QuestionSBA
QuestionChoice
Statins work by inhibiting the enzyme HMG-CoA reductase, an enzyme that is responsible for the synthesis of cholesterol. By blocking this pathway, statins reduce the total level of circulating cholesterol and LDLs. A lipid profile at the start of treatment and in subsequent consultations is important in monitoring treatment response.
50171
a
Lipid profile
QuestionChoice
This should only be measured if statin-associated myopathy or rhabdomyolysis is suspected. It is not part of routine monitoring while taking a statin. It also would not be used to measure treatment response.
50175
e
Creatinine kinase
QuestionChoice
Full blood count has no role in the monitoring of patients taking statins.
50172
b
Full blood count
QuestionChoice
It is recommended to measure renal function prior to starting atorvastatin to assess for adverse effects. Monitoring renal function would not assess for treatment response.
50174
d
Urea and electrolytes
QuestionChoice
It is recommended that liver function should be measured prior to starting treatment and at 3 months and 12 months afterwards as atorvastatin is known to be hepatotoxic. However, this would be monitoring the treatment for an **adverse** effect, the question asks for the test that monitors treatment response.
50173
c
Liver function test
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3614
Atorvastatin treatment response should be monitored by measuring the patient's full lipid profile
Topic
74
Elderly Care
10082
Case Presentation:  A 56 year old gentleman attends a follow-up appointment at his GP. 


**PMH** hypertension

**DH** ramipril 10mg PO OD, paracetamol 1g PO QDS

**FH** Father died of heart attack at the age of 50. Mother died of an ischaemic stroke at the age of 64

**SH** current smoker, 25-30 cigarettes a day but currently attending smoking cessation counselling.

**Investigations**

Q-risk score: 11%

It is decided that starting atorvastatin 20mg PO OD would help lower his risk of a cardiac event. A repeat consultation is booked in for 3 months later to assess treatment response.

Question: Select the most appropriate option to monitor for treatment response at the next consultation.
a