USMLE Q Bank Step 1- 208

A 43 year-old man presents to the ER with an excruciating chest pain radiates to his jaw and left shoulder. The patient is in moderate distress. Examination reveals a small nodule in his right Achilles tendon. Family history indicates that his father died of a heart attack in the age of 45. His laboratory tests reveal elevated levels of CK-MB, troponin T and very high level of cholesterol (670 mg/dL). A diagnosis of myocardial infarction and familial hypercholesterolemia is made in this patient. The patient is admitted to the intensive care unit (ICU) for urgent treatment. The patient has improved in the following week and is discharged. A list of medications has been prescribed for this patient.

Which one of these medications acts through inhibition of the enzyme HMG-CoA reductase?

A- Atenolol

B- Fenofibrate

C- Lovastatin

D- Niacin​

E- Orlistat


Statins lower LDL through inhibition of HMG-CoA reductase, the rate limiting step in the production of cholesterol. Statins dramatically reduce mortality of patients with hypercholesterolemia. Atenolol is a beta blocker and has no role in reducing cholesterol. Fenofibrate and niacin have different mechanism of action. They mainly lower triglycerides and increase HDL. Orlistat lowers rate of absorption of fat from diet by inhibition of pancreatic lipase.

The correct answer is C

4 thoughts on “USMLE Q Bank Step 1- 208”

  1. Thank you Dr Naresh. I am glad that my effort got a positive response.

  2. Excellent questions . though orthopaedic surgeon but love to solve these questions.

  3. Thank you Dr Yashwant

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