Acute MI with painless yellow bumps on his elbows, knees, and ankles - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
USMLE Articles
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam

Thread Tools Search this Thread Display Modes
Old 02-10-2010
USMLE Forums Scout
Steps History: Not yet
Posts: 33
Threads: 30
Thanked 60 Times in 24 Posts
Reputation: 70
Heart Acute MI with painless yellow bumps on his elbows, knees, and ankles

A 38-year-old man is brought to the emergency department with crushing chest pain radiating to his left arm and mild shortness of breath that began approximately 30 minutes ago. ECG showed ST-segment elevation in leads II, III, AVF, and V4-V6 and a threefold increase in cardiac enzyme levels. His medical history is negative, but he has a positive family history of “heart problems” in his brother and in several members on his father’s side of the family. Physical examination reveals numerous painless yellow bumps on his elbows, knees, and ankle, which he has had since late childhood. His blood triglyceride level is 130 mg/dL, and his LDL cholesterol level is 320 mg/dL. The remaining laboratory values are unremarkable. Which of the following is the most likely explanation for these findings?
A. Excessive alcohol consumption
B. Inheritance of one mutant LDL cholesterol receptor gene
C. Lack of thyroid hormones
D. Lipoprotein lipase abnormality
E. Resistance to insulin hormone

The correct answer is B. Familial hypercholesterolemia is caused by an absent or defective cell surface receptor for LDL cholesterol molecules. The heterozygous form of this autosomal codominant disorder is associated with elevated LDL cholesterol levels (200-400 mg/dL); normal triglyceride levels; coronary heart disease (CHD) in the 30s-40s; corneal arcus; skin xanthomas on the elbows, knees, and especially the Achilles tendons; and a positive family history of hypercholesterolemia and CHD. The homozygous form is very rare and presents as high levels of LDL cholesterol (>500 mg/dL), symptomatic CHD before puberty, and sudden death usually before age 30 years. Numerous other genetic abnormalities can produce a similar lipid profile and early onset CHD, but they are very rare compared with familial hypercholesterolemia.

Answer A is not correct. Chronic alcohol consumption can cause elevated triglyceride and HDL cholesterol levels. High triglyceride levels typically decline after decreasing alcohol use. This patient has a typical presentation for a genetic disorder of lipid metabolism, with a strong family history, but a secondary cause of hyperlipidemia should always be considered before starting lipid-lowering treatment.

Answer C is not correct. Hypothyroidism is one of the secondary causes of hyperlipidemia. There are no signs of hypothyroidism in either the patient’s history or the physical examination, but any patient who presents with hyperlipidemia should be screened for hypothyroidism.

Answer D is not correct. Familial hyperchylomicronemia is a rare autosomal recessive genetic abnormality of enzyme lipoprotein lipase that is associated with elevated fasting triglyceride levels (>1000 mg/dL), moderately high LDL cholesterol levels, recurrent episodes of pancreatitis during childhood, lipemia retinalis (creamy white retinal vessels), eruptive xanthomas, and hepatosplenomegaly. CHD is not a common feature of this disease. This patient’s clinical presentation and lipid profile are not consistent with this diagnosis.

Answer E is not correct. Resistance to insulin is one of the underlying mechanisms causing type 2 diabetes mellitus (DM). In obese patients with uncontrolled type 2 DM, a diabetic dyslipidemia may be seen, which includes elevated levels of triglycerides and total cholesterol and decreased levels of HDL cholesterol. Treatment of choice is exercise, diet, and hypoglycemic therapy. In patients with controlled type 1 DM, the lipid profile is usually normal or possibly the LDL cholesterol level is slightly increased.
Reply With Quote Quick reply to this message
The above post was thanked by:
DarkKnight (02-11-2010), wahaha007 (02-10-2010)

Old 02-10-2010
laithbv's Avatar
USMLE Forums Guru
Steps History: 1 + CS
Posts: 304
Threads: 9
Thanked 324 Times in 139 Posts
Reputation: 334

this is USMLERx
Reply With Quote Quick reply to this message
Old 03-02-2010
Sarah-cali's Avatar
USMLE Forums Scout
Steps History: Step 1 Only
Posts: 63
Threads: 12
Thanked 158 Times in 44 Posts
Reputation: 178

Originally Posted by laithbv View Post
this is USMLERx
But, it's a good question though
Reply With Quote Quick reply to this message


Cardiology-, Endocrinology-, Internal-Medicine-, Step-2-Questions

Quick Reply

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Please enter a password for your user account. Note that passwords are case-sensitive.
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Where you live. Leave blank if you don't want to tell.


Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Similar Threads
Thread Thread Starter Forum Replies Last Post
Acute Cholecystitis Vs Acute Ascending Cholangitis Hohepa USMLE Step 2 CK Forum 2 01-28-2015 04:28 AM
Painless Testicular mass + Gynecomastia rasheed USMLE Step 1 Classic Clues 4 05-07-2012 04:04 PM
painless enlargement of testicle doctorF USMLE Step 1 Forum 9 11-23-2011 10:58 AM
acute megakaryocytic leukemia or acute lymphoblastic leukemia in Down syndrome patients??? doctorF USMLE Step 1 Forum 6 10-05-2011 09:35 AM
Painless Ulcer in a Diabetic tkourkou USMLE Step 2 CK Forum 10 01-24-2011 05:48 AM

Find Us on Facebook
Powered by vBulletin® Version 3.8.8
Copyright ©2000 - 2020, vBulletin Solutions, Inc.
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2020 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2019)