lipid Q

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Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

lipid Q

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mash
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Topics: 147
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03/25/05 - 09:35 PM

A 60-year-old white male just moved to town and needs to establish care for coronary artery disease. He had a heart attack last year, but gradually eliminated several prescription medications (he does not recall the names) that he was on at the time of hospital discharge. However, he has been very conscientious about low-fat, low-cholesterol eating habits. Past history is negative for hypertension, diabetes, or smoking. The lipid profile you obtain shows the following:

Total cholesterol: 210 mg/dL
Triglycerides: 190
HDL: 52
LDL (calculated): 120

To optimally treat his lipid status, you suggest which of the following?
A. Continue dietary efforts
B. Add an HMG-CoA reductase inhibitor (statin drug)
C. Add a fibric acid derivative such as gemfibrozil
D. Review his previous medications and resume an angiotensin converting enzyme inhibitor

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dev
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Topics: 70
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03/25/05 - 10:00 PM

is it B??

prep4usmle
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Topics: 288
Posts: 1,184

03/25/05 - 10:14 PM

Target LDL in the presence of CAD is less than 100:
- lifestyle modifications (diet & exercise) should begin if LDL is more than 100
- medication should be added if LDL is more than 130

I would chose to add a statin because dietary efforts are not effective achieving the target LDL. Don't forget the exercise too.

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mash
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Topics: 147
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03/25/05 - 10:56 PM

prepforUSMLE,

thanks a lot ....ans is statins but i wasn't sure abt the reason..
(because i thought medication should be added if LDL is more than 130 )

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prep4usmle
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03/25/05 - 11:09 PM

"mash" wrote:
ans is statins but i wasn't sure abt the reason..
(because i thought medication should be added if LDL is more than 130 )

True ... on the very first initial evaluation of the patient the answer was diet & exercise but now they failed in this case so we'll go ahead to reach our target.

Don't forget to regularly check liver enzimes on patients on statins and also to check CPK if they have muscle cramps. :wink:

If you want to do some research find out the percentage of the patients where lifestyle modifications fail to control the hyperlipemia, I know it is pretty high but I forgot what it is.

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lndkrn
Forum Newbie

Topics: 2
Posts: 5

03/27/05 - 07:44 PM

hey mash...can you tell me where you got this Q from?...thanks

mash
Forum Fanatic

Topics: 147
Posts: 1,326

03/27/05 - 09:36 PM

"lndkrn" wrote:
hey mash...can you tell me where you got this Q from?...thanks

its from usmleasy.com

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