darkhorse
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A 42-year-old man comes to your office for a risk assessment for coronary artery disease. He is 178 cm (70 inches) tall and weighs 75 kg (165 Ib); his body mass index is 25. Blood pressure is 126/84 mm Hg. He does not have diabetes, and a lipid panel shows a plasma LDL cholesterol level of 120 mg/dL and HDL cholesterol level of 45 mg/dL. The patient runs 4 days a week and does weight training. He has a family history of premature vascular disease. His father died of a myocardial infarction at age 45 years. Which of the following tests should be included in this patients workup?
A. Measurement of serum lipoprotein (a) assay
B. Measurement of plasma homocysteine level
C. High-sensitivity measurement of C-reactive protein
D. Maximal treadmill exercise test
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| aaroho
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C
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| amritt786
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B
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| chemamr
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C
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| tamerbashir
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I DON'T KNOW BUT IAM WITH B
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| Vietnamese
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B is correct - high Homocysteine is another factor for atherosclerosis, MI is an example ( 2 familial conditions result in high homocystein). Actually, his relatives had early MI.
C - C-Reactive Protein is just precipitated factor to show a recent infection (often Mycoplasma pneumonia) and patient is subject to MI.
Vietnamese
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| drduck
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why not D,
patient has the history...
and does exercise and weight lifting...he should know his exercising limits or in other words shud go for stress test...
some one plz tell me....whether high plasma homocystiene levels are associated with normal or deranged serum lipids??
thanks
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| doyoudig
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D. Maximal treadmill exercise test
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| Vietnamese
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The patient runs 4 days a week and does weight training but not complaint at all. That mean the threadmild test is not nescessary.
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| neuroblastoma
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B. Measurement of plasma homocysteine level 
He has a family history of premature vascular disease.
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| darkhorse
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The correct answer is A
Educational Objectives
Identify the most appropriate and cost-effective screening test for coronary artery disease in a low-risk patient.
Critique
Standard guidelines for risk assessment in adults include a routine fasting lipid profile. This profile includes measurements of total cholesterol, LDL and HDL cholesterol, and triglyceride levels. This patients lipid profile findings are unremarkable. Some experts recommend a measurement of serum lipoprotein (a) especially in patients with a strong positive family history. Significant elevation of this lipoprotein is associated with an increased risk for coronary artery disease (CAD). The current NCEP-ATP III guidelines recommend repeating the fasting lipoprotein profile every 5 years. An elevated plasma homocysteine level is a possible risk marker for CAD. However, therapy for hyperhomocystinemia has not been tested in completed randomized trials. The benefits of folic acid and B vitamins are not known; therefore, routine measurement of the plasma homocysteine level is not recommended for risk assessment. High-sensitivity measurement of C-reactive protein is not recommended for routine risk assessment but may be adjunctive for patients in an intermediate risk category. Nevertheless, evidence of systemic inflammation suggests increased vascular risk in patients who have established CAD and in those without overt vascular disease. Observational data show a positive correlation between C-reactive protein levels and CAD events, even when the LDL cholesterol level is normal. Stress (exercise) testing is not recommended for routine assessment of CAD risk in healthy persons, except in those who have a strong risk factor profile or those with high-risk jobs, such as police, firefighters, and pilots.
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| deja_vu
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[quote=darkhorse]The correct answer is A
oh!
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| Vietnamese
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Thank you so much, darkhorse.
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| dudefop
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Thanks for the good question, darkhorse~
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