Multiple Choice Questions (MCQ)

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Category: Cardiology--->Hyperlipidemia
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Question 6# Print Question

Many randomized clinical trials (RCTs) and meta-analyses have contributed to the lipid management guidelines over the past two decades.

Which of the following statements is NOT correct?

A. PROVE-IT/TIMI-22 showed that individuals post myocardial infarction (MI) treated with the more potent statin atorvastatin versus pravastatin had a 16% relative risk reduction
B. The JUPITER trial demonstrated that in individuals without documented cardiovascular disease (CVD) and median LDL-C of 108 mg/dL, aggressive statin therapy with rosuvastatin offered greater benefit in individuals with ultrasensitive C-reactive protein (usCRP) >2 versus <2 mg/L
C. Primary prevention hypertensive patients in the ASCOT-LLA trial showed reductions in nonfatal MI, CHD death but not all-cause mortality when patients with average lipids and hypertension were treated with atorvastatin 10 mg daily for an average of 3.3 years
D. WOSCOPS and AFCAPS/TexCAPS were both primary CHD prevention studies, which showed significant clinical benefits for statin therapy, with similar percentage reductions in LDL-C. The main difference between these trials was that subjects in AFCAPS/TexCAPS had considerably lower baseline LDL-C levels than those in WOSCOPS
E. Meta-analyses have demonstrated a >20% reduction in CHD events for every 1 mmol/L reduction in LDL-C with similar proportional reductions in diabetics versus nondiabetics. Similar percent reductions were seen even in lower-risk groups with <5% 5-year risk for CVD

Question 7# Print Question

The Framingham Risk Score (FRS) was popularized in the National Cholesterol Education Project: Adult Treatment Panel (NCEP ATP) III guidelines.

Potential limitations of the FRS include the following:

1. Does not take family history into account

2. May overestimate lifetime risk in individuals ≤50 years of age with ≥1 NCEP risk factor

3. May not accurately calculate risk in certain ethnic groups because original Framingham population was almost entirely of European origin

4. Incorporates risk due to insulin-resistant conditions such as metabolic syndrome

5. Does not include emerging risk factors such as CRP, lipoprotein(a), and apoB

A. All of the above
B. 1, 3, and 5
C. 1, 3, 4, and 5
D. None of the above

Question 8# Print Question

Based on the definition proposed by the NCEP ATP III guidelines, metabolic syndrome would be present if three or more of five criteria were present.

Which of the following is NOT one of the criteria?

A. BP ≥130/≥85 or on treatment for hypertension
B. TGs ≥150 mg/dL
C. HDL-C of <40 mg/dL in men and women
D. Fasting glucose =100 mg/dL
E. Waist circumference of >40 inches in men and >35 inches in women

Question 9# Print Question

NCEP ATP III was published in 2001. Modifications to NCEP ATP III published in 2004 include all of the following except that:

A. LDL-C goal <70 mg/dL is a therapeutic option for very high-risk patients
B. LDL-C goal <70 mg/dL extends to patients at very high risk even with baseline LDL-C <100 mg/dL
C. factors that favor the optional goal of <70 mg/dL include CVD plus multiple major risk factors (especially diabetes), severe and poorly controlled risk factors (especially smoking), metabolic syndrome, and acute coronary syndromes
D. for moderately high-risk patients, LDL-C <100 mg/dL is an option with consideration of initiation of therapy with statins for LDL-C between 100 and 130 mg/dL
E. both higher-dose statins and addition of fibrates and niacin to achieve non–HDL-C goals should be considered to achieve secondary targets and to further reduce cardiovascular event rate

Question 10# Print Question

A 53-year-old obese, sedentary woman undergoes lipid screening, revealing TC of 310, TG of 720, HDL-C of 41. LDL-C was not calculated due to elevated TG. HbA1c is 5.9 and thyroid-stimulating hormone (TSH) is normal. NCEP ATP III guideline recommendations for TGs and HDL-C management include all but which of the following:

A. If TGs are ≥500 mg/dL, then TG is the primary target with use of therapeutic options to prevent pancreatitis including fibrates or niacin before LDL-lowering therapy, than treat LDL-C to goal
B. In patients attaining LDL-C goals, those with TG ≥200 mg/dL have an increased cholesterol content of TG-rich, atherogenic lipoprotein particles. Non–HDL-C takes into account cholesterol in these and LDL particles and is a secondary target for therapy
C. Therapeutic goal for TG is <150 mg/dL and for HDL-C is >40 in men and >50 in women
D. HDL-C <40 mg/dL is defined as low and is a risk factor for CVD
E. Non–HDL-C goal equals the LDL-C goal +30 mg/dL

Category: Cardiology--->Hyperlipidemia
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