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nbme1

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doctor75
Forum Senior

Topics: 14
Posts: 58

02/20/07 - 11:57 AM

aymptomatic 47yr man comes for preemployment examn.never hospitlized.computer progrmammer,plays handball once a week.his maternal grandma had type 2 diabetes mellitus,paternal uncle had heat disease.bp now 126/80.examn normal.his total serum cholesterol level 225mg/dl.which is the most appropriate next step in management?
a step2 american heart association cardiac diet
b serum lipid studies while fasting.
c exercise stress test
d oral cholestyramine and niacin therapy
e oral pravastatin at bedtime

please explain

mjl1717
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02/20/07 - 01:24 PM

Id say the current national trend is to be aggressive with statins, so I go with answer---e pravastatin.. . although low cholesterol diet supposedly would lower his cholesterol 15% and place him within normal levels.. answer-b means you are a non-aggressive doc ... Im letting the "increase the mortality factor" drive me!

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Aashi
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02/20/07 - 01:53 PM

B)---> serum lipid studies while fasting.

I am a non-aggressive doc ,mjl1717 wink

, he is asymptomatic , no hx of ASCAD except for family hx... moreover u put someone on lipid lowering diet or on drugs ,all based on the LDL levels and not on Total cholestrol levels..

GL wink

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doctor75
Forum Senior

Topics: 14
Posts: 58

02/20/07 - 03:19 PM

thanks for the explanations.even answered testing fasting levels.
is there a cut off for testing fasting lipid levels or do we test in every patient with high serum cholesterol?thanks

mjl1717
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02/20/07 - 05:15 PM

Aashi wrote:
B)---> serum lipid studies while fasting.

I am a non-aggressive doc ,mjl1717 wink

, he is asymptomatic , no hx of ASCAD except for family hx... moreover u put someone on lipid lowering diet or on drugs ,all based on the LDL levels and not on Total cholestrol levels..

GL wink

OK I just blew that one, Thanks Aashi

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damngood
Forum Newbie

Topics: 0
Posts: 79

02/23/07 - 01:28 AM

i agree with aashe we first need to test the fasting lipid levels before deciding anything

krsna
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Topics: 1
Posts: 211

02/23/07 - 09:30 AM

eaguin
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Topics: 9
Posts: 162

03/13/07 - 08:58 PM

I agree with B

fongch
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Topics: 71
Posts: 316

04/19/07 - 09:05 PM

I don't think fasting is necessary for the measurement of cholesterol level (I read from UW), and diet should definitely be tried first. Therefore I choose A.

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