Dyslipidemia Flashcards
- A 38-year-old woman presents to your clinic today with new onset chest pain that occurs after walking a few blocks. Her father had a heart attack at age 40. Her diet is low in saturated fats and
cholesterol. The patient is otherwise healthy and does not smoke. Her lipid panel today is: total cholesterol 350 mg/dL (9.05 mmol/L), HDL cholesterol 40 mg/dL (1.03 mmol/L), and triglycerides 120 mg/dL (1.36 mmol/L). What is her non-HDL cholesterol and LDL cholesterol?
A. 310 mg/dL (8.02 mmol/L) and 286 mg/dL (7.40 mmol/L)
B. 390 mg/dL (10.09 mmol/L) and 334 mg/dL (8.64 mmol/L)
C. 310 mg/dL (8.02 mmol/L) and unable to calculate
D. 350 mg/dL (9.05 mmol/L) and 286 mg/dL (7.40 mmol/L)
E. 310 mg/dL (8.02 mmol/L) and 230 mg/dL (5.95 mmol/L)
A
- What is this patient’s primary target for intervention?
A. Triglycerides
B. LDL cholesterol
C. Non-HDL cholesterol
D. HDL cholesterol
E. Non-HDL and LDL cholesterol
E
- A 38-year-old woman presents to your clinic today with new onset chest pain that occurs after walking a few blocks. Her father had a heart attack at age 40. Her diet is low in saturated fats and cholesterol. The patient is otherwise healthy and does not smoke. Her lipid panel today is: total
cholesterol 350 mg/dL (9.05 mmol/L), HDL cholesterol 40 mg/dL (1.03 mmol/L), and
triglycerides 120 mg/dL (1.36 mmol/L). What is her non-HDL cholesterol and LDL cholesterol?
What is your assessment of this patient’s lipid disorder?
A. She has hypercholesterolemia and is likely polygenic
B. She has hypercholesterolemia and heterozygous familial hypercholesterolemia
C. She has hypertriglyceridemia
D. She has a combined dyslipidemia
E. She has homozygous familial hypercholesterolemia
B
- According to the ACC/AHA guidelines, what intervention would be most appropriate for this patient?
A. Start simvastatin 80 mg daily
B. Start prescription omega-3 fatty acid esters 4 g daily
C. Start ezetimibe 10 mg daily
D. Start a high-intensity statin
E. Start gemfibrozil 600 mg twice daily
D
- The patient returns to clinic after 4 months for follow-up and post percutaneous coronary intervention of her left anterior descending coronary artery with the following lipid panel: total
cholesterol 230 mg/dL (5.95 mmol/L); triglycerides 100 mg/dL (1.13 mmol/L); HDL cholesterol 44 mg/dL (1.14 mmol/L); LDL cholesterol 166 mg/dL (4.29 mmol/L). According to the NLA guidelines, what are the non-HDL cholesterol and LDL cholesterol goals for this patient?
A. Less than 160 mg/dL (4.14 mmol/L) and less than 130 mg/dL (3.36 mmol/L)
B. Less than 130 mg/dL (3.36 mmol/L) and less than 100 mg/dL (2.59 mmol/L)
C. Less than 100 mg/dL (2.59 mmol/L) and less than 70 mg/dL (1.81 mmol/L)
D. At least a 50% reduction in atherogenic cholesterol
E. Cholesterol goals are not recommended
C
- What would be the next appropriate intervention for this patient?
A. Lomitapide 5 mg daily
B. Fenofibrate 160 mg daily
C. Ezetimibe 10 mg daily
D. Prescription omega-3 fatty acid esters
E. Change to atorvastatin 20 mg daily
C
- Which type of therapy would be most appropriate for a 58-year-old woman with type 2 DM, evidence of end-organ damage and total cholesterol 210 mg/dL (5.43 mmol/L), HDL cholesterol 45 mg/dL (1.16 mmol/L), triglycerides 850 mg/dL (9.61 mmol/L), and non-HDL cholesterol 165
mg/dL (4.27 mmol/L)?
A. Atorvastatin 10 mg daily
B. Pravastatin 20 mg daily
C. Cholestyramine one scoop twice daily
D. Gemfibrozil 600 mg twice daily
E. Alcohol and carbohydrate restriction
D
- According to the NLA, which risk category does this patient best fit?
