NMS Q&A Family Medicine

chap ter 38Obesity and DyslipidemiaExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Each of the following is a disadvantage of the weightloss drug Orlistat (xenical) except for which one?(A) Side effect of diarrhea(B) Hypoglycemia(C) Caution when combined with an antidiabeticagent(D) Cholelithiasis as a side effect(E) Side effect of reduction of high-densitylipoprotein cholesterol (HDL-C)2 The 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA) inhibitors (also called “statins”) are extremelyuseful drugs because they lower low-density lipoproteincholesterol LDL-C and triglycerides and raiseHDL-C as well as inhibit the inflammatory processthat plays a role in atherosclerosis. A disadvantage isthe risk of the side effect rhabdomyolysis that occursin susceptible patients in proportion to dosage. Inaddition to the dosage, each of the following is riskfactor for rhabdomyolysis in patients taking statinsexcept for which one?(A) Diabetes mellitus(B) Renal insufficiency(C) Concomitant drugs including amoxicillin(D) Age(E) Small frame3 Regarding rhabdomyolysis associated with statintherapy, the most significant sequela is acute renalfailure. Which of the following defines the syndromein someone known to be taking one of the drugs inthe statin family?(A) Myalgias(B) The occurrence of renal failure(C) Elevation of creatine phosphate (CK)(D) Tenfold elevation of CK levels(E) Onset of symptoms within 6 months ofinstitution of the medication4 A 45-year-old man sees you for a “checkup,” havingnot seen a physician since the age of 35. His olderbrother died recently after a myocardial infarction atthe age of 49 and his father died at the age of 55 ofheart disease. The patient has smoked for 25 yearsbut quit after the death of his brother. His weight is165 lb (74.8 kg) at a height of 5 ft, 9 in. (1.75 m). Hisblood pressure is 135/88. You measure his lipids andfind the following: total cholesterol (TC), 240 mg/dL;HDL-C, 37 mg/dL; LDL-C, 155 mg/dL; triglycerides,300 mg/dL. Which of the following is the best therapeuticplan for this patient?(A) Advise weight loss to the ideal, 160 lb (72.5 kg),and repeat lipid screen after 2 months(B) Start a lipid-lowering agent and repeat the lipidscreen after 1 month(C) Start the patient on a low-carbohydrate diet toprevent diabetes(D) Start the patient on a low-fat diet and repeat thelipid screen in 2 months(E) Reassure the patient that because he has stoppedsmoking, he need not be further concernedabout his cardiovascular status5 If drug therapy were chosen for the patient in Question4, which of the following would be the bestselection?(A) Nicotinic acid(B) Fibric acid derivative(C) Metformin(D) An HMG-CoA inhibitor(E) Cholestyramine6 A 23-year-old man weighs 180 lb (81.5 kg) at a heightof 5 ft, 10 in. (1.78 m). The patient has no family historyof cardiovascular disease, and there is no dyslipidemiain his family’s history. He has neversmoked. He is concerned about his weight becausehis mother is significantly overweight and his fatheris modestly overweight, neither of whom has diabetesor cardiovascular disease. His TC is 240 mg/dL;his HDL-C is 53 mg/dL; his LDL-C is 110 mg/dL;235