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mazinger
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10/24/06 - 05:11 PM       #1

42. A 42-year-old man comes for a routine health maintenance examination. There is no family history of coronary artery disease, and he does not smoke. His weight is appropriate for his height. His blood pressure is 120/80 mm Hg. Serum lipid studies show a total cholesterol level of 190 mg/dL, HDL-cholesterol level of 40 mg/dL, and triglyceride level of 150 mg/dL. Which of the following is the most appropriate next step in management?

A
) Recommend the Step 2 National Cholesterol Education Program diet

B
) Measure serum LDL-cholesterol level now

C
) Measure total serum cholesterol level in 5 years

D
) Prescribe prophylactic aspirin

E
) Begin treatment with lovastatin

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sheena2005
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10/24/06 - 06:18 PM       #2

B for no. 42

sheena2005
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10/24/06 - 06:21 PM       #3

B for no 33

sheena2005
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10/25/06 - 06:32 AM       #4

what r the coresct answers mazinger

doc68
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10/25/06 - 09:58 AM       #5

33- smoking

doc68
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10/25/06 - 09:59 AM       #6

42--A

mazinger
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10/25/06 - 03:01 PM       #7

Dear Sheena these are nbme's so there is no official correct answer or rationale..
First one I think is occupation and in the second one I am not sure wether picking measuring in five years from now or prescribing a diet. This patient has no risk factors and TOTAL cholesterol levels that are within the normal range for him. His LDL should be below 160 mg/dL which is optimal for his condition.
Diet never hurts anyone, and we should all eat healthy but from my perspective its not mandatory.. Anyways I dont know the right answer... But I go for C

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Guptashutosh
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10/26/06 - 04:02 AM       #8

wel i `ve a diff view
for 33) i`d suggest smoking cessationg , 12 of occ exposure alone might not give mesothelioma is smoking that added to his problem, so smoking for such a prolong duration has lead to this condition, agree with doc 98
for 42) C. the values r not so odd now , better to get the pt revaluated after 5 yrs with sr chol , since he donot have any family history,
thats my point of view , any suggestions r welcome
good luck

cerebral
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10/26/06 - 07:59 AM       #9

My view is smoking cessation can "decrease" the incidence and/or severity of bronchogenic ca but cannot "prevent" mesothelioma. So the only option which could have probably "prevented" pleural plaques(mesothelioma?) and a pleural based mass from occuring is his occupation.
For 42 LDL=toal cholesterol(190)-HDL(40)-TG/5(150/5)=120=very low risk with no other risk factors, so evaluate after 5 yrs--option C.

Edited by cerebral on 10/26/06 - 05:54 PM

mazinger
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10/26/06 - 04:22 PM       #10

Guys smoking doesnt increase the risk of mesothelioma, it increases the risk of bronchogenic Ca by 70-80 fold in patients with asbestosis..
Besides pleural plaques are not synonimus of mesothelioma, and this patient also has a peripheral mass lesion.. The question doesnt ask what made this patient have cancer, it asked what made this patient have abnormal findings in the Chest Xrays, which include pleural plaques and a mass..
C ya...


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mazinger
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10/26/06 - 04:23 PM       #11

cerebral wrote:

For 42 LDL=toal cholesterol(190)-HDL(40)-TG/5(150/5)=120=very low risk with no other risk factors, so evaluate after 5 yrs--option C.


COOL where did you get this formula from??
Nice!



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