patho exam 4- Chapter 23: Obesity and Disorders of Nutrition (Pages: 715-719)

The student asks the professor for a definition of "orexigenic neurons." What description by the professor is most accurate? a. Promote appetite and stimulate eating b. Suppress appetite and inhibit eating c. Increase overall metabolism d. Promote satiety after eating

ANS: A Orexigenic neurons promote appetite, stimulate eating, and decrease metabolism. The anorexigenic neurons suppress appetite, inhibit eating, increase metabolism, and promote satiety after eating

A health care professional is caring for a patient admitted to the hospital with severe anorexia. What action by the health care professional would be most important? a. Ensuring the patient is on a cardiac monitor b. Facilitating laboratory testing of electrolytes c. Arranging a psychiatry consultation d. Assessing the patient's favorite foods

ANS: A Patients with severe anorexia can have cardiac dysrhythmias, so this patient should be placed on a cardiac monitor as the priority. The other actions are appropriate; they just do not take priority.

2. A health care professional is speaking to a weight-loss support group and encourages the participants to have regular screening for medical conditions that are related to obesity. Which conditions does the professional include in this list? (Select all that apply.) a. Cancer b. Cardiovascular disease c. Cirrhosis d. Diabetes e. Dementias

ANS: A, B, D The three leading causes of death in the US related to obesity are cancer, cardiovascular disease, and diabetes. The professional would encourage the participants to be screened for these conditions. Obesity is not linked to cirrhosis of the liver or dementias.

1. A student asks the professor about the functions of adipose tissue. What responses by the professor are accurate? (Select all that apply.) a. Provides insulation b. Helps with mechanical support c. Dysregulates thyroid function d. Secretes adipokines e. Helps generate heat

ANS: A, B, D, E Adipose tissue has multiple functions including providing insulation and mechanical support, secreting adipokines, and heat generation. They do not specifically cause thyroid dysregulation

A student learning about the effects of obesogens discovers what information about them? (Select all that apply.) a. Can be found in personal care products b. Cannot cross the placental barrier c. Can be transmitted through breast milk d. Are limited to a single genetic defect e. Have been associated with pesticide exposure

ANS: A, C, E Obesogens are exogenous chemicals related to the development of obesity. They can be found in a variety of items such as person care products, plastics, pesticides, food products, and other household and consumer products. Some of them can cross the placental barrier and be transmitted through breast milk. They produce epigenetic changes in gene regulation and expression

3. What role does leptin resistance have in promoting obesity? (Select all that apply.) a. Promotes overeating b. Promotes early satiety c. Inhibits orexigenic outcomes d. Increases oxidative stress e. Leads to hyperglycemia

ANS: A, D, E Leptin resistance has a major role in obesity. Some of the effects of leptin resistance include: promotion of overeating, failure to inhibit orexigenic hypothalamic satiety signaling, increased oxidative stress, and hyperglycemia

A researcher is moving to an area with a year-round cold climate. The researcher asks the health care professional how people in these areas are able to adjust to the temperature. What response by the professional is most accurate? a. They have less adipose tissue. b. They have more beige (bAT) adipose tissue. c. Their bone marrow produces more adipose tissue. d. They gain weight which insulates them

ANS: B Chronic exposure to cold climates causes the conversion of white adipose tissue (WAT) to beige adipose tissue, which is thermogenic. Changing the amount of adipose tissue overall does not help with acclimation to cold climates

A patient weighs 82 pounds and is hospitalized for anorexia. In order to prevent refeeding syndrome, how many calories should the person eat in the first two days? a. 400 b. 745 c. 936 d. 1200

ANS: B In order to prevent refeeding syndrome, feedings should start slowly at about 20 kcal/kg/day. This 82-pound person weighs 37.2727 kg, so that would be 745 calories a day

A health care professional wishes to provide community screening for obesity. Which population should the professional focus on as the priority? a. Caucasians b. Non-Hispanic blacks c. Hispanics d. Asians

