Final Exam

A 62yo male comes into your office complaining of chest pain. He is obese, doesnt get much exercise and eats a diet high
in saturated fat. If you could see inside the patients coronary arteries you would most likely find:
o Bulges of endothelium due intima deposits

A 55yo male has had symptomatic atherosclerosis for several years. For the past 6 months, he has been taking marine oil
supplements. He wants to know when he can expect regression of his atherosclerotic lesions. You respond that:
o He might expect reduction in thrombosis risk

A 41 year old female in apparent good health is worried because her father just had a heart attack and a screening test
found that she had a moderately elevated cholesterol level. She is overweight and eats a diet with a lot of saturated and
partially hydrogenated fat. If she avoids most of these saturated and partially hydrogenated fats for the next year, what is
the most likely effect on her coronaries, which would not happen otherwise?
o Some fatty streaks will disappear

Which nutritional risk factors are likely to increase the risk of thrombotic coronary occlusion?
o Moderate to severe obesity

Which lipoprotein delivers dietary cholesterol to the liver?
o Chylomicron remnants

Which food constituent is transported with chylomicrons from the intestines to the liver and other tissues?
o Vitamin E

Following extensive abdominal surgery an elderly patient receives total parenteral nutrition with 10% fat. Which of the
following metabolic events is the essential first step to allow energy generation from the infused fat?
o Lipoprotein lipase cleaves emulsified triglycerides

A new patient comes to see you. From the chart you learn that the patient has a genetic defect and is unable to make
chylomicrons. In which nutrient will this patient most likely be deficient without high-dose supplementation?
o Vitamin E

A 51 yo female comes in to see you about menopausal symptoms. She is clearly overweight. Her LDL cholesterol has
recently increased from 145 to 165. You decide to talk to her about the risks of heart disease. You tell her that even a
modest weight loss is likely to decrease her LDL cholesterol. The most important mechanism for this is that:
o VLDL synthesis decreases

A frustrated 42yo obese female comes to see you with continued high LDL cholesterol levels. She cant understand why.
She reports following an extremely low fat, low cholesterol diet during this time; she satisfies her appetite with
carbohydrates instead. You explain to her that people who are very overweight make more:
o VLDL

A major function of VLDL is
o To deliver triglycerides from liver to muscle and fat cells

An overweight (BMI 29.1) 35yo AA male of Lebanese ancestry has a family history of MI. His current lipoprotein profile is as
follows: total cholesterol 302, LDL cholesterol 250, HDL cholesterol 32. What is the likely impact on his lipoproteins of a
combined exercise/portion control program that decreases his waist circumference from 103 to 99cm over a period of 3
months?
o The program will lower LDL cholesterol from 250 to 226



What is an especially good food course for the type of dietary fiber that lowers LDL cholesterol concentrations by more than
a percent with each daily serving?
o Oats and fruits

A 66yo male comes to your office. He recently read an article that said vegetables would protect against heart disease. He
wants to know more about these antioxidants. The antioxidants that protect lipoprotein from oxidation are:
o Alpha-tocopherol and carotenoids

What explains the high susceptibility of LDL to oxidation?
o Their high content of polyunsaturated fatty acids

How does extensive exposure to free radical change the metabolic fate of LDL?
o More circulating LDL ends up in extra-hepatic tissues

What is a mechanism that might explain beneficial effects of high fruit and vegetable consumption on coronary smooth
muscle cell function?
o Preventing the free radial interference with NO signaling

An overweight 23yo college student comes to see you about allergies. While you are taking, he asks about his risk of heart
disease. He eats a reasonable diet but gets little exercise. You explain to him that exercise will not only help him keep his
weight at a healthy level, but it will also aid in transport of cholesterol from the:
o Arteries to the liver

A 31yo woman comes to see you because of low back pain. After an extensive analysis of the situation, you recommend
regular exercise, such as walking. To encourage the patient, you tell her that exercise might increase her HDL levels.
Higher HDL levels are beneficial because they:
o Promote cholesterol transport from arteries to the liver

Which dietary change is most likely to decrease HDL concentrations?
o Excessive weight gain

T or F: Thee myristic acid in milk fat is more potent cholesterol-raising acid than the stearic acid in beef fat.
A: True

T or F: Replacement of 40g shortening with the same amount of olive oil will lower LDL cholesterol concentration.
A: True

T or F: Lifestyle changes, such as reducing saturated fat and increasing viscous fiber, can lower sum cholesterol ~7-10% at best.
A: False
Explanation: Lifestyle changes can reduce excessive LDL concentration by 20-40%

A 57yo AA man, BMI 22.7, with well controlled type 2 DM, has an LDL cholesterol concentration of 178mg/dL. Which of the following single dietary
modifications is likely to lower his LDL cholesterol concentration to 168mg/dL within a month?
A: boosting viscous fiber intake from 5 to 15g/d
Explanation: It is viscous fiber that helps lower LDL cholesterol through the binding of bile acids.
Higher intake of alcohol or saturated fatty acid tends to increase LDL. Neither folate nor vitamin E
supplements can lower LDL significantly.