Anesthesia And Obesity Quiz
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Questions and Answers
- 1.
The following occur in patients with Pickwickian syndrome, EXCEPT
- A.
Hypoventilation
- B.
Pulmonary hypertension
- C.
Right ventricular failure
- D.
Delayed emergence
Correct Answer
D. Delayed emergenceExplanation
Patients with Pickwickian syndrome typically experience hypoventilation, pulmonary hypertension, and right ventricular failure. However, delayed emergence is not a characteristic of this syndrome. Delayed emergence refers to a prolonged recovery from anesthesia or sedation, which is not directly associated with Pickwickian syndrome.Rate this question:
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- 2.
Hallmark of Pickwickian syndrome
- A.
Hypoventilation
- B.
Pulmonary hypertension
- C.
COPD
- D.
Polycythemia due to chronic hypoxemia
Correct Answer
A. HypoventilationExplanation
The hallmark of Pickwickian syndrome is hypoventilation. This condition, also known as obesity hypoventilation syndrome, is characterized by inadequate breathing during sleep, leading to low levels of oxygen and high levels of carbon dioxide in the blood. This can result in symptoms such as daytime sleepiness, fatigue, and difficulty breathing. Hypoventilation is a key feature of this syndrome and differentiates it from other conditions such as pulmonary hypertension, COPD, and polycythemia due to chronic hypoxemia.Rate this question:
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- 3.
False statement regarding obesity
- A.
Risks associated with obesity are related to the fat distribution
- B.
Effects are almost exclusively related to cardiovascular system
- C.
Android distribution is associated with increased oxygen consumption
- D.
Modest obesity is associated with increased risk for premature death and complications perioperatively
Correct Answer
B. Effects are almost exclusively related to cardiovascular systemExplanation
The given statement is false because it claims that the effects of obesity are almost exclusively related to the cardiovascular system. However, obesity is known to have a wide range of negative effects on various systems of the body, not just the cardiovascular system. These effects can include increased risk for conditions such as diabetes, hypertension, sleep apnea, joint problems, and certain types of cancer. Obesity can also impact mental health and overall quality of life. Therefore, it is incorrect to say that the effects of obesity are exclusively related to the cardiovascular system.Rate this question:
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- 4.
Which of the following cardiovascular changes does not occur with obesity?
- A.
Increased cardiac output in response to stress
- B.
Cardiomegaly with elevated circulating blood volume
- C.
Increased incidence of coronary artery disease
- D.
Impaired diastolic and systolic function
Correct Answer
C. Increased incidence of coronary artery diseaseExplanation
Obesity is known to be associated with various cardiovascular changes. Increased cardiac output in response to stress occurs in obesity as the heart needs to work harder to supply blood to the excess body weight. Cardiomegaly with elevated circulating blood volume is also observed in obesity due to the increased workload on the heart. Impaired diastolic and systolic function is commonly seen in obese individuals due to the accumulation of fat around the heart and increased pressure on the heart chambers. However, the increased incidence of coronary artery disease is not directly associated with obesity. While obesity is a risk factor for developing coronary artery disease, it does not necessarily cause a direct increase in its occurrence.Rate this question:
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- 5.
Respiratory changes in obesity, EXCEPT
- A.
Normal closing capacity in upright but abnormal in supine position
- B.
Normal FEV1 and FVC
- C.
Decreased chest wall and lung compliance
- D.
Decreased ERV and FRC in upright position
Correct Answer
A. Normal closing capacity in upright but abnormal in supine positionExplanation
Obesity can cause various respiratory changes, but one of the changes that is not typically seen is a normal closing capacity in the upright position but abnormal in the supine position. Closing capacity refers to the volume of the lungs at which small airways begin to close during expiration. In obesity, there is usually a decrease in chest wall and lung compliance, which can lead to decreased expiratory reserve volume (ERV) and functional residual capacity (FRC) in the upright position. However, closing capacity is not typically affected by body position in obesity. Therefore, the correct answer is that normal closing capacity is maintained in both upright and supine positions.Rate this question:
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- 6.
Rapid desaturation in the obese is secondary to:
- A.
Decreased FRC
- B.
Decreased oxygen consumption
- C.
Both
- D.
