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Endocrine > 1: Hyperlipidaemia > Flashcards

1: Hyperlipidaemia Flashcards

1
Q

How do lipids travel in the blood

A

Bound to lipoproteins

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2
Q

What are the four types of lipid and lipoprotein

A
  • Chylomicrons
  • VLDL
  • LDL
  • HDL
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3
Q

What are VLDLs

A

Triglycerides

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4
Q

What are LDLs

A

Cholesterol

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5
Q

What are HDLs

A

Phospholipids

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6
Q

What are the two types of hyperlipidaemia

A

Primary hyperlipidaemia

Secondary hyperlipidaemia

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7
Q

What are the two types of primary hyperlipidaemias

A
  1. Common primary hyperlipidaemia
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8
Q

What % of primary hyperlipidaemia are common primary hyperlipidaemia

A

70%

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9
Q

What is raised in common primary hyperlipidaemia

A

LDL (Cholesterol)

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10
Q

What is secondary hyperlipidaemia

A

Raised LDL due to another underlying disease process

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11
Q

How does secondary hyperlipidaemia present

A

Raised LDL (Cholesterol)

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12
Q

give 4 causes of secondary hyperlipidaemia

A
  • Cushing’s disease
  • DM
  • Hypothyroidism
  • Nephrotic syndrome
  • Cholestasis
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13
Q

what is a mixed hyperlipidaemia

A

Raised LDL (Cholesterol) and VLDL (TGs)

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14
Q

what is another method to classify hyperlipidaemia

A

Congenital and Acquired

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15
Q

who classified familial hyperlipidaemias

A

Freidrickson

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16
Q

what is type I

A

Familial Hyperchylomicronaemia

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17
Q

what is the inheritance pattern of familial hyperchylomicronaemia

A

Autosomal Recessive

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18
Q

what causes familial hyperchylomicronaemia

A

Apo C deficiency

Lipoproteinlipase deficiency

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19
Q

how does familial hyperchylomicronaemia present clinically

A
  • Recurrent acute pancreatitis
  • Eruptive xanthomas
  • Hepatosplenomegaly
  • Lipemia retinalis
  • Bile duct stenosis
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20
Q

what is the main feature of familial hyperchylomicronaemia

A

Recurrent acute pancreatitis

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21
Q

what defect is present in familial hyperchylomicronaemia

A
  • High chylomicrons

- High VLDLs (triglycerides)

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22
Q

how prevalent is familial hyperchylomicronaemia

A

rare

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23
Q

what is type IIa

A

Familial hypercholesterolaemia

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24
Q

what % of familial hyperlipidaemias are familial hypercholesterolaemia

A

10

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25
Q

what is the inheritance pattern of familial hypercholesterolaemia

A

Autosomal Dominant

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26
Q

what cause familial hypercholesterolaemia

A

LDL Deficiency

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27
Q

what are the 4 symptoms of familial hypercholesterolaemia

A
  • Xanthelasma
  • Tendon Xanthoma
  • Corneal Arcus
  • Premature atherosclerosis
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28
Q

what causes tendon xanthomas

A

Familial Hypercholesterolaemia

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29
Q

what deficit is present in familial hypercholesterolaemia

A

High LDL (Cholesterol)

