American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the July-August ACP Observer, copyright 2006 by the American College of Physicians.

Clinical Scenario

A 53-year-old man with a recent inferior myocardial infarction and a 12-year history of hypertension and type 2 diabetes mellitus is recovering in the hospital.

He has been diligent in the care of his diabetes. He has a normal body mass index, exercises at least five days a week for 30 minutes, and eats a heart-prudent diet including fruit, fiber and vegetables. His current medications include metformin and an angiotensin-converting enzyme inhibitor.

On examination, his blood pressure is 120/70 mm Hg and pulse rate is 70/min. He has an S4 at the cardiac apex; the rest of his examination is normal. Laboratory studies show a total cholesterol of 160 mg/dL with LDL cholesterol of 98 mg/dL, HDL cholesterol of 32 mg/dL and a triglyceride level of 190 mg/dL.

Which of the following interventions is most likely to achieve the desired LDL cholesterol goal?

A. Atorvastatin
B. Cholestyramine
C. Fenofibrate
D. Intensive life-style modification



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