None
Correct Answer
A. Decreased FRCExplanation
The correct answer is "Decreased FRC". In obese individuals, there is a decrease in functional residual capacity (FRC), which is the volume of air remaining in the lungs after a normal exhalation. This decrease in FRC leads to rapid desaturation, as there is less available oxygen in the lungs for gas exchange. Therefore, decreased FRC is the primary reason for rapid desaturation in obese individuals. Decreased oxygen consumption may also play a role, but it is not the main factor in this case.Rate this question:
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- 7.
True of OSA
- A.
Night time somnolence
- B.
Apnea and hypopnea due to intermittent bouts of airway obstruction
- C.
Snore heavily without periods of awakening
- D.
Respiratory acidosis during sleep and awake state
Correct Answer
B. Apnea and hypopnea due to intermittent bouts of airway obstructionExplanation
The correct answer is "Apnea and hypopnea due to intermittent bouts of airway obstruction". This answer is supported by the statement "Night time somnolence" which suggests that the individual experiences excessive sleepiness during the night, which is a common symptom of OSA. Additionally, the statement "Respiratory acidosis during sleep and awake state" indicates that there is a disruption in the normal breathing pattern during both sleep and wakefulness, further supporting the presence of apnea and hypopnea caused by airway obstruction. The statement "Snore heavily without periods of awakening" also aligns with the intermittent bouts of airway obstruction characteristic of OSA.Rate this question:
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- 8.
Risk of regurgitation and pulmonary aspiration in the obese maybe reduced by:
- A.
Decreasing LES tone
- B.
Slowing gastric emptying
- C.
Raising pH level of gastric contents
- D.
Increasing volume of gastric contents
Correct Answer
C. Raising pH level of gastric contentsExplanation
Raising the pH level of gastric contents can reduce the risk of regurgitation and pulmonary aspiration in obese individuals. This is because a higher pH level indicates a lower acidity level in the stomach, which can help prevent the backflow of stomach contents into the esophagus and lungs. By increasing the pH level, the gastric contents become less likely to cause irritation or damage to the respiratory system, reducing the risk of complications such as aspiration pneumonia.Rate this question:
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- 9.
Narrowed airway in the obese are due to, EXCEPT
- A.
Fleshy cheeks
- B.
Redundant palate
- C.
Large tongue
- D.
Excessive submental tissue
Correct Answer
D. Excessive submental tissueExplanation
The narrowed airway in obese individuals is caused by several factors, including fleshy cheeks, redundant palate, and a large tongue. However, excessive submental tissue, which refers to excess fat or tissue under the chin, does not directly contribute to the narrowing of the airway. While excessive submental tissue may be present in obese individuals, it is not a primary factor in causing airway narrowing.Rate this question:
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- 10.
Clinical characteristic in morbidly obese that is associated with the highest predictor of difficult intubation
- A.
Neck circumference >17 inches
- B.
BMI > 40 kg/m2
- C.
Apnea > 10 seconds
- D.
Tonsils that touched the midline
Correct Answer
A. Neck circumference >17 inchesExplanation
A neck circumference greater than 17 inches is associated with the highest predictor of difficult intubation in morbidly obese individuals. This is because a larger neck circumference can make it more challenging to properly position and secure the endotracheal tube during intubation. The excess fat and tissue around the neck can obstruct the airway and make it difficult to visualize the vocal cords, increasing the risk of complications during intubation. Therefore, a larger neck circumference is a significant clinical characteristic to consider when assessing the difficulty of intubation in morbidly obese patients.Rate this question:
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- 11.
Risk factors that correlate with difficult laryngeal intubation, EXCEPT
- A.
Increased BMI
- B.
History of OSA
- C.
Higher Mallampati score 3&4
- D.
Large neck circumference >40cm
Correct Answer
A. Increased BMIExplanation
Increased BMI is not a risk factor that correlates with difficult laryngeal intubation. This is because BMI is a measure of body weight in relation to height and does not directly affect the difficulty of intubation. However, the other factors listed, such as history of OSA, higher Mallampati score 3&4, and large neck circumference, have been shown to be associated with difficult laryngeal intubation.Rate this question:
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- 12.
Dosing for IV drugs that uses the ideal body weight in the obese
- A.
