Lipid Disorders

Question 1

In healthy endothelium, what two factors cause vasodilation?

Answer 1

Nitric oxide
Prostacyclin

Question 2

In patient’s with known cardiovascular disease, lowering what leads to a consistent reduction in total mortality and recurrent CV events?

Answer 2

cholesterol

Question 3

Risk of ischemic heart disease increases with higher levels of what?

Answer 3

total serum cholesterol levels

Question 4

Elevated what is correlated with increased incidence of CAD and
atherosclerosis?

Answer 4

LDL

Question 5

What condition promotes retention of lipoproteins in the intima and
can accelerate the process of atherosclerosis?

Answer 5

Hypertension

Question 6

What percentage of DM patients succumb to atherosclerosis-related events?

Answer 6

80%

Question 7

What benefits do exercise have in relation to the endothelium?

Answer 7

Raises HDL

Secretes NO, prostacyclines

Question 8

What level of triglycerides up the patient at risk for pancreatitis?

Answer 8

Triglycerides >500

Question 9

What hormone is protective by increasing HDL and decreasing LDL?

Answer 9

Estrogen

Question 10

What disease correlates with levels of plasma cholesterol and/or
tri-acylglycerol-containing lipoprotein particles 🡪 hyperlipidemias 🡪
atherogenesis

Answer 10

Coronary Artery Disease

Question 11

List some risk factors for coronary artery disease

Answer 11

Advanced age
Male gender
Heredity
Lack of physical exercise
Dyslipidemia
Tobacco smoking
HTN
DM
Metabolic syndrome
Estrogen status (post-menopausal)
HDL <35mg/dL

Question 12

You should start screening for hyperlipidemia in patients at age 20 if they have the following:

Answer 12

Smoker

Have diabetes

Heart disease runs in the family

Question 13

What are the lifestyle modifications for hyperlipidemia?

Answer 13

Diet
Smoking cessation
Exercise
Weight management
Control HTN
Glucose management
Raise HDL

Question 14

What is the best way to raise HDL?

Answer 14

Exercise

Question 15

What are the DOC for hyperlipidemia?

Answer 15

Statins

Question 16

What are ways to raise HDL?

Answer 16

Regular exercise
Weight reduction
Modest alcohol consumption

Question 17

What are some factors influencing serum lipids?

Answer 17

Certain drugs

Uncontrolled DM

Alcohol (Triglycerides)

hypothyroidism

Question 18

Plaques in blood vessel walls

Answer 18

Atheromas

Question 19

Plaques or nodules composed of lipid-laden histocytes in the skin,
especially the eyelids (xanthelasma)

Answer 19

Eruptive xanthomas

Question 20

Eruptive xanthomas are an indication of high levels of which lipid?

Answer 20

triglycerides

Question 21

Eruptive xanthomas in the eyelids is called what?

Answer 21

xanthelasma

Question 22

Lipid deposits in tendons

Answer 22

Tendinous xanthamos

Question 23

Tendinous xanthamos commonly are deposited in which tendon?

Answer 23

Achilles

Question 24

Tendinous xanthamos are an indication of high levels of which lipid?

Answer 24

LDL

Question 25

Lipid deposits in the cornea are called what?

Answer 25

Corneal arcus

Question 26

Cream-colored blood vessels in the fundus

Answer 26

Lipidemia retinalis

Question 27

Lipidemia retinalis is indicative of extremely high levels of what lipid level?

Answer 27

Extremely high triglycerides

Question 28

A genetic disorder that results in severe elevations of blood cholesterol levels and an increased risk of early cardiovascular disease Autosomal dominant

Answer 28

Familial Hypercholesterolemia

Question 29

This disease is caused by mutations that impair the body’s ability to remove LDL cholesterol from the blood

Answer 29

Familial Hypercholesterolemia

Question 30

Risk of premature coronary heart disease is elevated by about how much in untreated patients with Familial Hypercholesterolemia?

Answer 30

20-fold

Question 31

Screen children with a family history of early CVD of dyslipidemia between what ages?

Answer 31

ages 2 and 8

Question 32

A common genetic disorder Autosomal dominant Causes a higher than normal level of triglycerides

Answer 32

Hypertriglyceridemia

Question 33

Alcohol and estrogen use can make this condition worse

Answer 33

Hypertriglyceridemia

Question 34

What other factors are often present in patient's with hypertriglyceridemia?

Answer 34

Obesity, hyperglycemia, and high levels of insulin

Question 35

What factors/modifications can help improve the outcome in patients with hypertriglyceridemia?