30
Q

what is type IIb familial hyperlipidaemia

A

Familial Combined Hyperlipidaemia

31
Q

what % of individuals have type IIb

A

10%

32
Q

what is the inheritance pattern of familial combined hyperlipidaemia

A

Autosomal Dominant

33
Q

what is the cause of familial combined hyperlipidaemia

A

ApoB100 deficiency

34
Q

how does familial combined hyperlipidaemia present

A

Corneal Arcus

Xanthelasma

35
Q

what is the abnormalities in lipids in familial combined hyperlipidaemia

A

High LDL

High VLDL

36
Q

what is type III familial hyperlipidaemia

A

familial dysbetalipoproteinaemia

37
Q

what is the inheritance pattern of dysbetalipoproteiaemia

A

autosomal recessive

38
Q

what % of individuals have dysbetalipoproteinaemia

A

5

39
Q

what causes dysbetalipoproteinaemia

A

Autosomal Recessive

40
Q

what defect is present dysbetalipoproteinaemia

A

ApoE deficiency

41
Q

what are 3 symptoms of dysbetalipoproteinaemia

A

Palmar striae
Pre-mature atherosclerosis
Tubero-eruptive xanthoma

42
Q

what defect is present in dysbetalipoproteinaemia

A 
Increase VLDL (triglycerides)
Increase chylomicrons
43
Q

what is the most common familial hyperlipidaemia disorder

A

Familial hypertriglyceridaemia (70%)

44
Q

what is the inheritance pattern of familial hyper triglycerdiaemia

A

AD

45
Q

what causes familial hypertriglyceridaemia

A

Overproduction of VLDL by the liver

46
Q

what are symptoms of familial hypertriglyceridaemia

A
  • Premature atherosclerosis
  • Eruptive xanthoma
  • Lidipaemia retinalis
  • Hepatosplenomegaly
47
Q

what defect is present in familial hypertriglyceridaemia

A

Raised LDL

48
Q

how should individuals at risk of hyperlipidaemia be screened

A

Fasting Lipid Profile

49
Q

what are the two ‘at-risk’ categories

A
  • Those at risk of hyperlipidaemia

- Those at risk of CVD

50
Q

what are 3 indicators of ‘at risk’ of hyperlipidaemia

A
  • FH
  • Corneal Marcus before 40-years
  • Xanthomata
51
Q

what is an eruptive xanthoma

A

Itchy yellow nodules

52
Q

what is an tuberous xanthoma

A

Yellow nodules on knees or elbows

53
Q

who are individuals at risk of CVD

A
  • FH
  • Known CVD
  • Diabetes
  • IGT
  • HTN
  • Smoking
  • High BMI
54
Q

explain gender changes in cholesterol

A

Males have higher cholesterol until menopause - then females

55
Q

how do patients with high lipids usually present

A

Asymptomatic. May have xanthomas

56
Q

which lipid has greatest risk for coronary artery disease

A

LDL

57
Q

how is LDL measured

A

LDL = Total serum cholesterol - HDL - TG/5

58
Q

what is the effect of HDL

A

protective: transports LDL from tissues to the liver

59
Q

explain cholesterol (LDL) to HDL ratio

A

Lower LDL:HDL - the lower risk of CAD. A ratio of 10 doubles CAD

60
Q

what is first line investigation in hyperlipidaemia

A

Lipid screen

61
Q

if lipid screen is abnormal, what is ordered

A

If LDL or HDL abnormal on lipid screen order fasting lipid profile

62
Q

when is fasting lipid profile the first-investigation

A
  • FH Hyperlipidaemia
  • Corneal arcus under 50-years
  • Xanthoma
  • FH CVD under 60
  • CVD
  • Smoker
  • Higher BMI
  • HTN
63
Q

what is first-line management of hyperlipidaemia

A

Statin

64
Q

what dose of atorvastatin is given for primary prevention

A

20mg

65
Q

what are indications for primary prevention

A

T1DM
GFR <60
QRISK2 >10%

66
Q

what dose is given for secondary prevention

A

80mg

67
Q

what are indications for secondary prevention

A

CVD, CAD, PAD

68
Q

what is aim when individual is put on statin

A

non-HDL reduction by 40%

69
Q

what is second line for high lipids

A

Ezetimibe

70
Q

what is ezetimibe

A

Prevents absorption of cholesterol

71
Q

when is ezetimibe used

A

Statins not tolerated or 40% reduction in HDL cannot be achieved

72
Q

how much does familial hypercholesterolaemia (IIa) increase risk of CAD

A

40-times.

50% will have MI by 60-years if untreated

Endocrine (20 decks)

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