Succinylcholine
- B.
Midazolam
- C.
Rocuronium
- D.
Fentanyl
Correct Answer
C. RocuroniumExplanation
In obese patients, the dosing for IV drugs often uses the ideal body weight instead of the actual body weight. This is because using the actual body weight can result in overdosing the medication, as the excess body fat can affect the distribution and metabolism of the drug. Rocuronium is a neuromuscular blocking agent that is commonly used during anesthesia. It is dosed based on the patient's ideal body weight to ensure that the correct amount of medication is administered and to minimize the risk of adverse effects.Rate this question:
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- 13.
The following may apply to intraop anesthetic management of the obese patients, EXCEPT
- A.
Allowing general anesthesia with spontaneous respiration are relatively contraindicated
- B.
Consider awake fiberoptic intubation in all patients >75% above their ideal body weight
- C.
Intrarterial monitoring maybe necessary in some patients where arterial blood pressure monitoring maybe difficult
- D.
Premedications given through IM maybe useful for relieving preop anxiety
Correct Answer
D. Premedications given through IM maybe useful for relieving preop anxietyExplanation
The correct answer is "Premedications given through IM maybe useful for relieving preop anxiety." This statement is incorrect because premedications given through IM (intramuscular) route may not be as effective in relieving preoperative anxiety in obese patients compared to other routes of administration such as oral or intravenous.Rate this question:
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- 14.
Optimal position that provide the longest safe apnea period during induction
- A.
Supine
- B.
Reverse Trendelenburg
- C.
Trendelenburg
- D.
Lateral decubitus
Correct Answer
B. Reverse TrendelenburgExplanation
The correct answer is Reverse Trendelenburg. Reverse Trendelenburg position refers to elevating the patient's head and upper body while keeping the lower body lower than the head. This position helps to improve ventilation and oxygenation by promoting lung expansion and increasing the functional residual capacity. It also helps to prevent aspiration of gastric contents and reduces the risk of regurgitation during induction of anesthesia. By optimizing the patient's position, Reverse Trendelenburg provides the longest safe apnea period during induction.Rate this question:
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- 15.
Pertinent statement regarding preop evaluation in the obese patients, EXCEPT
- A.
Serum evaluation of liver function test due to fatty liver
- B.
Aspiration prophylaxis
- C.
Radiographic evaluation of cervical mobility to assess possible airway difficulty
- D.
Routine airway evaluation without consideration of possible awake intubation
Correct Answer
B. Aspiration prophylaxisExplanation
The correct answer is "Aspiration prophylaxis." In preoperative evaluation of obese patients, it is important to consider the possibility of difficult airway management and the need for awake intubation. This may involve radiographic evaluation of cervical mobility to assess possible airway difficulty and routine airway evaluation. Additionally, serum evaluation of liver function tests may be necessary due to the presence of fatty liver. However, aspiration prophylaxis is not specifically mentioned as a pertinent statement regarding preop evaluation in obese patients.Rate this question:
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- 16.
Disorders associated with obesity, EXCEPT
- A.
Glomerular hypofiltration
- B.
Impaired glucose tolerance
- C.
Delayed gastric emptying
- D.
Dysrhythmias
Correct Answer
A. Glomerular hypofiltrationExplanation
Obesity is known to be associated with various health disorders. Glomerular hypofiltration refers to a decrease in the filtration rate of the kidneys, which is not typically associated with obesity. On the other hand, impaired glucose tolerance, delayed gastric emptying, and dysrhythmias are commonly observed in individuals with obesity.Rate this question:
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- 17.
Gold standard for definitive diagnosis of OSA requires overnight polysomnography
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The gold standard for definitive diagnosis of OSA (Obstructive Sleep Apnea) is overnight polysomnography. This diagnostic test involves monitoring various physiological parameters during sleep, such as brain activity, eye movements, heart rate, and breathing patterns. It provides comprehensive information about the severity and characteristics of OSA, helping healthcare professionals accurately diagnose and treat the condition. Therefore, the statement "Gold standard for definitive diagnosis of OSA requires overnight polysomnography" is true.Rate this question:
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- 18.
