Target: Lipids and CAD

From "Nonfasting triglycerides and ischemic heart disease in men and women"

Learning objectives

Describe the utility of measuring fasting versus nonfasting triglyceride levels for predicting the risk of myocardial infarction (MI), ischemic heart disease, and death in the general population and noting sex-related differences.

Questions

1. At moderate hypertriglyceridemia, chylomicron remnants and ______ enter into the arterial intima, appear to be preferentially trapped with the arterial wall, and thus may cause atherosclerosis leading to MI, ischemic heart disease, and ultimately, death.
   
   
   1. low-density lipoproteins
   2. very-low-density lipoproteins
   3. intermediate-density lipoproteins
   4. high-density lipoproteins.
   
   
2. In this prospective cohort study, age-adjusted hazard ratios were more pronounced in men with entry age of ≤55 years versus those >55 years and in _________.
   
   
   1. nonsmokers versus smokers
   2. those without familial heart disease versus those with familial cardiovascular disease
   3. those with a body mass index (BMI) <30 versus those with a BMI >30
   4. light versus heavy alcohol drinkers
   
   
3. The study found that nonfasting triglycerides ≥5 mmol/L predict a _____ and _____ fold risk of MI in men and women in the general population, respectively.
   
   
   1. 3-; 6-
   2. 2-; 4-
   3. 5-; 17-
   4. 4-; 10-
   
   
4. Subanalyses of 3 randomized double-blind trials suggest that among patients with elevated triglycerides, a ________ reduction in triglyceride levels associate with a 30% to 40% reduction in risk of ischemic heart disease.
   
   
   1. 5 to 10%
   2. 10 to 20%
   3. 15 to 30%
   4. 20 to 40%
   
   
5. According to the author, all but which of the following are considered advantages of this study?
   
   
   1. The sample was ethnically heterogeneous
   2. There was a high participation rate
   3. The authors had 26 years 100% complete follow-up
   4. The authors corrected for regression dilution bias
   
   

To take this exam, you can download the CME answer form (PDF) and mail, fax, or email it to address given; or go to the University of Cincinnati's Center for Continuous Professional Development. Cardiology Review materials are posted to that site on a continuous basis (registration required).

Target: Heart Failure

From "Serial biomarker measurements in chronic heart failure"

Learning objectives

Explain the value of using serial measurements of cardiac troponin T (cTnT) and B-type natriuretic peptide (BNP) over several years to estimate prognosis in heart failure.

Questions

1. In this cohort study of 190 subjects with NYHA class III and IV heart failure, survival for subjects with a cardiac troponin T (cTnT) level of more than _____ at any point during the study was significantly worse.
   
   
   1. 0.01 ng/mL
   2. 0.02 ng/mL
   3. 0.03 ng/mL
   4. 0.04 ng/mL
   
   
2. In the study, there was a 3.38-fold greater risk of death or cardiac transplantation among subjects with an increased cTnT level above ________ from one follow-up visit to the next or if subjects had a persistently elevated cTnT level.
   
   
   1. 0.01 ng/mL
   2. 0.02 ng/mL
   3. 0.03 ng/mL
   4. 0.04 ng/mL
   
   
3. Over time, increased B-type natriuretic peptide (BNP levels) did not have the same effect as increased cTnT levels. Although subjects with new elevations above normal had greater risk, once the BNP level was elevated, further increases or decreases did not make any difference. Long-term observation of BNP levels might, therefore, not be effective. This could be the result of the fact that the subjects in this study had _____ instead of acutely decompensated heart failure.
   
   
   1. cardiomyopathy
   2. chronic arrhythmia
   3. ischemic heart disease
   4. chronic stable heart failure
   
   
4. The combination of increased BNP and cTnT levels resulted in a ______ greater risk of death or cardiac transplantation.
   
   
   1. 8-fold
   2. 6-fold
   3. 4-fold
   4. 2-fold
   
   
5. The patient in the case study presented with a fairly moderate degree of decompensated chronic heart failure (BNP level of 1152 pg/mL and a cTnT level of 0.09 ng/mL). In addition to fluid and sodium restriction, he was treated with an increased daily dose of _________. At his follow-up visit 4 weeks later, his BNP level was 240 pg/mL and his cTnT level was <0.01 ng/mL.
   
   
   1. spironolactone
   2. furosemide
   3. amiloride
   4. hydrochlorothiazide
   
   

To take this exam, you can download the CME answer form (PDF) and mail, fax, or email it to address given; or go to the University of Cincinnati's Center for Continuous Professional Development. Cardiology Review materials are posted to that site on a continuous basis (registration required).