Lipid Biochemistry USMLE Step 1 Practice Question
A 67-year-old man with atherosclerotic cardiovascular disease on pravastatin 40 mg daily presents with progressive cognitive decline and proximal muscle weakness over 3 weeks. Vital signs: BP 138/82, HR 78, RR 16, Temp 37°C, SpO2 98%. Creatine kinase is elevated at 850 U/L; LDL cholesterol is 65 mg/dL (goal achieved). Brain MRI demonstrates acute white matter changes. He denies fever or recent infection. Which statin-related adverse effect is most likely responsible for these findings?
Answer choices
- ASecondary vitamin D deficiency from statin-mediated CYP3A4 inhibition
- BAccumulation of neurotoxic sterol intermediates from HMG-CoA reductase blockade
- CDirect immune-mediated inflammation of myelin sheaths
- DStatin-induced myopathy progressing to central nervous system involvement
- EExcessive cholesterol depletion impairing myelin maintenance and CNS functionCorrect answer
- FPravastatin-induced mitochondrial dysfunction leading to impaired ATP production in muscle and neural tissues
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