Harrisons

Question 1

What are the major features of metabolic syndrome

Answer 1

central obesity

hyperglycemia

hypertension

hypertrigylceridemia

low HDL level

Question 2

what is the most challenging feature of metabolic syndrome

Answer 2

waist circumference

Question 3

what is the greatest value of determining metabolic syndrome

Answer 3

predicting type 2 DM

Question 4

to be diagnosed with metabolic syndrome, at least how many for the 5 major features should be fulfilled

Answer 4

at least 3 major features

Question 5

central obesity in males vs females is defined as having waist circumference of ____ accdg to NCEP : ATPIII 2001 criteria

Answer 5

males: > 102 cm

females > 88cm

**for south Asians and Chinese accdg to another criteria (Harmonizing Definition)

males: 90cm or more
females: 80cm or more

Question 6

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

Answer 6

insulin resistance

Question 7

relationship of insulin resistance and fatty acids

Answer 7

insulin resistance –>

increased lipolysis –>

increased FA –>

FA impair insulin-mediated glucose uptake by modifying downstream signalling –>

insulin resistance (cycle continues)

Question 8

effect of leptin on:

a. appetite
b. energy expenditure
c. . insulin sensitivity

Answer 8

reduces appetite

promotes energy expenditure

enhances insulin sensitivity

Question 9

what is the effect of insulin on blood vessels and sodium reabsorption in the kidney under:

a. normal physiologic condition
b. in the setting of insulin resistance

Answer 9

Normally, insulin is a vasodilator and promotes sodium reabsorption in the kidney

In the setting of insulin resistance, insulin loses its vasodilator effect but still has sodium reabsorpition ability (via kidney)

Thus, the relationship between insulin resistance and HTN is well established

Question 10

how can hyperuricemia contribute to hypertension

Answer 10

adverse effect of uric acid on NITRIC ACID SYNTHASE in the MACULA DENSA of the kidney and stimulation of the RENIN-ANGIOTENSIN ALDOSTERON SYSTEM (RAAS)

Question 11

This is an anti-inflammatory cytokine produced exclusively by adipocytes. It enhances insulin sensitivity and inhibits many steps in the inflammatory process

Answer 11

adiponectin

Question 12

what happens to the level of adiponectin in metabolic syndrome

Answer 12

decreased

Question 13

what is the most common liver disease

Answer 13

NAFLD

Question 14

how does NAFLD occur

Answer 14

increased FFA flux –>

decreased intrahepatic FA oxidation –>

increased TG biosynthesis and hepatocellular accumulation

Question 15

what is the primary approach to tx of metabolic syndrome

Answer 15

weight reduction

Question 16

what are the 2 major classes of weight loss drugs

Answer 16

appetite suppressants

absorption inhibitors

Question 17

phentermine is an appetite suppresant drug that can only be used short term…. for how long

Answer 17

3 months

Question 18

example of weight loss drug that inhibits GI absorption

Answer 18

Orlistat

Question 19

common problem in taking orlistat

Answer 19

oily leakage per rectum

Question 20

metabolic or bariatric surgery is an option for patients with metabolic snydrome who have BMI of

Answer 20

BMI 40 or more or…

> 35 BMI with comorbidities

Question 21

a statin should be prescribed in all patients with diabetes age 40-79 with an LDL cholesterol between ____ mg/dL

Answer 21

60-189 mg/dL

Question 22

for those patients with DM and ASCVD, the current evidence supports a high-intensity statin dose… a high intensity statin dose of atorvastatin is ______ while for rosuvastatin it is _____

Answer 22

atorvastatin 40-80mg/day

rosuvastatin 20-40 mg/day

Question 23

What is the first and second choice medications to lower LDL cholesterol

Answer 23

1st: statins
2nd: ezetimibe

**ezetimibe localizes at the brush border of the small intestine and inhibits absorption of cholesterol via the sterol transporter NPC1L1

Question 24

first line meds to lower LDL vs triglycerides

Answer 24

LDL: statins

TG: fibrates

Question 25

patients taking Fibrates concomitantly with drugs metabolized by the 3A4 cytochrome P450 system increases the risk of what adverse effect

Answer 25

myopathy

Question 26

what is the only currently available drug with predictable HDL cholesterol-raising properties

Answer 26

nicotinic acid

**however, there is no evidence that raising HDL cholesterol with nicotinic acid beneficially affects ASCVD events

Question 27

in patients who have the metabolic syndrome without DM, the best choice for the initial anti-HTN medications is

Answer 27

ACEi or ARBs

Question 28

both metformin and TZD enhance insulin action in the liver, muscle and adipose tissue.. True or false

Answer 28

false….

only TZD enhances insulin action in the liver, muscle and adipose tissue

metformin only enhances insulin action in the liver