04-12-2007, 07:07 PM
A 29-year-old truck driver comes to the health center for advice regarding his serum cholesterol concentration, which was determined recently at a shopping mall health fair. He had the test at the request of his wife, who is pregnant with their first child. The test result read "high," with advice to see a physician. The patient has a family history of premature coronary artery disease. Two uncles had myocardial infarctions (MI), one at age 41 years and the other at age 45 years. His father died of an MI at age 47 years. He tells you that his 34-year-old brother takes "some type of cholesterol pill." The patient has no significant medical history. He denies smoking cigarettes but admits to drinking a few beers in the evenings at home. Two to three times per week he meets his friends at a local tavern before driving home. He is currently taking no medications, and his physical examination is normal except for mild obesity. A fasting serum lipid profile was done 2 days ago at the suggestion of the nurse who took his history by phone. Results are available today and show:
Serum
Cholesterol
Total
171 mg/dL
HDL
29 mg/dL
LDL
117 mg/dL
Triglycerides
156 mg/dL
Item 1 of 2
23. To evaluate his risk for cardiac disease, in addition to his serum lipid concentrations it is appropriate to obtain which of the following serum laboratory studies?
A
) Angiotensin II concentration
B
) Apolipoprotein B concentration
C
) Endothelin concentration
D
) Homocysteine concentration
E
) Lipoprotein lipase concentration
Item 2 of 2
24. With respect to his alcohol intake, it is most appropriate to do which of the following?
A
) Determine if his uncles and father drank and whether it affected their lipid levels
B
) Encourage him to continue drinking in moderation given his lipid analysis
C
) Investigate the risk of his drinking while driving his truck
D
) Recommend that he switch from beer to red wine
E
) Recommend that he switch to a low-calorie beer
Serum
Cholesterol
Total
171 mg/dL
HDL
29 mg/dL
LDL
117 mg/dL
Triglycerides
156 mg/dL
Item 1 of 2
23. To evaluate his risk for cardiac disease, in addition to his serum lipid concentrations it is appropriate to obtain which of the following serum laboratory studies?
A
) Angiotensin II concentration
B
) Apolipoprotein B concentration
C
) Endothelin concentration
D
) Homocysteine concentration
E
) Lipoprotein lipase concentration
Item 2 of 2
24. With respect to his alcohol intake, it is most appropriate to do which of the following?
A
) Determine if his uncles and father drank and whether it affected their lipid levels
B
) Encourage him to continue drinking in moderation given his lipid analysis
C
) Investigate the risk of his drinking while driving his truck
D
) Recommend that he switch from beer to red wine
E
) Recommend that he switch to a low-calorie beer