Risk (Public Health)

Question 1

Which lipoproteins are good and which are bad?

Answer 1

HDL are good (protective against atherosclerosis) and LDL are bad

Question 2

Which lipoproteins are good and which are bad?

Answer 2

HDL are good (protective against atherosclerosis) and LDL are bad

Question 3

What are the clinical features of high cholesterol?

Answer 3

• Xangthelasma (eyelids)
• Tendon xanthomas
• Tuberous xanthomas
• Eruptive xanthomas

Question 4

What is the defining level for CVS risk for triglycerides?

Answer 4

> 1.7 mmol/l

Question 5

What is the defining level for CVS risk for HDL-C?

Question 6

What is the defining level for CVS risk for Fasting glucose??

Answer 6

> 5.6 mmol/l

Question 7

Which cholesterol, which component is the primary target to prevent CHD?

Answer 7

LDL

Question 8

What do statins reduce?

Answer 8

Total cholesterol and LDL cholesterol

Question 9

What are the 5 kinds of lipoproteins?

Answer 9

Chylomicrons, VLDL, IDL, LDL and HDL

Question 10

Where are chylomicrons synthesised and what is their function?

Answer 10

In the gut after a fatty meal. They transport dietary triglyceride from the gut to the sites of use and storage

Question 11

How are IDL made and what is their function?

Answer 11

Formed during the breakdown of VLDL and chylomicrons. They are involved in the recycling of cholesterol by the liver as well as formation of LDL in the blood.

Question 12

What is the defining level for CVS risk for triglycerides?

Answer 12

> 1.7 mmol/l

Question 13

What is the defining level for CVS risk for HDL-C?

Question 14

What is the defining level for CVS risk for Fasting glucose??

Answer 14

> 5.6 mmol/l

Question 15

Which cholesterol, which component is the primary target to prevent CHD?

Answer 15

LDL

Question 16

What do statins reduce?

Answer 16

Total cholesterol and LDL cholesterol

Question 17

What are the 5 kinds of lipoproteins?

Answer 17

Chylomicrons, VLDL, IDL, LDL and HDL

Question 18

Where are chylomicrons synthesised and what is their function?

Answer 18

In the gut after a fatty meal. They transport dietary triglyceride from the gut to the sites of use and storage

Question 19

Where are VLDL made and what is their function?

Answer 19

Made in the liver. They are the main carriers of endogenous triglycerides and cholesterol to sites for use or storage. They are also involved in the synthesis of LDL and HDL,

Question 20

How are IDL made and what is their functions?

Answer 20

Formed during the breakdown of VLDL and chylomicrons. They are involved in the recycling of cholesterol by the liver as well as formation of LDL in the blood.

Question 21

How are LDL made and what is their function?

Answer 21

Made from IDL. They are the main carriers of cholesterol

Question 22

What is the function of HDL?

Answer 22

They return about 20–30% of cholesterol in the blood to the liver from peripheral tissue for excretion, and therefore have a protective role.

Question 23

Which lipoproteins are implicated in atherosclerosis?

Answer 23

VLDL, IDL and LDL

Question 24

How do we reduce the risk of CVD?

Answer 24

• Reduce Risk in Environment
  • Make it harder to buy things that are bad and easer to buy healthy things
• Reduce risk factors
• Identify disease early
• Optimise treatment
  • Maintain a lifestyle that allows treatment to work at its best
• Minimise impact
  • Cardiovascular rehab etc to ensure it doesn’t worsen or reoccur

Question 25

Primary prevention

Answer 25

Stop a disease before it starts

Question 26

Secondary prevention

Answer 26

Stop a disease from being as bad as it could be or re-occuring

Question 27

Tertiary prevention

Answer 27

Stopping later complications from occurring

Question 28

What are ways of making probability understandable to the patient?

Answer 28

1/1 - 1/10 - person within the family (very common)

1/10-1/100 - person within street (common)

Question 29

Which score is used to estimate CVD risk?

Answer 29

ASSIGN score in Scotland (QRISK score in England)

Question 30

What is the definition of high risk?

Answer 30

%20 chance of it happening in the next 10 years

Question 31

What are the 2 types of plaque that can form in atherosclerosis?

Answer 31

• Fibro-fatty plaque - consists of a lipid core (product of dead lipid-laden foam cells) and a fibrous cap (of smooth muscle cells and connective tissue)
• Fibrous plaque – contains collagen fibres, precipitates of calcium and, occasionally, lipid-laden cells

Question 32

What are the stages of atheroma formation? (again, I know)

Answer 32

1. LDL (low density lipoprotein) is up-taken into the intima of the artery and is oxidised to atherogenic oxidised LDL (OXLDL)
2. Migration of monocytes, across endothelium of the artery, into the intima where they become macrophages
3. Uptake of OXLDL by macrophages converts them to cholesterol-laden foam cells, that form a FATTY STREAK
4. Release of inflammatory mediators from cells causes division and proliferation of the smooth muscle cells, from the media, into the intima of the artery; there is also collagen deposition
5. Formation of an ATHEROMATOUS PLAQUE

Question 33

What is a healthy rate of weight loss?

Answer 33

1.2kg per week

Question 34

Which BMI is the criteria for surgery?

Answer 34

BMI of more than >35

Question 35

What is the physical activity recommendations?

Answer 35

30 mins moderate activity at least 5 days a week (150 mins over a week) with at least 2 sessions of weight bearing a week or 75 mins of vigorous exercise over a week