a.Gastrointestinal lipase inhibition can cause steatorrhea.
b.Orlistat reduces weight but has no effect on secondary disease such as diabetes.
c.Satiety is associated with increased serotonin uptake.
d.Is as effective as surgery.
e.Sibutramine tends to increase blood pressure.
15.Management of diabetes in obese patients.
a.sulphonyl ureas are frequently associated with weight loss
b.insulin is associated with weight loss
c.glucagon like peptide-1 (GLP-1) is associated with weight loss
d.dipeptidyl peptidase-4 inhibitors may prolong endogenous GLP-1 and hence reduce the requirement for other hypoglycaemic agents.
e.GLP-1 is an incretin.
16.Which of these interactions of anti hypertensives and obesity are correct.
a.Beta blockers improve glucose tolerance
b.Beta blockers worsen dyslipidaemia
c.Thiazides worsen glucose tolerance.
d.ACE inhibitors are associated with coughing.
e.Indapamide has a minimal effect on glucose metabolism.
17.Obstructive sleep apnoea.
a.Is always associated with oxygen desaturation.
b.5–15% of the population have abnormal sleep patterns
c.Symptomatic (OSA) in 1–4% of the population
d.Obesity is not a risk factor.
e.Is more common in obese women than obese men
18.Complications/consequences of sleep apnoea.
a.Early morning headaches
b.Symptoms correlate with the severity of the disease.
c.Left ventricular failure
d.Obstruction is least during REM sleep
e.Episodic bradycardia is common.
19.Surgical interventions that are often helpful in OSA include.
a.Appendicectomy
b.Cholecystectomy
c.Palatal surgery.
d.Tonsillectomy in children with tonsillar hypertrophy.
e.Apronectomy.
20.Complications of Gastric bypass.
a.anastomotic leak (0.5–5%)
b.less bowel obstruction with laparoscopy
c.venous thrombo-embolism (<1.3%).
d.more splenic injury with laparoscopy.
e.nutritional deficiencies
Short answer questions
1.Describe the pathophysiology of Obese hypoventilation
2.What are the useful things to look for that might predict a difficulty intubation in the obese?
Clinical scenario
A 48 year old man presents electively for removal of intra-gastric balloon followed by laparoscopic Roux-en Y gastric bypass. He weighs 156Kg, with a BMI of 55.
Past medical history includes obstructive sleep apnoea (OSA) diagnosed 6 years ago, with home CPAP therapy, but he has been lost from sleep service follow-up. Past medical history also includes Type II Diabetes Mellitus treated with Insulin, and controlled hypertension.
He has a past surgical history of open cholecystectomy performed over 20 years ago. On examination of his airway a Mallampati score 3 and neck circumference of 53cm is noted.
His exercise tolerance is limited by shortness of breath and he can manage 50m on the flat before stopping. He is a lifelong smoker and drinks no alcohol.
Questions
1.What would constitute appropriate pre-operative investigations in this patient?
2.Is intubation likely to be difficult in this patient?
3.What are the main considerations for intravenous induction and removal of gastric balloon?
4.What are the possible intra-operative surgical problems?
5.What are the possible intra-operative anaesthetic problems?
6.What are the most likely post-operative complications in this case?
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