Lipidology

Question 1

Type I (Chylomicrons)

Answer 1

Contain TGAs
Defect dec’d familial LPL, CII
Skin lesions: eruptive xanthomas

Question 2

Type II (LDL)

Answer 2

Contains: LDL
Defect - dec’d LDL rct’s
Skin lesions: Tendon, xanthomas

Question 3

Type III (IDL)

Answer 3

Contains: LDL+TGAs
Defect Abnormal APoE
Skin lesions: Palmar/Tuberous Xanthomas

Question 4

Type IV (VLDL)

Answer 4

Contains: TGAs
Defect dec’d familial LPL, CII
Skin Lesions: Eruptive Xanthomas

Question 5

Type V (VLDL+Chylomicrons)

Answer 5

Contains: TGAs
Defect dec’d familial LPL, CII
Skin Lesions: Eruptive Xanthomas

Question 6

Statins

Answer 6

Primary LDL tx, dec’s LDL, inc’s TGA, inc’d HDL
S/E - inc’d LFTs, CPK, wt gain
Glucose intolerance

Question 7

Fibric Acid derivatives

Answer 7

Primary TGA tx
Inc’d /N LDL, dec’d TGA, inc’d HDL
S/E Gallstone, hepatoma

Question 8

Bile Acid derivatives

Answer 8

Secondary LDL tx
dec’d LDL, TGAs, inc’d HDL
S/E Bloating, constipation, nausea

Question 9

Nicotinic Acid

Answer 9

Primary HDL, secondary LDL
dec’d LDL, very dec’d TGA, very inc’d HDL
S/E Abd pain, nausesa, flushing, dry skin

Question 10

Ezetimibe

Answer 10

TGA tx, seconary LDL

dec’d LDL, dec’d TGA

Question 11

Apo protien E def

Answer 11

Type III

Question 12

Def of LDL rct’s

Answer 12

Type IIa

Question 13

Tendon xanthomas

Answer 13

Type IIa

Question 14

Pancreatitis

Answer 14

Type I, IV, V

Question 15

Pt with LDL 140, TGA 600 -0 fhx hypertriglyceridemia

Answer 15

Fibrinc acid derivative (gemfibrozil, fenofibrate)

Question 16

Which reduces TG of 500 in pt with BMI 30

Answer 16

Losing wegith 5-10%
Defect - C II def - eruptive xanthoma
Tx: Gemfibrozil

Question 17

Palmar Xanthoma

Answer 17

Most likely defect Apo E

Question 18

Chol guidelines

Answer 18

No CAD, 0-1 risk factor LDL <130

Question 19

CAD equivalent risk factors

Answer 19

DM, Vascular dz, multiple risk factors with 10 year framingham >20%

Question 20

Treatment

Answer 20

First line = diet
Goo fats, < 200mg chol
15% calories from protienes
excercise 1hr/day, 5 days/ week
smoking cessagion

Question 21

Reynolds vs Framingham

Answer 21

Reyolds include high sensitivety CRP
Parental h/o MI
Accounts for gender…

Question 22

Pt wants alternative med for prevention of CAD

Answer 22

Omega 3 fatty acid

Question 23

40yo no risk factors for CAD with LDL 175

Answer 23

first diet/excercise

Question 24

Pt with DM likely has…

Answer 24

inc’d LDL, inc’d TGA, dec’d HDL

Question 25

Primary target for therapy in DM pt

Answer 25

LDL

Question 26

62yo F with HTN and DM2 requests advice of CAD risk reduction BP 152/92, A1c 7.6, chol 268, LDL 180, HDL 42

Answer 26

Statin for LDL <100

Question 27

What is initial drug for DM pt with LDL 160, TGA 250, HDL 45

Answer 27

Statin

Question 28

57yo F with MI, quits smoking, changes diet, started on zocor 20 LDL 180 to 140, TGA 350 to 250, HDL 48 wtd?

Answer 28

inc to zocor 40

Question 29

Pt over age 50, LDL 140, CRP more than 2mg - what will dec mortality?

Answer 29

Statin

Question 30

Pt on zocor - 8 wks later with genralized myalgias, CPK 75, AST/ALT 30/40 dz?

Answer 30

statin induced myalgia

Best management - switch to pravastatin

Question 31

67yo M c/o pain/wk legs, difficulty getting up from seated postion, stpped taking lipitor 3 mo ago after CPK elevated - - repeat CPK 1925 - not much change - mulscel bx necrotizing fibers no inflamm, no vaculole - dx?

Answer 31

Statin induced myopathy 2/2 to HMGCR

Question 32

Hyperlipidemia in pregnancy

Answer 32

Colesevelam (welchol)

Question 33

Lipitor 40-> 80 - AST/ALT up but not 2x ULN, LDL now 80 , HDL now 59, wtd?

Answer 33

continue current dose

Question 34

40yo M strong fhx prem MI LDL 130, HDL 28, TGA 175 what is elevated?

Answer 34

Lp(a) (dec’d HDL)

tx: Niacin

Question 35

Prevention of flushing aw Niacin

Answer 35

ASA 30min prior

Question 36

55yo M strong fhx premature coronary dz LDL 180, HDL 29, TGA 375 - started on zocor 40 - LDL now 120, HDL 35, TGA 245 wtd?

Answer 36

continue zocor, add niacin

Question 37

Pt on zocor with Wk CPK 850

Answer 37

d/c zocor

Question 38

Pt for regular checkup LDL 150 TG 160, HDL 80 wtd?

Answer 38

No need for meds