Answers to Hyperlidemia Questions

  1. In all adults age 20 or older – how often would you perform a fasting lipoprotein profile screening (total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglyceride):

The correct answer is d. According to ATP III screening standards, all adults should have a  9 – 12 hour fasting lipoprotein profile (total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglyceride) performed once every five years. Adults with hypertension, obesity, or diabetes should have surveillance fasting lipoprotein profile drawn more frequently (every 6 months to annually) as these groups have a higher risk of hyperlipidemia and metabolic syndrome.

  1. Patients with hyperlipidemia and coronary artery disease or coronary artery disease equivalents have extremely high morbidity and mortality. A physician should consider treatment with:

The correct answer is d. According to ATP III treatment standards, patients with hyperlipidemia and coronary artery disease or coronary artery disease equivalents, physicians should consider treatment with therapeutic lifestyle changes and drug simultaneously due to the extremely high morbidity and mortality risk. Recent studies suggest that high intake of omega-3 fatty acids may reduce risk of major coronary events in persons with established coronary heart disease, but simultaneous therapeutic lifestyle changes and drug therapy should be considered first in this high risk group.

  1. A basic principle of prevention is that the intensity of risk-reduction therapy is adjusted based on the individual’s absolute risk. Absolute risk is:

The correct answer is b. Relative risk is used to compare the risk in two different groups of people such as the obese versus the non-obese. Incidence is the number of new cases of disease occurring in a population during a defined time interval. Prevalence is the total number of cases of a given disease in a specified population at a specified time. Absolute risk is an individual’s risk of developing a disease over a time-period. A basic principle of prevention is that the intensity of risk-reduction therapy is adjusted based on the individual’s absolute risk.

  1. Mrs. Monique Washington is a 42 year old African American female who comes to your office for follow up of her hyperlipidemia (elevated LDL only) and high blood pressure. She takes hydrochlorothiazide and simvastatin only. She has never smoked tobacco, and reports no alcohol or drug use. Her father, age 65, is alive and has hypertension and glaucoma. Her mother is age 60, and has diabetes. She has no siblings or children. Today her blood pressure is well controlled at 130/72 on her diuretic. Her weight is 160 lbs and her height is 5’ 6”. Her BMI is 25.8 and waist circumference is 32 inches. Her urine microalbumin and recent fasting glucose (95 mg/dL) serology were within normal limits.
    • Fasting cholesterol panel prior to her statin:

Total Cholesterol 245
LDL 195
HDL 50
Triglycerides 140

    • Fasting cholesterol panel on her statin:

Total Cholesterol 189
LDL 115
HDL 55
Triglycerides 138

                According to the Adult Treatment Panel III criteria for metabolic syndrome, Mrs. Washington:

The correct answer is d. Clinical identification of metabolic disorder requires that any three of the following be present: abdominal obesity defined in men as >102 cm (>40 in) and in women >88 cm (>35 in); triglycerides  ≥150 mg/dL; an HDL cholesterol that is less than 40 mg/dL and less than 50 mg/dL in women; blood pressure that is ≥130/ ≥85 mmHg or if the patient is being treated for hypertension; a fasting glucose that is  ≥110 mg/dL or if the patient is being treated for diabetes or glucose intolerance. Mrs. Washington is being treated for hypertension and hyperlipidemia (elevated LDL only), and thus does not have a third condition to be present to clinically identify her as having metabolic syndrome. A positive family history of diabetes or hypertension is not one of the conditions that needs to be present to identify metabolic syndrome.

  1. In our multicultural society, physicians must understand how each patient’s socio-cultural background affects his or her health beliefs and behaviors, and must take the time to assess the patient’s understanding of their illness (Kleinman, et al. Ann Internal Med 1978). Which of the following is not an expected result using this method?

The correct answer is e. Acquiring effective listening skills and taking the time to understand your patients’ understanding of their illness can avoid unnecessary medical testing and improve clinical diagnosis and management. It also promotes culturally appropriate health education, leads to better understanding between physicians and their patients, and improves patient adherence with their medical regimen. This approach also increases patient satisfaction with their physician.