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nbme5

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intern_doc
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08/22/05 - 11:12 PM

A 52-year-old woman with alcoholism comes to the physician after a serum cholesterol level of 290 mg/dL was found on a routine screening. She drinks a pint of vodka daily. She takes captopril for hypertension and glyburide for type 2 diabetes mellitus. She also has intermittent episodes of gout. Fasting serum studies show:

Total cholesterol 252 mg/dL
HDL-cholesterol 80 mg/dL
Triglycerides 300 mg/dL
Glucose 118 mg/dL
Thyroid-stimulating hormone 4.5 ìU/mL

Which of the following is the most appropriate next step in management?

A) Alcohol cessation

B) Better control of diabetes

C) Switch from captopril to calcium-channel blocking agent therapy

D) Gemfibrozil therapy

E) Thyroid replacement therapy

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nisha
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08/22/05 - 11:30 PM

a

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chemamr
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08/23/05 - 06:14 AM

go with A, too

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tamar
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08/23/05 - 07:19 AM

A. more safer choice in this case

intern_doc
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08/23/05 - 11:45 AM

A. is the best choice
remember that HDL is decrease by SMOKING,androgen, progersterone, and hypertriglyceride

B. cant b/c the problem is not her DM, it's her cholesterol
C. ACE is prefer in DM + HTN, so why would you switch
D. this is correct too, but I would stop smoking first
E. thyryoid rx....i dont think so

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JH
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09/26/06 - 04:06 PM

Why not choose D? her Total cholesterol is hight enough to start drug treatment.

The HDL-cholesterol (80 mg/dL) is good. Although she drinks a lot, does the alcohol afect LDL?

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