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USMLE Biochemistry > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

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USMLE® Step 1 flashcards
1
Q

What is actually measured when assessing a patient’s lipid levels?

A
  • Total cholesterol
  • LDL-C
  • HDL-C
  • TG
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2
Q

How is the LDL cholestrerol usually measured?

What is the formula called?

A

Friedewald Formula

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3
Q

Give the equation for the Friedewald Formula

A

LDL-C = TotChol - HDL-C - TG/5

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4
Q

What do patients have to do before getting a cholesterol level/ lipid measurement?
Why do they have to do this?

A

Fast

  • Triglyceride level will be low
  • This means an accurate LDL-C can be obtained using the formula
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5
Q

Hyperlipidemia can be elevated levels of either what 3 things?

A
  • Total cholesterol
  • LDL
  • Triglycerides
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6
Q

What are the possible causes of secondary hyperlipidemia?

A
  • Nephrotic syndrome (LDL)
  • Alcoholism (TG)
  • Pregnancy (TG>TC)
  • Beta blockers (TG)
  • HCTZ (TC, LDL, TG)
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7
Q

What drugs can modestly increase lipid levels?

A
  • Beta blockers (TG)

- HCTZ (TC, LDL, TG)

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8
Q

What are the signs of significant hyperlipidemia?

A
  • Xanthomas
  • Tendinous Xanthoma
  • Corneal arcus
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9
Q

What are Xanthomas due to?

Where are they commonly found?

A
  • Plaques of lipid-laden histiocytes

- Appear as skin bumps or on eyelids

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10
Q

Where can Tendinous Xanthomas (lipid deposits in tendons) be found commonly?

A

Achilles

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11
Q

When may corneal arcus be found?

A

Fundoscopy

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12
Q

At what elevated levels of triglycrides would pancreatitis actually be seen?

A

> 1000

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13
Q

What is the mechanism behind pancreatitis due to hypertriglyceremia thought be?

A

Increased chylomicrons in plasma

  • Chylomicrons usually formed after meals and cleared
  • May obstruct capillaries -> ischemia
  • Vessel damage can expose triglycerides to pancreatic lipases
  • Triglycerides breakdown -> free fatty acids
  • Acid -> tissue injury -> pancreatitis
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14
Q

What are the signs of type 1 dyslipidemia (Hyperchylomicronemia)?

A
  • > 1000 TG
  • Milk plasma appearence
  • Increased chylomicrons
  • Recurrent pancreatitis
  • Hepatomegaly
  • Xanthomas
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15
Q

How is type 1 dyslipidemia (Hyperchylomicronemia) inherited?

A

AR

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16
Q

What type 1 dyslipidemia (Hyperchylomicronemia) due to?

2 possible mechanisms

A

Severe LPL dysfunction

  • LPL deficient
  • LPL co-factor deficient (apolipoprotein C-II)
17
Q

What is the treatment for type 1 dyslipidemia (Hyperchylomicronemia)?

A

Very low fat diet

- Normal lifespan and no incr risk of stherosclerosis

18
Q

How is Type II familial dyslipidemia (Familial Hypercholesterolemia) inherited?

A

Aut Dominant

19
Q

What is thought to cause Type II familial dyslipidemia (Familial Hypercholesterolemia)?

A

Few or zero LDL receptors

20
Q

What are the clinical signs / lab findings in Type II familial dyslipidemia (Familial Hypercholesterolemia)?

A
  • V. High LDL (>300 Heterozygote, >700 homozygote)
  • Tendon xanthomas, corneal arceus
  • Atherosclerosis, MI often in 20s
21
Q

What is Type III familial dyslipidemia (familial dysbetalipoproteinemia) due to?

A

Apo-E2 subtype of Apo-E

  • Poorly cleared by liver
  • Accumulation of chylomicron remnants and VLDL (collectively known as B-lipoproteins)
  • Elevated cholesterol and triglycerides
22
Q

What will TC levels be in Type III familial dyslipidemia (familial dysbetalipoproteinemia)?

A

Usually mild TC >300mg/dL

23
Q

What will be seen in Type III familial dyslipidemia (familial dysbetalipoproteinemia)?

A
  • Xanthmoas

- Premature coronary artery disease

24
Q

If you have ApoE2 allelle (Type III familial dyslipidemia) what are your chances of Alzheimers?

A

Decreased risk

25
Q

What is the risk of Alzheimers with an ApoE4 allelle?

A

Increased risk

26
Q

What is Type IV familial dyslipidemia (hypertriglyceridemia) due to?

A
  • VLDL overproduction or impaired catabolism
  • Increased TG (200-500), not pancreatitis
  • Increased VLDL
27
Q

What is Type IV familial dyslipidemia (hypertriglyceridemia) associated with?

A
  • Type II diabetes

- CVD, premature coronary disease

28
Q

What familial dyslipidemias are Aut Dominant?

A
  • Type II: Familial Hypercholesterolemia

- Type IV: hypertriglyceridemia

USMLE Biochemistry (44 decks)

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