A. Very High Risk
B. High Risk
C. Moderate Risk
D. Low Risk
E. Need more information to determine
A
- Which of the following is not a secondary cause of dyslipidemia?
A. Hypothyroidism
B. Hyperthyroidism
C. Diabetes
D. Renal failure
E. Protease inhibitors
B
- For which patients would you consider calculating a quantitative risk score?
A. Patients with three major ASCVD risk factors
B. Patients with preexisting ASCVD
C. Patients with HDL exceeding 50 mg/dL (1.29 mmol/L)
D. Patients with two major ASCVD risk factors and not very high-risk or high-risk conditions.
E. Patients with triglycerides exceeding 500 mg/dL (5.65 mmol/L)
D
- A patient diagnosed with metabolic syndrome and CHD is taking atorvastatin 20 mg daily. His non-HDL cholesterol is 118 mg/dL (3.05 mmol/L) and LDL cholesterol is 78 mg/dL (2.02 mmol/L). His primary care physician has tried to increase atorvastatin to 40 mg; however, the patient complains of muscle pain and weakness shortly after the dose is escalated. His triglycerides are currently 198 mg/dL (2.24 mmol/L), HDL cholesterol is 39 mg/dL (1.01 mmol/L), and total cholesterol is 157 mg/dL (4.06 mmol/L). What would be the most appropriate intervention?
A. Continue current therapy and monitor his progress
B. Add ezetimibe 10 mg daily
C. Add gemfibrozil 600 mg twice daily
D. Add niacin ER 500 mg at bedtime
E. Switch to pravastatin 20 mg at bedtime
E
- Which lipoprotein particle is not considered to be atherogenic
A. LDL
B. IDL
C. VLDL
D. Small-dense LDL
E. HDL
E
- A 56-year-old woman who smokes two packs of cigarettes per day is admitted to the emergency room with severe left-sided chest pain and numbness down her left arm. She is diagnosed with acute coronary syndrome and undergoes percutaneous coronary intervention of her right coronary artery. Her lipid profile obtained in the emergency room reveals the following: total cholesterol 229 mg/dL (5.92 mmol/L), non-HDL cholesterol 181 mg/dL (4.68 mmol/L), LDL cholesterol 152 mg/dL (3.93 mmol/L), HDL cholesterol 48 mg/dL (1.24 mmol/L), and triglycerides 147 mg/dL (1.66 mmol/L). What would be the most appropriate initial therapy?
A. Mipomersen 200 mg once weekly
B. Pravastatin 40 mg daily
C. Atorvastatin 80 mg daily
D. Rosuvastatin 20 mg daily
E. Pitavastatin 4 mg daily
E
- Which side effect can be caused by statin therapy?
A. Fatty liver
B. New onset diabetes
C. Gout
D. Flushing
E. None of the above
B
- Choose the best answer that explains the difference in liver toxicity between IR niacin and sustained-release niacin.
A. Sustained-release preparations result in higher blood levels of nicotinuric acid
B. Sustained-release preparations quickly saturate the low-affinity, high capacity metabolic pathway
C. Sustained-release preparations have a slow absorption rate allowing more niacin to be metabolized by the amidation pathway
D. Sustained-release niacin only causes liver toxicity when used in doses exceeding 4 g
E. None of the above
C
A 50-year-old woman presents to your clinic today for routine follow-up on her hypertension, cholesterol, and type 2 diabetes mellitus. Her mother is alive, but her father passed away at age 55 from a myocardial infarction. She tries to follow a low sugar and low sodium diet. The patient
smokes one pack of cigarettes per day but is otherwise healthy. Her lipid panel today is total cholesterol 220 mg/dL (5.69 mmol/L), HDL cholesterol 45 mg/dL (1.16 mmol/L), and triglycerides 160 mg/dL (1.81 mmol/L).
- What is this patient’s non-HDL cholesterol and LDL cholesterol?
