2018 Lipidology 2%

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 recept
Skin lesions: Tendon xanthomas*

Question 3

Type III (IDL)

Answer 3

Contains: LDL+TGAs
Defect Abnormal APoE
Skin lesions: Palmar/Tuberous Xanthomas (yellowish looking palm)

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, decr LDL **, decr. TGA, inc’d HDL

S/E - inc’d LFTs, CPK, wt gain, Glucose intolerance

Question 7

Fibric Acid derivatives

Answer 7

Primary TGA tx (start when TG > 880)
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 fasting TG of 500 in pt with BMI 30

Answer 16

Losing 5-10% of body weight

Question 17

Palmar Xanthoma

Answer 17

Most likely defect Apo E

Question 18

xanthoma treatment

Answer 18

1. First line = diet
2. monounsaturated fats: olive oil, canola, peanut, sunflower oil,
3. Omega 3 and 6 fatty acids
4. < 200mg chol
5. 15% calories from protein
6. fiber 20-30g/day
7. exercise
8. smoking cessation

Question 19

What do omega 3 fatty acids do

Answer 19

decrease TG

Question 20

40yo no risk factors for CAD with LDL 175, wtd next

Answer 20

first diet, therapy, exercise

Question 21

Pt with DM likely has…

Answer 21

inc’d LDL, inc’d TGA, dec’d HDL

Question 22

Primary target for therapy in DM pt

Answer 22

LDL

Question 23

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

Answer 23

Statin

Question 24

57yo F with MI, quits smoking, changes diet, started on lipitor 40 LDL 180 to 140, TGA 350 to 250, in about 3 months, HDL 48 wtd?

Answer 24

increase atorvastatin to 80

Question 25

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

Answer 25

Statin

Question 26

57yo F with MI, quits smoking, changes diet, started on lipitor 40 LDL 180 to 140, TGA 350 to 250, in about 3 months, HDL 48, you increased lipitor to 80……. now….. 8 wks later with genralized myalgias, CPK 75, AST/ALT 30/40?

Answer 26

statin induced myalgia
Best management - decrease dose of lipitor to 40

now patient tolerated reduced dose but LDL showed less than 50% drop in LDL.. wtd? add extimibe or bile acid sequesterant… if still doesn’t work then add PCSK9 inhibitor

Question 27

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 27

Statin induced myopathy 2/2 to HMGCR

Question 28

Hyperlipidemia in pregnancy

Answer 28

Colesevelam (welchol)

Question 29

Lipitor 40-> 80 - AST/ALT up but not 2x ULN, LDL now 80 from 180 , HDL now 59 from 40, wtd?

Answer 29

continue current dose.

you decrease statin if LFTs s-5x above normal, and dc if >5x above normal.

Question 30

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

Answer 30

Lp(a) (dec’d HDL)

tx: Niacin

Question 31

Prevention of flushing aw Niacin

Answer 31

ASA 30min prior

Question 32

Pt on simvastatin with weakness CPK 850, wtd

Answer 32

d/c simvastatin

Question 33

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

Answer 33

No need for meds

Question 34

The MC heritable hyperlipidemia is familial combined hyperlipidemia. the best test would be ..

Answer 34

Apo protein B

Question 35

eruptive xanthomas.. most likely deficit is

Answer 35

C2 deficiency