Lipids

Question 1

Give 5 modifiable cardiovascular risk factors

Answer 1

smoking
high cholesterol 
high BP
Obesity 
diabetes
lack of exercise
excess alcohol

Question 2

Give 3 non-modifiable risk factors for cardiovascular disease

Answer 2

Fhx
gender
age
ethnicity

Question 3

3 roles of cholesterol in the body

Answer 3

repair of cell membranes
synthesis of steroid hormones
synthesis of vitamin D
synthesis of bile acids

Question 4

describe the exogenous pathway of lipid metabolism

Answer 4

The exogenous metabolic pathway is concerned with the transport and utilisation of dietary fats.

Chylomicrons (transport triglyceride from gut to liver) are formed, which enter the blood stream via intestinal lymphatics and thoracic duct.

chylomicron is hydrolysed and releases its triglyceride core, FFAs and mono and diglycerides

chylomicron remnant is transported to the liver and is degraded.

Question 5

describe the endogenous pathway of lipid metabolism

Answer 5

Triglycerides together with cholesterol, cholesteryl ester and other lipids are transported in VLDL in the bloodstream, where VLDL undergoes delipidation with the enzyme lipoprotein lipase in a similar way to chylomicrons; this is the endogenous pathway of lipid metabolism.

Small dense LDL particles are the most atherogenic

Question 6

3 secondary causes of hyperlipidaemia

Answer 6

Hypothyroidism
Diabetes
Renal disease
Liver disease
Excess alcohol

Question 7

2 clinical signs O/E for hyperlipidaemia

Answer 7

xanthelasma

xanthomata

Question 8

Baseline Ix for pt with lipid disorders

Answer 8

Lipid profile (TC, LDL, HDL, Triglyceride and non-HDL)
Liver function tests and Gamma-GT
Fasting glucose / HbA1c
Thyroid Function test
Urine dipstick
Renal Function test

Question 9

name 3 genes involved in familial hypercholesterolaemia

Answer 9

LDLR
APOB
PCSK9

Question 10

Diagnosis of familial hypercholesterolaemia

Answer 10

Simon Broome Criteria (NICE guideline)

Total cholesterol > 7.5 mmol/L
Low density lipoprotein cholesterol (LDL-C) > 4.9
Family history
-Premature coronary artery disease (<60 years)
-Hypercholesterolaemia

Question 11

3 clinical signs o/e for hypercholesterolaemia

Answer 11

tendon xanthoma
corneal arcus
xanthelasma

Question 12

3 categories of Mx of hyperlipidaemia

Answer 12

lifestyle
statins
other lipid lowering drugs

Question 13

How do PCSK9 inhibitors work?

Answer 13

LDLR recycling: LDL receptor binds to cholesterol, is taken into the liver cell, the cholesterol is unbound and the receptor moves back to the cell membrane

PCSK9 attaches to the receptor and takes it into the cell and keeps it there- this means that there are fewer LDLR to take the cholesterol out of the blood stream. PCSK9 inhibitors are new drugs used in the treatment of hypercholesterolaemia.

Question 14

What is used to assess cardiovascular risk score?

Answer 14

QRISK

Question 15

What are the 3 types of troponin

Answer 15

T- tropomyosin binding
I- inhibitory protein
C- calcium binding

Question 16

Troponin levels in MI

Answer 16

A rise of troponin of more than 7 ng/L to >14 ng/L suggests acute cardiac damage.
A rise to a value exceeding 200 ng/L is highly suggestive of AMI.

Question 17

examples of secondary ischaemic cardiac injury causes

Answer 17

Pulmonary Embolus
End Stage Renal Failure
Acute Heart Failure (?Only if  IHD aetiology)
Chronic Heart Failure
Coronary Artery Spasm (Cocaine)
Hypotension
Aortic Stenosis and HOCM
Extreme Marathons

Question 18

5 non ischaemic cardiac injury causes

Answer 18

infection
surgery
contusion
ablation 
pacing
defibrillators
cardioversion 
autoimmune 
alcohol
chemo 
CO
snakebite