401 Metabolic Syndrome

Question 1

Harmonising definition of metabolic syndrome

Answer 1

3 of the following. Waist circumference more than 94 cm in males of Europoid, African and Middle Eastern more than 90 cm in south Asian more than 85 cm in Japanese; more than 80 cm in females Europoid, African, Middle Eastern, more than 80 cm in South Asian and more than 90 cm in Japanese; Fasting triglyceride more than 150 mg/dl HDL less than 40 mg/dl; SBP more than 130 mmHg DBP more than 85 mmHg, FBS more than 100 mg/dl

Question 2

strongly related to insulin resistance and risk of diabetes and CVD

Answer 2

intraabdominal circumference

Question 3

key feature of the metabolic syndrome

Answer 3

central adiposity

Question 4

True or false. No single gene explains the complex phenotype called the metabolic syndrome

Answer 4

True.

Question 5

most accepted and unifying hypothesis to describe pathophysiology of the metabolic syndrome

Answer 5

insulin resistance

Question 6

early major contributor to development of insulin resistance

Answer 6

overabundance of circulating fatty acids

Question 7

most sensitive pathway of insulin action

Answer 7

inhibition of lipolysis in adipose tissue

Question 8

pathologic mechanism to explain metabolic syndrome

Answer 8

leptin resistance

Question 9

provides the unifying theory for aging and the predisposition to the metabolic syndrome

Answer 9

oxidative stress hypothesis

Question 10

recently emerged as an important contributor to the development of obesity and related metabolic disorders

Answer 10

??

Question 11

excellent marker of the insulin resistant condition

Answer 11

hypertriglyceridemia

Question 12

other major lipoprotein disturbance in metabolic syndrome

Answer 12

reduction in HDL cholesterol

Question 13

inhibitory to lipoprotein lipase further controbuting to hypertriglyceridemia

Answer 13

Increase in apoC-III

Question 14

True or false. Hyperuricemia is another consequence of insulin resistance

Answer 14

True.

Question 15

how does uric acid lead to hypertension

Answer 15

effect of uric acid on nitric acid synthase in the macula densa of the kidney and stimuation of the renin angiotensin aldosterone system

Question 16

proinflammatory cytokines the reflect overproduction by the expanded adipose tissue mass

Answer 16

IL 1,6,18; resistin, TNF alpha, CRP

Question 17

may be primary source of pro inflammatory cytokines locally and in the systemic circulation

Answer 17

adipose tissue macrophages

Question 18

anti inflammatory cytokine produced exclusively by adipocytes

Answer 18

adiponectin

Question 19

what is the action of adiponectin

Answer 19

enhances insulin sensitivity and inhibits many steps in the inflammatory process

Question 20

True or false. Reductions in adiponectin levels are common in metabolic syndrome

Answer 20

True.

Question 21

most common liver disease in part as a consequence of the insulin resistance of metabolic syndrome

Answer 21

NAFLD

Question 22

True or false.Women with PCOS are 2-4 times more likely to have metabolic syndrome

Answer 22

True.

Question 23

primary approach to metabolic syndrome

Answer 23

weight reduction

Question 24

most important component in weight loss

Answer 24

calorie restriction

Question 25

important for the maintenance of weight loss

Answer 25

increase in physical activity

Question 26

reduction of how much leads to weight reduction of 1 lb per week

Answer 26

About 500 kcal restriction daily

Question 27

anti hypertensive of choice for metabolic syndrome

Answer 27

ACEI

Question 28

given to inhibit fat absorption in metabolic syndrome

Answer 28

orlistat

Question 29

given to improve insulin mediated glucose update in muscle and adipose tissue

Answer 29

TZD

Question 30

given to increase HDL cholesterol

Answer 30

nicotinic acid

Question 31

can lead to weight loss but causes headache and nasopharyngitis

Answer 31

lorcaserin

Question 32

side effect of lorcaserin

Answer 32

headache and nasopharyngitis

Question 33

side effect of liraglutide

Answer 33

nausea and emesis

Question 34

appetite suppressants approved by US FDA

Answer 34

phertermine/topiramate, lorcaserin, naltrexone/bupropion and high dose liraglutide

Question 35

dose of liraglutide for weight loss vs in T2DM

Answer 35

3.0 mg liraglutide vs 1.8 mg in T2DM

Question 36

statin dose of those patients with metabolic syndrome with diabetes and known ASCVD

Answer 36

high intensity statin atorvastatin 40-80 mg or rosuvastatin 20-40 mg

Question 37

when should statin therapy by initiated if patient has metabolic syndrome but without diabetes

Answer 37

ASCVD score of 7.5%

Question 38

first drug of choice for lowering LDL

Answer 38

statin

Question 39

second line drug for choice for lowering LDL

Answer 39

ezetimibe

Question 40

what drug may be given in patient with familial hypercholesterolemia with insufficient lowering of LDL on statins and ezetimibe

Answer 40

Proprotein convertase/kexin type 9 (PCSK9 ) inhibitor

Question 41

why are cholestyramine, colestipol and colesevalam which are more effective than ezetimibe in lowering LDL is not given in patients with metabolic syndrome

Answer 41

they can increase triglyceride levels

Question 42

drug of choice to lower triglyceride level

Answer 42

fibrate (gemfibrozil or fenofirate)

Question 43

other drugs that lower triglyceride levels

Answer 43

nicotinic acid and omega 3 fatty acids

Question 44

is the only currently available drug with predictable HDL cholesterol raiding properties

Answer 44

??

Question 45

Physical activity advocated in the management of metabolic syndrome

Answer 45

60-90 min daily activity required

Question 46

when is gastric bypass or vertical sleeve gastrectomy an option

Answer 46

BMI more than 40 with no cormorbities BMI more than 35 with comorbidites