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Exercise 1: Cholesterol

    You have received the materials in your kit for you to evaluate one person's cholesterol levels.  You are basically going to act as a doctor for that one patient.  Your case is numbered either case 1, 2, 3, or 4.  Below you will find the case history for your patient-- he or she has been put on a cholesterol reduction program.  None of the patients have been given any cholesterol-lowering drugs as part of their program.  It is your job to evaluate whether your patient has improved on their program.  You will then have to explain what factors are responsible for the success or lack of success of their program. Each group will be given two blood samples from their patient:  one taken prior to starting their cholesterol reduction program and the current one (6 months after beginning the program).

Case A:

Description of Patient: A 52 year old male. Occupation: bus driver.

Physical Examination:

Initial: 5’10" and 230 lb. Blood Pressure: 140 / 95 mmHg. He has a healthy overall appearance, although quite a bit overweight. Patient complains of shortness of breath when physically active. Patient says that he eats well-balanced meals.

Current: 5’10" and 210 lb. Blood Pressure 125 / 75 mmHg. Patient appears to have much energy and sense of well-being. He indicates an ability to sustain exercise. Patient says that he has maintained an exercise regimen since the last visit.

Family History: Father died at age 60 from heart attack. Mother is 80 years old and still in good health. Grandfather died during military service, grandmother died at age 55, but patient does not know the cause of death.

Case B:

Description of Patient: 41 year old female. Occupation: bank teller.

Physical Examination:

Initial: 5’5" and 332 lbs. Blood pressure is 150 / 94 mmHg. This pre-menopausal female is morbidly obese, yet does not consider it a problem. She complains of job-related stresses (difficulty interacting with particular coworkers). She mentioned that when she hasn’t eaten for several hours, she feels weak and light-headed.

Current: 5’5" and 329 lbs. Blood pressure is 152 / 96 mmHg. Patient reports that she has markedly cut back on her dietary intake, although she still needs to snack to prevent her light-headedness. She said that her work situation has not changed and remains stressful.

Family History: Both of her parents are healthy adults in their 70s. Her maternal grandfather died of cancer, while the maternal grandmother died from complications of diabetes. Her paternal grandfather is in a nursing home in his 90s with Alzheimer’s, and her paternal grandmother died during childbirth.

Case C:

Description of Patient: 15 year old male, currently enrolled in the 10^th grade.

Physical Examination:

Initial: 5’8" and 150 lb, active young man. Blood pressure is 115 / 75. He is a member of his high school varsity hockey team and appears to be in healthy condition. Patient indicates a dislike of most vegetables, and says that he is very picky about the foods he will eat.

Current: 5’9" and 160 lb. Blood pressure is 118 / 72. All other conditions the same.

Family History: His father had angioplasty at age 38. His 22 year old sister has a cholesterol level of 260 mg/dL, and his 18 year old brother has a cholesterol level of 180 mg/dL. His mother’s cholesterol level and blood pressure are normal. He has no living grandparents, his maternal grandfather died of a heart attack at age 45. The causes of death of his other grandparents are unclear.

Case D:

Description of Patient: 73 year old female, retired school principal, who still volunteers as a tutor in local middle schools.

Physical Examination:

Initial: 5’3" and 120 lb. Blood pressure is 130 / 90 mmHg. Patient is not on estrogen replacement. Patient reports an active lifestyle, walking at least 4 miles a day with her dog. She appears to be in excellent physical condition. However, patient agreed to begin taking calcium supplements to help prevent osteoporosis—we discussed that she appears to be losing some stature.

Current: 5’2 ¾" and 114 lb. Blood pressure is 127 / 85 mmHg. Patient has continued her active lifestyle, walking in the local mall when the weather is poor. She reports that she has been taking the calcium supplements and watching her dietary intake. She is clearly upset that her height has decreased.

Family History: Patient’s mother is currently in an assisted living facility and has her mental faculties, but is suffering from arthritis. Patient’s father died of a heart attack at 85. Patient is unsure of the causes of death of her grandparents.

Procedures for cholesterol testing

    The materials you have for your particular patient are drops of fake blood.  Please read the instructions carefully, because you do not have enough test strips to do this more than once!  You also received two test strips (these say "Bayer" on them) and a spot plate (the plastic white tray with about a dozen wells) to make it easier to work with the fake blood.  The steps are as follows:

1. Shake up your fake blood-- it is important that it is mixed well before you do this.
2. Place 2 - 3 drops of each blood sample in a well on your spot plate.
3. Take a look at the chart below before you start using your dipsticks:

4. You will be timing this next step-- be sure to let no more than 10 seconds pass before you check the cholesterol level.  If you wait too long, the color deepens and you will get faulty results.
5. Dip the colored end of the dipstick in the initial blood sample-- wait no more than 10 seconds, and then compare the color of the dipstick to the color on the chart above.  Write down your results.
6. Repeat step 5 for the current blood sample.  Use a new dipstick to do this.