Clinical Cases - Part I
Today, you have three patients here to see you: Mr. Mark Guttman, Mrs. Maria De Los Santos, and Mr. Nelson Nguyen. All three patients in these case scenarios are here to see you after an initial fasting cholesterol screen. Feel free to use handheld organizer programs or the internet to answer the questions.
Case One: Mark Guttman is a 39 year old white male living in Stamford, Connecticut. Mr. Guttman is here to see you for a follow up to an initial routine health care maintenance exam.
- Past Medical History
- None
- Not on any medications
- No known allergies
- Social History
- Smokes tobacco ¼ pack a day
- Occasional EtOH at social functions only
- No drug use
- Works as a teacher in a middle school
- Was born in Westchester County, NY and lived in Connecticut is entire life
- Single, Not sexually active currently
- Family History
- Father is alive and healthy, Age 60
- Mother has diabetes, Age 59
- No siblings or children
- Pertinent Physical Exam
- BP 135/80
- Weight 190 lbs
- Height 5’ 9”
- BMI 28.1
- Waist Circumference 38 inches
- Fasting Cholesterol Panel
- Total Cholesterol 220
- LDL 162
- HDL 38
- Triglycerides 165
What is Mr. Guttman’s 10-year cardiovascular risk category?
The correct answer is B. Mr. Guttman has 2 risk factors – he smokes tobacco and his HDL is low. According to the Framingham point score system – he falls into the 10-year risk category of 10-20%.
Case Two: Maria De Los Santos is a 67 year old Dominican female living in Washington Heights. She has been your patient for 8 years and is here to discuss the results of her fasting lipid panel.
- Past Medical History
- Diabetes, Hypertension
- Meds – Metformin, Ramipril only
- No known allergies
- Social History
- Has never smoked tobacco
- No alcohol use
- No drug use
- Worked as an office administrator and retired 2 years ago
- Was born in Santiago, Dominican Republic and moved to New York City 37 years ago
- Married, and sexually active currently in monogamous relationship
- Family History
- Father is alive and has diabetes, hypertension, and peripheral vascular disease, age 87
- Mother has diabetes, age 88
- Brother has diabetes, age 65
- She has 3 adult children that are all healthy
- Pertinent Physical Exam
- BP 145/81
- Weight 210
- Height 5’ 8”
- BMI 31.9
- Waist Circumference 42 inches
- Fasting Cholesterol Panel
- Total Cholesterol 189
- LDL 115
- HDL 56
- Triglycerides 179
What is Mrs. De Los Santos 10-year cardiovascular risk category?
The correct answer is A. Mrs. De Los Santos has diabetes which is a CHD risk equivalent. She has a >20% 10-year CHD risk.
Case Three: Nelson Nguyen is a 43 year old Vietnamese male living in Castro Valley, CA. He has been your patient for 5 years and is here to discuss the results of his fasting lipid panel. He had been lost to follow up to your practice for 2 years. He was taking only hydrochlorathizide (was buying it on own over past 2 years – you added a second hypertension med at the last visit)
- Past Medical History
- Hypertension
- Meds – Now taking hydrochlorathizide and a beta blocker
- Allergies - Penicillin
- Social History
- Smokes tobacco – 1 pack a day
- No alcohol use
- No drug use
- Works as a coffee shop manager
- Was born in Quy Nhon, Vietnam and immigrated to the United States at age 23
- Married, and sexually active currently in monogamous relationship
- Family History
- Father died at age 47 of unknown causes
- Mother is alive and healthy in Vietnam, age 65
- Older brother died of a myocardial infarction at age 45
- Has 2 sons that are healthy and in college
- Pertinent Physical Exam
- BP 160/90
- Weight 200
- Height 5’ 6”
- BMI 32.3
- Waist Circumference 39 inches
- Fasting Cholesterol Panel
- Total Cholesterol 272
- LDL 188
- HDL 42
- Triglycerides 202
What is Mr. Nguyen’s 10-year cardiovascular risk category?
The correct answer is A. Mr. Nguyen has hypertension, smokes cigarettes, and has a family history of premature CHD in a first degree relative who was less than 55 years of age at the time of their event. He has 2+ risk factors but a 10-year risk of greater than 20%.