Answer 35

Losing weight Keeping diabetes under control

Question 36

What is a complication of excessive TG >500?

Answer 36

Pancreatitis

Question 37

“hardening” of the arteries Chronic inflammatory process of large arteries involving lipids, thrombosis, elements of vascular wall, and immune cells

Answer 37

Atherosclerosis

Question 38

Leading cause of mortality and morbidity – number one killer in US and worldwide

Answer 38

Atherosclerosis

Question 39

What are the major manifestations of atherosclerosis??

Answer 39

cardiovascular disease and stroke

Question 40

What medications have become indispensable in the treatment of CAD?

Answer 40

Statins

Question 41

All cells require cholesterol to form membranes and maintain fluidity of phospholipid bilayer, and we need a minimum of what level to function properly?

Answer 41

minimum of 120mg/dL

Question 42

Cholesterol that drops below 120mg/dL is associated with what disorders?

Answer 42

cancers and psychiatric disorders

Question 43

What portion of the arterial wall is described below? Outermost layer Contains nerves, lymphatics, and blood vessels that nourish cells of the arterial walls

Answer 43

Adventitia

Question 44

What portion of the arterial wall is described below? Middle layer Thickest layer Internal and external elastic laminae Smooth muscle cells and extracellular matrix

Answer 44

Medial

Question 45

What portion of the arterial wall is described below? Inner layer Closest to arterial lumen Single layer of endothelial cells Metabolically active barrier between circulating blood and vessel wall There is where the damage occurs

Answer 45

Intima

Question 46

Maintains homeostasis of vessel wall Forms a barrier that contains blood within the lumen and limits passage of large molecules from circulation into subendothelial space (example: proteins) Produces antithrombotic molecules which prevent clotting (can also produce prothrombotic molecules) Secrete substances that modulate contraction of smooth muscle Regulate immune response

Answer 46

Endothelial Cells

Question 47

Under normal conditions what protects against development of atherosclerosis?

Answer 47

Endothelium

Question 48

When damaged, plays a significant major role in the development of atherosclerosis

Answer 48

Endothelium

Question 49

Earliest visible lesions of atherosclerosis Yellow discoloration on artery’s inner surface

Answer 49

Fatty streak

Question 50

Which type of fibrous cap is described below: Tend to be more fragile and more likely to rupture Less obstructive by angiography

Answer 50

Thinner cap: vulnerable plaque

Question 51

Which type of fibrous cap is described below: Causes pronounced arterial narrowing Have less propensity to rupture

Answer 51

Thick cap: stable plaque

Question 52

Areas of your body where you can have complications from atherosclerosis:

Answer 52

CNS – stroke Kidneys - Renal artery disease Heart – coronary artery disease Peripheral artery disease Aneurysms

Question 53

Common manifestations of atherosclerosis include:

Answer 53

Angina pectoris Myocardial infarction Stroke Peripheral arterial disease

Question 54

List some modifiable risk factors for atherosclerosis

Answer 54

90% Dyslipidemia Tobacco smoking Hypertension Diabetes Metabolic syndrome Lack of physical exercise

Question 55

List some non-modifiable risk factors for atherosclerosis

Answer 55

10% Advanced age Male gender heredity

Question 56

Elevated LDL levels correlate with increased incidence of what?

Answer 56

atherosclerosis and CAD

Question 57

What are some causes of elevated LDL cholesterol?

Answer 57

High-fat diet Abnormalities in LDL-receptor clearance mechanism Genetic defects – familial hyperchoesterolemia

Question 58

Coronary risk ____ as high with total cholesterol level 240mg/dL compared to 200 mg/dL

Answer 58

twice

Question 59

This risk factor promotes retention of lipoproteins in the intima by accentuating the production of LDL-binding proteoglycans by smooth muscle cells

Answer 59

Hypertension

Question 60

What percentage of diabetics succumb to atherosclerosis-related conditions?

Answer 60

80%

Question 61

What disease is considered atherosclerotic risk equivalent, in the same category as people with history of MI?

Answer 61

Diabetes

Question 62

Screening in patients without atherosclerotic cardiovascular disease should start when in men and women?

Answer 62

Age 35 in men Age 45 in women

Question 63

Basic screening for atherosclerosis should include what labs?

Answer 63

Total cholesterol HDL LDL Triglycerides Thyroid function tests Liver function tests Fasting glucose Baseline creatinine kinase Urine analysis Consider uric acid level (if think might initiate niacin therapy)

Question 64

Lifestyle modifications in patients with atherosclerosis

Answer 64

Diet Smoking cessation Controlling HTN Weight management Raising HDL levels Glucose management