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  #1  
Old 01-28-2014
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. A 52-year-old woman with alcoholism comes to the physician after a serum cholesterol level of 290 mg/dL was found on a routine screening. She drinks a pint of vodka daily. She takes captopril for hypertension and glyburide for type 2 diabetes mellitus. She also has intermittent episodes of gout. Fasting serum studies show:

Total cholesterol 252 mg/dL
HDL-cholesterol 80 mg/dL
Triglycerides 300 mg/dL
Glucose 118 mg/dL
Thyroid-stimulating hormone 4.5 μU/mL

Which of the following is the most appropriate next step in management?

A
) Alcohol cessation

B
) Better control of diabetes

C
) Switch from captopril to calcium-channel blocking agent therapy

D
) Gemfibrozil therapy

E
) Thyroid replacement therapy
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  #2  
Old 01-28-2014
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i think its A
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  #3  
Old 01-28-2014
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i think also its A..all others are not make sence...gemfibrozil is wrong,glucose controle..its 118 so its good controlled, captopril to ccb i dont think so cause DM +HTN=ACEi is DOC....
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Old 01-28-2014
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thyroid replacememt may be.. she has hypercholestrolemia due to subclinical hypothyroidism I guess. and she has DM which is a cad equivalent. . so treatment will be excercise and statins. not fibrates
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Old 02-01-2014
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why not gemfibrozil???? fibrates can also be used to lower TGs and cholesterol.
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Old 02-02-2014
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as a treatment for hyerlipidemia fisrt drug is statins...Gemfirozil ususaly use as combinattion
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Old 02-02-2014
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I chose gemfibrozil too, but i was thinking about thyroid replacement cause i thought the tsh was high, but i just chose the other because there wasn't any thyroid symptoms, plus the high cholesterol was made clear 2 times in the question.
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Old 02-03-2014
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Quote:
Originally Posted by ecgram View Post
. A 52-year-old woman with alcoholism comes to the physician after a serum cholesterol level of 290 mg/dL was found on a routine screening. She drinks a pint of vodka daily. She takes captopril for hypertension and glyburide for type 2 diabetes mellitus. She also has intermittent episodes of gout. Fasting serum studies show:

Total cholesterol 252 mg/dL
HDL-cholesterol 80 mg/dL
Triglycerides 300 mg/dL
Glucose 118 mg/dL
Thyroid-stimulating hormone 4.5 μU/mL

Which of the following is the most appropriate next step in management?

A
) Alcohol cessation

B
) Better control of diabetes

C
) Switch from captopril to calcium-channel blocking agent therapy

D
) Gemfibrozil therapy

E
) Thyroid replacement therapy

i'll go wid thyroid replacement therapy
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Old 02-03-2014
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I feel the answer is A. Alcoholism is known to cause elevated TG levels. Her increased total cholesterol is probably due to elevated TG. Rest of the labs are fine.

so first step would be to stop alcohol consumption and later look for lipid profie. If then, it remains abnormal, then you would investigate for the elevated cholesterol levels.
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Old 02-06-2014
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Default A

high TG and Gout, with normal TSH levels. Alcohol cessation seems 1st TOC
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