?
A. Respiratory alkalosis
B. Pulmonary hypertension
C. PCO2 40-45
D. Anxiety and restlessness
B, AKA obesity hypoventilation syndrome
Resp acidosis, PCO2 >45, daytime hypersomnolence
Which factors are reduced by obesity? (Select 2)
A. Vital capacity
B. Expiratory reserve volume
C. Closing volume
D. Residual volume
A & B
Closing volume is increased and residual volume remains unchanged
Adipocytes release free fatty acids in response to all of the following except:
A. Catecholamines
B. Glucocorticoids
C. Histamine
D. Beta receptor agonism
E. Insulin mediated reduction of lipid storage
C
Which apnea-hypoapnea index score is indicative of mild obstructive sleep apnea?
A. 3
B. 17
C. 25
D. 40
A
5-15 mild
15-30 moderate
>30 severe
Which of the following are appropriate actions of the SRNA when managing an obese patient?
A. Increasing tidal volume as the SRNA knows obese patients have an increased baseline minute ventilation
B. Utilizing a PEEP of 12mmHg to maintain lung recruitment
C. Keeping the FiO2 <90% during maintenance to prevent absorption atelectasis
D. Maintaining peak inspiratory pressures below 40 cmH2O
B
Should increase RR to increase MV
FiO2 <80%
PIP below 30
Which of the following physiologic parameters is decreased in the obese patient?
A. Renal clearance
B. Blood volume
C. Total body water
D. QT segment
C, by 40%
Blood volume and renal clearance increase
QT prolonged
All of the following decrease in the obese patient except?
A. Functional residual capacity
B. Oxygen consumption
C. Work of breathing
D. Lung compliance
C, WOB increases
Your patient is shaped like a big ol apple, you know this puts them at an increased risk of:
A. DM, asthma, and mortality
B. Ischemic heart disease, HTN, and insulin resistance
C. Morbidity, dyslipidemia, and valvular heart disease
D. COPD, dyslipidemia, and gout
B: Ischemic heart disease, HTN, insulin resistance, DM, dyslipidemia, morbidity
Which of the following lead to hypertension in the obese patient, SATA:
A. Hyperinsulinemia
B. Angiotensinogen
C. Decreased blood viscosity
D. Cytokines
E. SNS activation
A, B, D, & E
The initial/loading dose of which drugs should be based on total body weight for an obese patient? (Select 3)
A. Succinylcholine
B. Propofol
C. Rocuronium
D. Remifentanil
E. Suggamadex
F. Fentanyl
A, E, F
Propofol is LBW for induction
Roc = IBW
Remifentanil = IBW
Which of the following complications are associated with maternal obesity?
A. Decreased duration of first stage labor
B. Increased incidence of type 1 diabetes
C. Increased risk of preterm labor
D. Oligohydramnios
C
Increased first stage
Gestational diabetes
Hydraminos
What is the most sensitive sign of an anastomotic leak after gastric bypass surgery?
A. Fever
B. Tachycardia
C. Left shoulder pain
D. Abdominal pain
B
Sustained HR >120
All others are signs, just not as sensitive
Which of the following is a characteristic of gynecoid obesity?
A. More metabolically active fat tissue than other types of obesity
B. Direct effect on pulmonary mechanics
C. Joint disease
D. A waist circumference of greater than 35 inches in women
C
Android fat is more metabolically active and other factors are associated with android/central obesity
How much does FRC decrease in the obese patient in a supine position after the induction of anesthesia?
A. 30%
B. 40%
C. 50%
D. 60%
C
20% in normal healthy pt
All of the following are true regarding the obese patient except:
A. They are hypercoagulable due to increased levels of procoagulants and decreased fibrinolysis
B. They exist in chronic hypoxemia which leads to secondary polycythemia
C. Their FRC will be less than closing capacity
D. Obstructive sleep apnea can be inhibited by some medications, including opiates
D
Induced not inhibited, extreme caution using opioids in OSA and OHA
All of the following statements by the CRNA regarding metabolic syndrome are true except?
A. "The proinflammatory state produced by metabolic syndrome results in decreased production of fibrinogen and plasminogen activator inhibitor"
B. "The insulin resistance results in both an increase in circulating glucose and insulin"
C. "95% of patients who lose weight from bariatric surgery fix their metabolic syndrome"
D. "Patients with metabolic syndrome have a ton of complications, like polycystic ovary syndrome, fatty liver disease, and sexual impotence"
A. both increased
True or false: Leptin is the hormone responsible for increasing appetite and food intake when we are hungry and ghrelin is the counter regulatory hormone that decreases appetite and food intake.
False, Opposite, ghrelin increases appetite and food intake
Which sentence from the SRNAs care plan indicates she has no idea what she is talking about?
A. A patient with a home CPAP level >10 will likely be a difficult mask ventilation
B. Lipophilic drugs are most commonly dosed based on total body weight
C. Obese patients should receive the inhaled anesthetic with the highest blood:gas coefficient
D. My patient is 130kg so I will ensure they receive 3 grams of Cefazolin
C, lowest: Sevo or Des, IA are sequestered in fat, high b:g will prolong emergence
All of the following are helpful management techniques for extubating the obese patient except:
A. Having the patient fully awake and muscle relaxant reversed before extubating
B. Placing the patient on CPAP after extubation
C. Placing the patient in reverse trendelenburg
D. Weaning your sevoflurane early and giving fentanyl 25mcg PRN to prevent coughing and bucking
D - cautious use of opioids, especially on emergence
Regional anesthesia is challenging in obese patients and dosing varies due to engorgement of epidural veins and increased epidural fat content. Dosing of local anesthetics must be decreased by
A. 20%
B. 25%
C. 50%
D. 75%
D