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31 Cards in this Set
- Front
- Back
General objective of lipid control?
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Reduce CHD risk and prevent pancreatitis (in extreme cases of hypertriglyceridemias)
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Classification of lipid disorders
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1. Isolated hypercholesterolemia (mild--> moderate --> severe)
2. Isolated hypertriglyceridemia (mild--> moderate --> severe) 3. Mixed hyperlipidemia |
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Effects of lipid level normalisation and the associated CHD risk? Basis for HDL relevance?
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1. In the LRC study a 9% cholesterol reduction resulted in an 18% decrease in CHD risk. Similar results were obtained in the Helsinki studies.
2. 2-3% reduction in CHD risk for every 1mg/dL of HDL. Both animal and regression studies support these findings. |
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Most dangerous lipid disorder?
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1. Massive increase in LDL (which is rare)
2. High cholesterol/LDL and low levels of HDL is more common, and is almost dangerous |
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Target value of lipids?
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>200mg/dL
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What is the most common dyslipidemia?
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Mixed dyslipidemia
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Lipid levels should be measured in?
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1. Those at risk (FHx, diabetes, etc)
2. All adults over 25, every 5th year. More frequent in smokers, obese people, diabetics, etc. |
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Lipid target values for children?
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Cholesterol levels of:
1. <170mg/dL - Acceptable 2. 170-189mg/dL - Borderline 3. >200mg/dL - High |
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In normal individuals, serum glycerol levels are negligible, however, in some patients these levels are really high. Which conditions may cause a high serum level of glycerol?
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1. Diabetes mellitus
2. Renal failure treated by hemodialysis |
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What is the use of the cold flotation test?
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Distinguishes between TG elevation from dietary sources (TGs packed in chylomicrons) or if they're endogenous (VLDLs produced in the liver). A creamy top layer indicates nonfasting sample or deficit in lipoprotein lipase)
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How would you measure LDL levels indirectly?
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Friedewald's formula:
1. LDL-C=Total Cholesterol - HDL C - (triglycerides/5 [if mg/dL]) 2. LDL-C=Total Cholesterol - HDL-C - (triglycerides/2.2 [if mmol/L]) |
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Substances or conditions that may interfere with cholesterol analysis?
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1. Bilirubin
2. Hemolysis 3. Lipemia 4. Ascorbic acid |
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Drugs that are effective at lowering triglycerides and raising HDL?
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1. Nicotinic acid
2. Fibrates |
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What is the HELLP syndrome?
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HELLP is an abbreviation of the three main features of the syndrome:
1. Hemolysis 2. Elevated Liver enzymes 3. Low platelet count |
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Possible reasons for the increased morning levels of lipids?
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1. Increased lipolysis
2. Increased hepatic uptake of non-esterified fatty acids (NEFA) 3. Increased hepatic secretion of lipoproteins |
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Total cholesterol levels vary with the menstrual cycle. At which point is the total cholesterol at a high? Low? What about VLDL?
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1. Highest seen in follicular phase
2. Lowest in the menstrual phase 3. Increase in VLDL and decrease in LDL during luteal phase (possibly owing to estrogen) |
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Effect of surgery on lipid levels?
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Decrease in both cholesterol and triglyceride concentrations
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What effect does posture have on lipid levels?
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Serum cholesterol and triglyceride levels are higher when standing, differences being as much as 9%-19%
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Inheritance of familial hypercholesterolemia?
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AD
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What is Abetalipoproteinaemia?
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AR disorder, extremely low serum cholesterol levels. Malabsorption of lipids and fat soluble vitamins. Acantocytes in blood.
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HDL-modifying plasma enzymes and transfer proteins?
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1. LCAT
2. CETP 3. PLTP 4. Lipoprotein lipase 5. Hepatic lipase 6. Endothelial lipase |
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What is "Fish Eye Disease"?
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Partial deficiency of LCAT
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What is Tangier disease?
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1. Familial alpha-lipoprotein deficiency.
2. AD inheritance, mutation in both alleles of ABC1 |
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Common findings in both types of LCAT deficiency?
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1. Markedly reduced HDL-C and apoA-I levels
2. Rapid catabolism of apoA-I and apoA-II 3. Corneal arcus 4. Premature atherosclerotic vascular disease |
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Unique features of complete LCAT deficiency?
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Proteinuria and progressive renal insufficiency
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Inheritance of CETP deficiency?
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Autosomal co-dominant
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Features of CETP deficiency?
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1. Markedly elevated HDL-C and apoA-I levels
2. Delayed catabolism of HDL, HDL particles enlarged 3. No evidence of protection against atherosclerosis |
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Inheritance of familial hyperlphalipoproteinemia?
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AD; molecular etiology unknown
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Features of familial hyperalphalipoproteinemia?
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1. Modest to marked elevations in HDL-C and apoA-I
2. Selective increased synthesis of apoA-I in some families 3. Assoiated with longevity and protection against atherosclerotic vascular disease |
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Inheritance of hepatic lipase deficiency?
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AR
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In general, tests for specific genetic mutations are not performed in CAD. What are the reasons for this?
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1. It is not clear how much additional information will better treatment
2. The best way to avoid CAD is to modify lifestyle |