A. 150 mg/dL (3.88 mmol/L) and 134 mg/dL (3.47 mmol/L)
B. 175 mg/dL (4.51 mmol/L) and 143 mg/dL (3.70 mmol/L)
C. 190 mg/dL (4.91 mmol/L) and 157 mg/dL (4.06 mmol/L)
D. 200 mg/dL (5.17 mmol/L) and 170 mg/dL (4.40 mmol/L)
B
A 50-year-old woman presents to your clinic today for routine follow-up on her hypertension, cholesterol, and type 2 diabetes mellitus. Her mother is alive, but her father passed away at age 55 from a myocardial infarction. She tries to follow a low sugar and low sodium diet. The patient
smokes one pack of cigarettes per day but is otherwise healthy. Her lipid panel today is total cholesterol 220 mg/dL (5.69 mmol/L), HDL cholesterol 45 mg/dL (1.16 mmol/L), and triglycerides 160 mg/dL (1.81 mmol/L).
- What is this patient’s primary target for intervention?
A. Triglycerides and non-HDL cholesterol
B. Triglycerides and HDL cholesterol
C. HDL cholesterol and LDL cholesterol
D. Non-HDL cholesterol and LDL cholesterol
D
A 50-year-old woman presents to your clinic today for routine follow-up on her hypertension, cholesterol, and type 2 diabetes mellitus. Her mother is alive, but her father passed away at age 55 from a myocardial infarction. She tries to follow a low sugar and low sodium diet. The patient
smokes one pack of cigarettes per day but is otherwise healthy. Her lipid panel today is total cholesterol 220 mg/dL (5.69 mmol/L), HDL cholesterol 45 mg/dL (1.16 mmol/L), and triglycerides 160 mg/dL (1.81 mmol/L).
- According to the 2018 AHA/ACC cholesterol guideline, which medication would be the most appropriate to start in this patient?
A. Rosuvastatin 10 mg daily
B. Bempedoic acid 180 mg daily
C. Ezetimibe 10 mg daily
D. Simvastatin 10 mg daily
A
A 50-year-old woman presents to your clinic today for routine follow-up on her hypertension, cholesterol, and type 2 diabetes mellitus. Her mother is alive, but her father passed away at age 55 from a myocardial infarction. She tries to follow a low sugar and low sodium diet. The patient
smokes one pack of cigarettes per day but is otherwise healthy. Her lipid panel today is total cholesterol 220 mg/dL (5.69 mmol/L), HDL cholesterol 45 mg/dL (1.16 mmol/L), and triglycerides 160 mg/dL (1.81 mmol/L).
- The patient returns to clinic 12 months after her last visit. She reports she was diagnosed with peripheral artery disease 6 months ago. Her lipid panel is as follows today: total cholesterol 170 mg/dL (4.40 mmol/L), triglycerides 90 mg/dL (1.02 mmol/L), HDL cholesterol 42 mg/dL (1.09
mmol/L), LDL cholesterol 110 mg/dL (2.84 mmol/L). She has been taking atorvastatin 10 mg daily for the last 6 months. According to the 2018 AHA/ACC guideline, what is the next step to optimize this patient’s cholesterol and lower her risk of future CV events?
A. Change atorvastatin to simvastatin 80 mg daily
B. Change atorvastatin to rosuvastatin 10 mg daily
C. Increase atorvastatin to 80 mg daily
D. Add ezetimibe 10 mg daily
C
- Which side effect can be caused by bempedoic acid therapy?
A. Hypertension
B. Hypothyroidism
C. Hyperuricemia
D. Renal failure
C
- According to the AACE/ACE guidelines, what are the LDL cholesterol and non-HDL
cholesterol goals for a patient who is considered extreme risk?
A. Less than 30 mg/dL (0.78 mmol/L) and 60 mg/dL (1.55 mmol/L)
B. Less than 55 mg/dL (1.42 mmol/L) and 80 mg/dL (2.07 mmol/L)
C. Less than 80 mg/dL (2.07 mmol/L) and 100 mg/dL (2.59 mmol/L)
D. Less than 100 mg/dL (2.59 mmol/L) and 130 mg/dL (3.36 mmol/L)
B
- Which of the following is considered an ASCVD risk-enhancing factor per the 2018
AHA/ACC cholesterol guideline?
A. hs-CRP greater than 1 mg/L
B. Ankle-brachial index less than 1
C. Premature menopause
D. LDL cholesterol greater than 130 mg/dL (3.36 mmol/L)
C
- Choose the patient scenario below that meets the FDA-approved indication for icosapent ethyl as a lipid-lowering therapy to reduce risk of a cardiovascular event.
