WBR1123

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	USMLE Step 3
Main Category	Primary Care Office
Sub Category	Endocrine, Endocrine
Prompt	A 35 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago. She has been following a diet and exercise beside her metformin as an oral hypoglycemic therapy. The patient is hypertensive with blood pressure 160/90 mmHg on beta blockers, and smokes ½ pack per day for 10 years. Her labs have been sent to your office and shows: Total blood cholesterol of 270mg/dL LDL of 190mg/dL HDL of 28 mg/dL HgbA1C 9.8% ALT 15 IU/L AST 10 IU/L In addition to diet, exercise, and smoking cessation, which of the following would have the greatest effect in reducing her cholesterol?
Answer A	Controlling her blood pressure
Answer A Explanation	Incorrect Controlling blood pressure has no known direct effect on lipid profile
Answer B	Controlling her diabetes mellitus
Answer B Explanation	[[AnswerBExp::Correct By controlling her diabetes mellitus, will lowering LDL and triglyceride levels and, therefore, decreasing total cholesterol]]
Answer C	Adding alcoholic beverages twice per day
Answer C Explanation	Incorrect Alcohol cannot be used as main line in the treatment of high lipid profile
Answer D	Improving her sleeping habits
Answer D Explanation	Incorrect Sleeping will not reduce her lipid profile.
Answer E	Adding thyroid hormone to her medications.
Answer E Explanation	[[AnswerEExp::Incorrect The patient has no symptoms of hypothyroidism, and although thyroid hormone helps reducing the lipid level, it shouldn’t be used unless there are symptoms.]]
Right Answer	B
Explanation	[[Explanation::Diabetes mellitus control would positively affect the lipid profile by lowering LDL and triglyceride levels and, therefore, decreasing total cholesterol Educational Objective: References: ]]
Approved	No
Keyword	[[WBRKeyword::Diabetes mellitus]], [[WBRKeyword::Hypercholesterolemia]]
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