Cardiology

Question 1

What is the order of abnormal blood sugar lab progression?

Answer 1

1. postprandial insulin
2. fasting insulin
3. two hour postprandial glucose
4. fasting glucose

Question 2

How does elevated insulin increase dyslipidemia?

Answer 2

HMG CoA reeducates synthesizes cholesterol via the mevalonate pathway. insulin and leptin stimulate this enzyme.

Question 3

What is the rate limiting step of cholesterol production and what suppresses it?

Answer 3

HMG COA reductase, suppressed by internalization of LDL

Question 4

What is the rate limiting step of cholesterol production and what stimulates it?

Answer 4

HMG COA reductase, Insulin and leptin

Question 5

what is true regarding folate, hyperhomocysteinemia, and coronary artery disease?

Answer 5

lowering homocysteine is primary prevention

Question 6

BMI 29, elevated waist circumference, and a normal waist to hip ratio, with normal bioelectrical impedance

Answer 6

increased muscle mass

Question 7

what TG/HDL ratio is considered insulin resistance?

Answer 7

> 3

Question 8

what waist/hip ratio is considered high?

Answer 8

Men >1

Question 9

What are direct nutraceutical insulin sensitizers?

Answer 9

cinnamon, vanadium, ALA, chromium, magnesium

Question 10

What are indirect insulin sensitizers?

Answer 10

microbiome influencing such as berberine, probiotics, inflammation targeting such as omega 3s or antiox/NFkB inhibitors

Question 11

insulin resistance increases risk factor for what gyn cancer?

Answer 11

endometrial cancer

Question 12

29-yo Female with metabolic syndrome and elevated insulin what would you expect the influence to be on sex hormones?

Answer 12

Increase estrogen and androgens

Question 13

What test is most useful to assess vulnerable plaque?

Answer 13

Lp-PLA2

Question 14

what is the marker associated with animal fat consumption?

Answer 14

F2 isoprostanes

Question 15

Which statement is correct regarding heart rate variability (HRV)?

Answer 15

Decreased HRV indicates high sympathetic and parasympathetic tone, increasing cardiac risk

Question 16

Which IFM food plan would be most indicated for a patient with sleep apnea, elevated blood pressure, elevated HbA1c, and peripheral neuropathy?

Answer 16

Cardiometabolic Food Plan

Question 17

Elevation of which lipoprotein significantly increases the risk of heart disease?

Answer 17

Apolipoprotein‐B

Question 18

Which of the following statements accurately describes the relationship between inflammation and the generation of interleukin‐6 (IL‐6) during exercise?

Answer 18

The more muscle used, the greater the release of the anti‐inflammatory myokine IL‐6.

Question 19

Which pharmacologic interventions are most likely to deplete CoQ10?

Answer 19

Statins and beta‐blockers

Question 20

Niacin should be used with caution in which group of patients?

Answer 20

Patients with diabetes mellitus type 2.

Question 21

Which of the following is most likely to stimulate NF‐kappaB production?

Answer 21

Lipopolysaccharides

Question 22

Which of the following is correct regarding the relationship between leptin and obesity?

Answer 22

Obese patients likely have elevated leptin.

Question 23

what is the proposed mechanism of berberine?

Answer 23

increasing insulin receptor expression, microbiome effects

Question 24

which of the following effects of hyperinsulinemia is the most relevant to cardiometabolic risk?

Answer 24

increasing hsCRP - it is pro-inflammatory

Question 25

relevance of genetic markers of CVD?

Answer 25

``` MTHFR (homocysteine, cofactors riboflavin and niacin), ApoE (diet), familial hypercholesterolemia (treat) ```

Question 26

what food groups should be emphasized in patients with HTN?

Answer 26

(Cardiometabolic food plan emphasis) lycopene, arginine, dietary fiber. NOT on this list if sulfur/brassicas which are on the detox food plan instead. condition specific phytonutrients. review food plan wheels.

Question 27

what are foods to include in HTN?

Answer 27

soy, whey, legumes (plant fiber), cold water fish (EFA), L-arginine containing (nitric. oxide), cocoa, lycopene (antioxidant)

Question 28

What is the relationship between heart rate variability and sympathetic tone?

Answer 28

inverse: high HRV, low tone, low risk | low HRV, high tone, high risk

Question 29

what are the HR exercise intensity cut offs?

Answer 29

low 50-63% mod 64-76% high 77-93% (max 220 - age)

Question 30

what are the recommended dietary changes for ApoE3 and ApoE4?

Answer 30

low fat, low alcohol, fish oil

Question 31

Your 25‐year‐old college‐aged patient tells you his dad just had a heart attack at the age of 48. Your patient is known to carry homozygous ApoE 4/4 mutation. Accurate advice about his lifestyle includes:

Answer 31

Encouraging avoidance of alcohol and implementing a low‐fat diet plan to improve lipid profile and reduce cardiovascular risk.

Question 32

Your 47‐year‐old patient asks how you know she is heading toward insulin resistance (prediabetes) simply by looking at her advanced lipid profile, even though her fasting glucose levels are only 85 mg/dl. Her results would most likely look like:

Answer 32

Normal LDL‐C, elevated LDL‐particle #, low HDL2b, elevated large‐sized VLDL.

Question 33

In discussing dipping vs. non‐dipping nocturnal blood pressure concerns with your 50‐year‐old female school teacher patient with stage 1 hypertension, you explain:

Answer 33

Patients classified as non‐dippers are at an increased risk for multiple forms of cardiovascular disease

Question 34

Your patient is a 62‐year‐old female with tender lumps on the distal interphalangeal joints of her fingers. On examination, you note that she has seborrheic dermatitis around her scalp. Which of the following nutrient deficiencies might explain these findings?

Answer 34

Vitamin B6

Question 35

On which of the following biomarkers does insulin resistance have a direct effect?

Answer 35

It increases small, dense LDL particles

Question 36

Which of the following is the most useful marker in assessing levels of oxidative damage to DNA?

Answer 36

8-hydroxydeoxyguanosine

Question 37

What biomarker is associated with rupture-prone plaque?

Answer 37

Myeloperoxidase

Question 38

Which of the following would be most effective in reducing risk of cardiovascular disease

Answer 38

Reducing oxidized LDL and high sensitivity C-reactive protein (hs-CRP)

Question 39

A 56-year-old male presents to your office with a five-year history of diabetes. He has recently had a hemoglobin A1c, which was elevated at 8.2. He reports tingling in both feet and on physical exam shows a loss of vibratory sensation in his toes. What supplemental nutritional intervention would you suggest?

Answer 39

High dose lipoic acid and methylcobalamin

Question 40

What aspects of exercise should an "exercise prescription" address?

Answer 40

Frequency, duration, and intensity

Question 41

The following is true regarding HMG-CoA reductase:

Answer 41

It is stimulated by leptin and insulin and suppressed by internalization of LDL.

Question 42

Which of the following nutrient combinations would be most helpful to support endothelial function in a patient with atrial fibrillation?

Answer 42

CoQ10 and taurine

Question 43

Which of the following dietary recommendations is associated with decreased LDL, increased HDL, and decreased triglycerides?

Answer 43

Mediterranean diet