ANS: B Non-Hispanic blacks have the highest age-adjusted rate of obesity at 48.1% followed by Hispanics (42.5%), non-Hispanic whites (34.5%), and non-Hispanic Asians (11.7%). The professional's priority should be on the group with the highest prevalence rate, which is nonHispanic blacks

A severely malnourished patient is in the hospital to improve nutrition. On the second day, the patient reports palpitations and difficulty breathing. After placing the patient on a cardiac monitor, what action does the health care professional take next? a. Take the patient's temperature. b. Have lab drawn for electrolyte levels. c. Cancel the patient's next meal. d. Facilitate a chest x-ray

ANS: B Refeeding syndrome occurs when patients are fed too quickly, causing rapid shifts of fluids and electrolytes, often leading to dysrhythmias. After placing the patient on a cardiac monitor, the professional should next ensure that serum electrolytes are measured. The patient's temperature is not relevant to this situation. The patient should continue to eat although calories should be decreased. There may or may not be a need for a chest x-ray

A student asks the health care professional why obese people are at higher risk for hypertension than non-obese individuals. What response by the professional is best? a. They produce more ghrelin in the stomach. b. Their thyroid gland secretes less hormone. c. They produce more angiotensinogen. d. They secrete fewer endocannabinoids

ANS: C Angiotensinogen is a precursor of angiotensin I, which, converted to angiotensin II, is a potent vasoconstrictor. Angiotensinogen is produced both by the liver and by adipocytes; therefore obese individuals have more, leading to increased vasoconstriction and increased systemic vascular resistance which leads to high blood pressure. Ghrelin, produced in the stomach, increases food intake. The thyroid gland function is not directly linked to obesity. Endocannabinoids are associated with increase in appetite and nutrient absorption

A person has abnormally severe tooth decay and erosion of the tooth enamel. What problem should the health care professional assess the person for? a. Anorexia nervosa b. Binge eating c. Bulimia d. Refeeding syndrome

ANS: C Chronic vomiting and exposure to gastric acids leads to loss of tooth enamel and decay. These are not signs of anorexia, binge eating, or refeeding syndrome

4. What does the student learn about the effects of long-term starvation? (Select all that apply.) a. Energy is supplied through glycogenolysis. b. Gluconeogenesis begins for energy requirements. c. Increase in inflammatory mediators. d. Use of ketone bodies for energy needs. e. Proteolysis begins in adipose tissue.

ANS: C, D Glycogenolysis and gluconeogenesis supply energy needs in short-term starvation, or fasting states. During long-term starvation the body produces more inflammatory mediators and begins using ketones for energy. Proteolysis begins once adipose tissue has been depleted

5. A family is concerned that their most elderly member is not eating. What information about the anorexia of aging does the health care professional provide the family? (Select all that apply.) a. Usually there is a direct cause that can be treated successfully. b. Is not related to age-related changes and signifies illness c. Decreases in saliva and the sense of taste are contributing factors. d. Age-related loss of appetite is common finding. e. Social stimulation at meals might promote better eating habits.

ANS: C, D, E Anorexia of aging has multiple causes that include normal age-related changes, physiologic alterations, and social/psychological factors. Decreases in saliva and the senses of smell and taste are contributory. Aging is marked by a decrease in orexigenic signals and an increase in anorexigenic signals, leading to decreased appetite. Social isolation has also been implicated in this phenomenon

Which individual does the health care professional determine is obese? a. Body mass index 23 kg/m2 b. Body mass index 25 kg/m2 c. Body mass index 29 kg/m2 d. Body mass index 32 kg/m

ANS: D Overweight is defined as a body mass index (BMI) of >25 kg/m2 , while a BMI of >30 kg/m2 is considered obese. The individual with the BMI of 23 kg/m2 would be considered of normal weight, those with BMIs of 25 and 29 kg/m2 would be considered overweight, and the person with the BMI of 32 kg/m2 is obese