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Old 10-20-2011
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Question Screening a an overweight person with strong family history of MI

A 48-year-old man comes to the clinic for initial evaluation. He denies symptoms of chest pain, shortness of breath, or palpitations. He denies any prior medical history. He is on no medications. He does report very strong family history of myocardial infarction. The patient denies alcohol intake, smoking, or drugs. Examination reveals a moderately obese patient with a body mass index of 29. Heart rate is 92/min; blood pressure is 115/82 mm Hg. The remainder of the examination is unremarkable. His electrolytes and complete blood count are unremarkable. As part of the evaluation, a panel of triglycerides, high-density lipoprotein, total cholesterol, and low-density lipoprotein is obtained. Which of the following should also be obtained in this patient as part of his initial evaluation?
A. Measurement of his erythrocyte sedimentation rate
B. Measurement of C-reactive peptide
C. Measurement of lipoprotein (a)
D. Measurement of homocysteine
E. Measurement of plasma glucose
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Old 10-20-2011
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i would check glucose for DM
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E. Measurement of plasma glucose
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E. Measurement of plasma glucose - a patient with risk for CAD should be checked for DM risk.
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also anyone with 45 +ve age needs FBS screening.
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E. Measurement of plasma glucose
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The correct answer is E. Cardiac risk factors include cigarette smoking, high blood pressure, elevated lipids, and diabetes. Diabetes mellitus is a major cardiovascular risk factor. It is highly prevalent and predisposes patients to atherosclerotic disease. Given this patient’s elevated body mass index, he is at high risk for glucose intolerance. Thus, his plasma glucose level should be measured.

Elevated erythrocyte sedimentation rate (choice A) is an indication of inflammation. Recent research has underscored the relationship between inflammation and heart disease. Typically, C-reactive protein has been studied for this relationship.

Measurement of C-reactive peptide (choice B) in patients with heart disease has shown a relationship with elevated peptide levels. These are considered to be “putative” risk factors.

Similarly, lipoprotein (a) (choice C) may be elevated in patients with heart disease. However, this is not considered a traditional risk factor.

Homocysteine (choice D) has gained recent attention for its relationship with carotid disease. However, it has not yet been accepted as a routine measure for assessing coronary disease risk.
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