Approximately 80% of patients with moderate to severe OSA are undiagnosed
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Approximately 80% of patients with moderate to severe OSA are undiagnosed. This means that a large majority of individuals suffering from moderate to severe obstructive sleep apnea (OSA) are not aware of their condition. OSA is a sleep disorder characterized by repeated episodes of partial or complete blockage of the upper airway during sleep, leading to disrupted breathing patterns. The fact that 80% of patients with moderate to severe OSA are undiagnosed highlights the importance of raising awareness about this condition and the need for early detection and treatment.Rate this question:
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- 19.
Preop benzodiazepine premedication can be given to OSA patients
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Preop benzodiazepine premedication should generally be avoided in patients with obstructive sleep apnea (OSA). OSA patients already have impaired breathing during sleep, and benzodiazepines can further depress the respiratory system, potentially worsening the condition. This can lead to increased risk of airway obstruction and respiratory complications during and after surgery. Therefore, it is not recommended to give benzodiazepine premedication to OSA patients.Rate this question:
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- 20.
OSA is more common in females
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
OSA stands for obstructive sleep apnea, a sleep disorder characterized by the repeated cessation of breathing during sleep. While OSA can affect both males and females, it is generally more common in males. This is believed to be due to anatomical differences, such as the size and shape of the upper airway. However, it is important to note that OSA can still occur in females, and the prevalence may vary depending on factors such as age and body mass index. Therefore, the statement that OSA is more common in females is false.Rate this question:
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- 21.
Patients with obesity will have evidence of restrictive lung disease
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Patients with obesity often experience restrictive lung disease due to the excess weight putting pressure on the chest wall and lungs. This can lead to decreased lung volume and reduced ability to fully expand the lungs during inhalation. As a result, patients may have difficulty breathing deeply and may experience symptoms such as shortness of breath and decreased exercise tolerance. These factors contribute to the development of restrictive lung disease in individuals with obesity.Rate this question:
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- 22.
Correcting abnormal ventilatory drive of obese patients should include a 2 week period of CPAP therapy
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Correcting abnormal ventilatory drive of obese patients should include a 2 week period of CPAP therapy. This statement implies that using CPAP therapy for a 2 week period is an effective method to correct abnormal ventilatory drive in obese patients.Rate this question:
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- 23.
Obesity is reported to positively correlate with increased risk of gastric aspiration
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement suggests that obesity is positively correlated with an increased risk of gastric aspiration. However, the correct answer is false. Obesity is actually associated with an increased risk of gastroesophageal reflux disease (GERD), which can lead to gastric aspiration. This means that obesity indirectly increases the risk of gastric aspiration through its association with GERD, but it is not a direct correlation.Rate this question:
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- 24.
Obesity is reported to positively correlate with increased risk of difficult laryngeal intubation
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Obesity is associated with an increased risk of difficult laryngeal intubation. This is because excess fat in the neck and throat area can make it more challenging to visualize and access the larynx during intubation. Additionally, obese individuals may have reduced lung volumes and decreased respiratory function, which can further complicate the intubation process. Therefore, it is true that obesity correlates with an increased risk of difficult laryngeal intubation.Rate this question:
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- 25.
Gynecoid obesity is assessment with increased incidence of cardiovascular disease
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement is false because gynecoid obesity is actually associated with a decreased risk of cardiovascular disease. Gynecoid obesity refers to a body shape where excess fat is primarily stored in the hips and thighs, rather than around the abdomen. This type of fat distribution is considered less harmful to cardiovascular health compared to abdominal obesity, which is associated with a higher risk of heart disease, high blood pressure, and diabetes. Therefore, the correct answer is false.Rate this question:
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- 26.
Factors such as age and fat distribution should be taken into consideration when using the BMI because it cannot distinguish between overweight and overfat
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because the Body Mass Index (BMI) is a measurement that calculates a person's weight in relation to their height. However, it does not take into account other factors such as age and fat distribution. As a result, two individuals with the same BMI may have different body compositions, where one may have more muscle mass and the other may have a higher percentage of body fat. Therefore, it is important to consider these factors when using the BMI as a measure of overweight or overfat.Rate this question:
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- 27.
