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Thread: Cardio#1

  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    Cardio#1

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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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    why even bother with the obvious. Just know where you are need it and where you can help the most.

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    Bubbamier is offline Newbie 510 points
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    B. High levels of homocysteine levels could be the cause of the premature MI of his father. Homocysteine is a known risk factor for coronary artery disease. The lipid profile should be measured only as follow up.
    -------------------
    Dr. Mier
    -------------------

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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.

    Moderator: USMLE AND Residency Forums.

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    why even bother with the obvious. Just know where you are need it and where you can help the most.

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