Dyslipidaemias and Metabolic Syndrome — WACS Viva & Clinical Scenarios (Endocrinology, Diabetes, and Metabolism)

Exam-style dyslipidaemias and metabolic syndrome viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 36-year-old bank executive presents for a routine executive health screening. He is asymptomatic, but physical examination reveals bilateral thickened, non-tender nodular swellings over the Achilles tendons and prominent bilateral corneal arcus. His father died suddenly of a myocardial infarction at age 42. Laboratory evaluation reveals: fasting total cholesterol 10.2 mmol/L, triglycerides 1.5 mmol/L, HDL cholesterol 1.1 mmol/L, and calculated LDL cholesterol 8.4 mmol/L. Fasting plasma glucose, serum creatinine, and thyroid-stimulating hormone are normal. Which of the following is the most l
• SCENARIO 2: A 44-year-old male with poorly controlled type 2 diabetes mellitus and excessive alcohol consumption presents to the emergency department with sudden-onset severe epigastric pain radiating to the back, associated with nausea and repeated vomiting. Physical examination reveals multiple 2 mm to 4 mm yellowish papules with erythematous bases clustered over his buttocks and extensor surfaces of the elbows. Fundoscopic examination shows pale, creamy-appearing retinal vessels. Serum amylase is 980 U/L and serum triglycerides are reported as 16.4 mmol/L.
• SCENARIO 3: You are evaluating a 50-year-old female school administrator in the medical outpatient clinic who was referred for cardiometabolic assessment. Physical measurements demonstrate a waist circumference of 94 cm and blood pressure of 142/88 mmHg. Laboratory findings reveal: fasting plasma glucose 6.3 mmol/L, serum triglycerides 2.4 mmol/L, total cholesterol 5.8 mmol/L, and HDL cholesterol 1.0 mmol/L. Liver transaminases show mild alanine aminotransferase elevation (62 U/L).
• SCENARIO 4: A 48-year-old male living with HIV on long-term antiretroviral therapy comprising tenofovir disoproxil fumarate, lamivudine, and ritonavir-boosted atazanavir presents with progressive abdominal distension, thinning of his limbs, and facial wasting. Fasting lipid panel reveals total cholesterol 7.8 mmol/L, triglycerides 4.9 mmol/L, HDL cholesterol 0.8 mmol/L, and direct LDL cholesterol 4.8 mmol/L. Fasting blood glucose is 6.8 mmol/L.
• SCENARIO 5: 1. Describe the molecular pathways governing endogenous and exogenous lipoprotein metabolism, specifically highlighting the roles of apolipoprotein B-100, apolipoprotein E, lipoprotein lipase, and PCSK9.