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Chem Path > L26 Dyslipidemia > Flashcards

L26 Dyslipidemia Flashcards

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1
Q

Lipids has low solubility and they require carriers like ________________ to carry them. (2)

A

Lipoproteins;

Hormone binding proteins

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2
Q

Hyperlipidemia esp LDL is a significant risk factor for atherosclerosis, leading to? (4)

A
  1. Brain: stroke
  2. Heart: ACS
  3. Kidney: secondary HTN, renal artery stensosi
  4. Peripheral: PVD
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3
Q

List the 3 functions of apolipoproteins and give examples for each function.

A
  1. Ligand for receptors
    - ApoB 100: for binding LDLR (VLDL,IDL, LDL)
    - ApoE: for binding to LDLR (liver) (CM - chylomicrons,IDL, HDL)

2 Co-factors for enzymes
- ApoC-II (CM, VLDL,HDL): cofactor for Lipoprotein lipase (LPL)

  1. Structural components for lipoprotein assembly
    - ApoB48 : structural protein for chylomicrons
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4
Q

Which lipoprotein has the largest size?

List the lipoproteins from largest to smallest size.

How about density?

A

Chylomicrons

> VLDL > IDL > LDL > HDL

Density: the other way round

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5
Q

What is the function of ApoA-I?

A

Structural protein for HDL

at intestines, liver

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6
Q

What is the function of Apo(a)?

A

Structural protein for Lp(a) [Lipoprotein A].

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7
Q

What are the 2 types of lipid contents in lipoprotein particles?

How is Chylomicrons made up of?
VLDL?
LDL and HDL?

A
  1. Triglyceride
  2. Cholesterol

Chylomicrons & VLDL : mostly triglyceride
LDL(6:42%) and HDL (3:13%): mostly cholesterol

Cholesterol content highest in LDL

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8
Q

What is required in patients if assessing lipid profile by enzymatic colorimetry?

What tube is used?

A
  • Fasting: otherwise contain chylomicrons

- Plasma in Lithium heparin tube (green)

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9
Q

Special investigations of lipid include

  1. Lipoprotein electrophoresis
  2. Ultracentrifugation (not routinely done)
  3. Apolipoprotein measurement

For 1&2, they separate lipids by?

A

1: by electrophoretic mobility
- to determine hyperlipoproteinemia
> WHO-Fredrickson classification

  1. by its density
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10
Q

Which of the following has to be noted to establish test validity of lipids?

A. Patients have to fast and Li heparin tube has to be used
B. Acute stress: recent MI
C. Concurrent drug use
D. Paraprotein (e.g. multiple myeloma)

A

All of the above

B: LDL decreases in acute events, blood should be taken soon after presentation (24 hours)/ 4-6 weeks after patient recovered

D: interfere with spectrophotometry
e.g. TC, HDL-C

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11
Q

Always identify the pattern of abnormalities by lipid profile:
Triglyceride/ Cholesterol dominant/ combined?

List 2 MC examples of secondary causes to be excluded and how.

A
  1. DM (MC cause):
    fasting glucose, HbA1c; increased cholesterol and TG
  2. Hypothyroidism (2nd MC cause):
    due to reduced LDL-R and LPL activity
    > increased cholesterol; check TFT

others:

  • Nephrotic syndrome
  • Cholestasis
  • Anorexia nervosa
  • Immunoglobulin disorders
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12
Q

If there are clinical features of dyslipidemia with an early onset <40 years old, what to suspect?

A

Familial hypercholestrolemia

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13
Q

Name 5 stigmata of hyperlipidemia

A
  1. Papular eruptive xanthoma
  2. Tendon xanthoma
  3. Tuberous xanthoma
  4. Xanthoma striatum palmare
  5. Xanthelasma
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14
Q

What score is used to calculate the CV risk of patients with hyperlipidemia?
- estimate patient’s 10 year risk of developing coronary heart diseases
What parameters are considered as very high risk?

A

Framingham risk score.

  • DM
  • CKD
  • documented CVD
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15
Q

Intermediate risk patients whose LDL-C does not already suggest treatment, what can be used for risk stratification?

A

hsCRP

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16
Q

Familial hypercholestrolemia causing increased cholesterol: list examples of single gene defect.

A
  1. LDL-receptor
  2. ApoB-100
  3. PCSK9
17
Q

Other than Familial hypercholestrolemia, give an example of primary cause of increased cholesterol.
Briefly describe.

A

Sitosterolemia

- plant steroid disorder

18
Q

Familial hyperlipidemia causing increased triglyceride: list examples of deficiency.

A
  1. LPL deficiencies

2. ApoC-II deficiencies

19
Q

What is the disease for congenital combined hypercholestrolemia and hypertriglyceridemia?
How is it diagnosed?

A

Familial dusbetalipoproteinemia (type III broad beta band disease)

  • diagnosed by electrophoresis and ApoE genotyping
20
Q

Visual inspection of lipid sample: becomes hazy when TG > ______ mmol/L?

A

2.3 mmol/L?

21
Q

What is Friedewald Equation of the indirect LDL-cholesterol level and when is it not valid?

A

LDL = TC- HDL - TG/2.2

not valid if

  • TG > 4.5nM
  • chylomicrons are present
  • IDLs are abnormally present (Type III hyperlipidemia)

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