Lipid Biochemistry USMLE Step 1 Practice Question
A 67-year-old woman on chronic prednisone therapy for rheumatoid arthritis presents with fatigue. Vital signs: BP 148/92 mmHg, HR 88/min, RR 16/min, temp 37°C, SpO2 98%. Laboratory studies show triglycerides 520 mg/dL, LDL cholesterol 95 mg/dL, ALT 62 U/L, fasting glucose 128 mg/dL. Abdominal ultrasound reveals no fatty infiltration. BMI is 34 kg/m². Which mechanism best explains glucocorticoid-induced hypertriglyceridemia in this patient?
Answer choices
- ADirect inhibition of cholesterol esterification in VLDL particles
- BIncreased hepatic VLDL production through enhanced de novo lipogenesis and gluconeogenesisCorrect answer
- CEnhanced apoB-100 degradation reducing VLDL particle clearance
- DInhibition of lipoprotein lipase activity in adipose tissue and muscle
- EStimulation of LDL receptor expression causing increased cholesterol uptake
- FDecreased hepatic triglyceride lipase activity impairing remnant particle metabolism
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