Obese should be allowed to drink up to 300 ml of clear liquids up to 2 hours prior to an elective procedure
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
This statement is true because allowing obese individuals to drink up to 300 ml of clear liquids up to 2 hours prior to an elective procedure is generally considered safe. Clear liquids are easily digested and do not pose a high risk of aspiration during the procedure. However, it is important to note that this may vary depending on the specific procedure and the individual's overall health condition. It is always best to consult with a healthcare professional for specific guidelines and recommendations.Rate this question:
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- 28.
Drug dosing based on actual body weight could lead to excessive plasma concentration
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Drug dosing based on actual body weight could lead to excessive plasma concentration because some drugs have a narrow therapeutic index, meaning that the difference between the effective dose and the toxic dose is small. If a drug is dosed based on actual body weight, individuals with higher body weights will receive higher doses, potentially resulting in higher plasma concentrations. This can increase the risk of adverse effects and toxicity. Therefore, adjusting drug doses based on factors such as lean body mass or ideal body weight may be more appropriate to ensure optimal dosing and minimize the risk of excessive plasma concentration.Rate this question:
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- 29.
Waist circumference is not considered to be an independent risk factor for cardiovascular disease
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Waist circumference is considered to be an independent risk factor for cardiovascular disease. Studies have shown that abdominal obesity, as measured by waist circumference, is associated with an increased risk of cardiovascular disease, including heart attacks and strokes. Excess fat around the waist is particularly dangerous because it is metabolically active and can release harmful substances into the bloodstream, leading to inflammation, insulin resistance, and other risk factors for heart disease. Therefore, monitoring waist circumference is important in assessing cardiovascular risk.Rate this question:
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- 30.
Sibutyramine is associated with hypotension and cardiac valvular lesions than Fen-Phen combination
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Sibutyramine is not associated with hypotension and cardiac valvular lesions more than the Fen-Phen combination. This statement implies that the Fen-Phen combination is more likely to cause hypotension and cardiac valvular lesions compared to Sibutyramine.Rate this question:
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- 31.
Morbid obesity is a major independent risk factor for sudden death from acute pulmonary embolism
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Morbid obesity refers to a severe form of obesity where an individual has a body mass index (BMI) of 40 or higher. This condition is associated with various health risks, including an increased risk of developing blood clots. Acute pulmonary embolism occurs when a blood clot travels to the lungs and blocks the blood flow, leading to sudden death. Studies have shown that morbid obesity significantly increases the risk of developing pulmonary embolism. Therefore, it is correct to say that morbid obesity is a major independent risk factor for sudden death from acute pulmonary embolism.Rate this question:
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- 32.
Four VC breaths with 100% oxygen within 30 seconds is more superior than the 3 minutes of 100% preoxygenation in the obese
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
The statement is true because four VC breaths with 100% oxygen within 30 seconds can provide a higher concentration of oxygen to the body compared to three minutes of 100% preoxygenation. This is especially important in obese individuals who may have reduced lung capacity and require more oxygen to adequately oxygenate their tissues. The quick delivery of oxygen through VC breaths ensures that the body receives a sufficient amount of oxygen before any potential airway manipulation or procedure.Rate this question:
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- 33.
Neuropathy of the radius and increasing BMI has documented association
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The given statement is false. There is no documented association between neuropathy of the radius and increasing BMI. Neuropathy refers to damage or dysfunction of the nerves, while BMI (Body Mass Index) is a measure of body fat based on height and weight. These two conditions are unrelated and do not have a documented association.Rate this question:
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- 34.
Blood loss is greater in the obese for the same type of surgery thus early blood transfusion is necessary
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Obese individuals tend to have a higher blood volume due to their increased body weight. During surgery, the larger blood volume can lead to greater blood loss compared to non-obese individuals undergoing the same procedure. Therefore, early blood transfusion may be necessary to compensate for the increased blood loss in obese patients.Rate this question:
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- 35.
Arterial oxygenation during laparoscopy in morbidly obese is affected mainly by body position compared to body weight
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The given statement is false. Arterial oxygenation during laparoscopy in morbidly obese individuals is affected mainly by body weight rather than body position. The excess body weight in obese individuals can lead to decreased lung volumes and impaired respiratory mechanics, resulting in reduced oxygenation. Body position may have some impact on oxygenation, but it is not the main factor.Rate this question:
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