A. A 40-year-old woman with heterozygous familial hypercholesterolemia (HeFH) taking atorvastatin 80 mg daily with an LDL cholesterol of 50 mg/dL (1.29 mmol/L)
B. A 60-year-old man with type 2 diabetes mellitus, hypertension, dyslipidemia, and gout taking atorvastatin 80 mg daily with an LDL cholesterol of 70 mg/dL (1.81 mmol/L) and triglycerides of 175 mg/dL (1.98 mmol/L)
C. A 40-year-old man with history of a myocardial infarction 1 year ago receiving atorvastatin 10 mg daily with an LDL cholesterol of 100 mg/dL (2.59 mmol/L) and triglycerides of 200 mg/dL (2.26 mmol/L)
D. A 60-year-old woman with hypertension and hypothyroidism receiving atorvastatin 20 mg daily with an LDL cholesterol of 130 mg/dL (3.36 mmol/L) and triglycerides of 150 mg/dL (1.70 mmol/L)
B
- A 46-year-old man with a history of dyslipidemia and hypertension is taking atorvastatin 40mg daily (started 1 year ago). His lipid values today are non-HDL cholesterol 156 mg/dL (4.03 mmol/L) and LDL cholesterol 110 mg/dL (2.84 mmol/L). His 10 year ASCVD risk prior to starting atorvastatin was 9%. The patient complains of mild muscle pain and weakness today
with a creatine kinase of 120 U/L (2.00 µkat/L). What would be the most appropriate intervention?
A. Continue current therapy and monitor his progress
B. Decrease his atorvastatin dose to 20 mg daily and monitor his progress
C. Add fenofibrate 145 mg daily
D. Add niacin ER 500 mg at bedtime
A
- A 45-year-old man with a history of hypertension is coming in today for his annual follow-up. He has a family history of early heart disease with his father having a heart attack at age 50. His lipid values today are total cholesterol 180 mg/dL (4.65 mmol/L), HDL cholesterol 40 mg/dL (1.03 mmol/L), and LDL cholesterol 110 mg/dL (2.84 mmol/L). He has a 10 year
ASCVD risk score of 7.5%. Which of the following tests are recommended by the AHA/ACC cholesterol guideline to help decide whether to initiate a statin in this patient?
A. Microalbumin
B. Coronary artery calcium score
C. hs-CRP
D. Apo B
B
- Which of the following statins and doses are considered moderate-intensity statins?
A. Atorvastatin 40 mg daily
B. Pravastatin 20 mg daily
C. Simvastatin 20 mg daily
D. Lovastatin 20 mg daily
C
- Which type of therapy would be most appropriate for a 40-year-old woman with stage 4 chronic kidney disease and hypertension with a total cholesterol 190 mg/dL (4.91 mmol/L), HDL cholesterol 50 mg/dL (1.29 mmol/L), and triglycerides 550 mg/dL (6.22 mmol/L)?
A. Atorvastatin 80 mg daily
B. Colestipol 2 g daily
C. Vascepa 2 g twice daily
D. Gemfibrozil 600 mg once daily
C
- A 76-year-old man suffered a stroke 2 years ago and has a history of type 2 diabetes mellitus, hypertension, and dyslipidemia. He reports he has been on atorvastatin 80 mg daily since his
stroke. His lipid values yesterday were total cholesterol 150 mg/dL (3.88 mmol/L), HDL
cholesterol 45 mg/dL (1.16 mmol/L), triglycerides 120 mg/dL (1.36 mmol/L), and LDL cholesterol 81 mg/dL (2.09 mmol/L). What is the best recommended lipid-lowering therapy for this patient based on 2018 AHA/ACC cholesterol guideline?
A. Continue atorvastatin 80 mg daily
B. Add ezetimibe 10 mg daily
C. Decrease atorvastatin to 40 mg daily
D. Add evolocumab 140 mg every 2 weeks
B
- Which of the following are considered major risk factors for atherosclerotic cardiovascular disease?
A. Females greater than 45 years of age
B. Systolic blood pressure greater than 130 mm Hg
C. Current cigarette smoker
D. Males with an HDL cholesterol greater than 50 mg/dL (1.29 mmol/L)
C
- A high-intensity statin regimen is capable of lowering LDL cholesterol by how much on average?
A. Greater than or equal to 20%
B. Greater than or equal to 30%
C. Greater than or equal to 50%
D. Greater than or equal to 70%
C
