120E37｜第120回 医師国家試験 過去問
A 64-year-old man. He visited the family physician for an abnormal finding in the annual health check-up. He quit smoking three years ago. He does not have any history of stroke, coronary heart disease, or peripheral artery disease. He is currently not on any medication. His body measurements are as follows：height 170cm, weight 65kg, waist circumference 81cm, blood pressure 128/74mmHg. His fasting blood test results are as follows：LDL cholesterol 183mg/dL, HDL cholesterol 58mg/dL, triglycerides 130mg/dL, glucose 102mg/dL, HbA1c 5.5％（reference range 4.9-6.0）, creatinine 0.76mg/dL. Which of the following best describes the man’s condition?
解答・解説を見る
正解: b
Correct answer
b Dyslipidemia
Explanation
The key abnormality is an elevated LDL cholesterol level of 183mg/dL.
His BMI is about 22.5, so he is not obese. Blood pressure is 128/74mmHg, so hypertension is not diagnosed from these values. HbA1c is within the reference range, so diabetes mellitus is not present.
Metabolic syndrome is also unlikely because waist circumference is 81cm and triglycerides and glucose are not diagnostic.
Choice review
a Obesity
BMI is not in the obese range.b Dyslipidemia
LDL cholesterol is elevated, so this is correct.c Hypertension
Blood pressure is not in the hypertensive range.d Diabetes mellitus
HbA1c and fasting glucose do not meet diagnostic criteria.e Metabolic syndrome
The abdominal circumference and metabolic abnormalities do not meet the pattern.
Key point
High LDL cholesterol alone is enough to identify dyslipidemia.