Hyperlidaemia

Question 1

A patient has a total cholesterol of 5.8 mmol/L. What is the target total cholesterol level?
A. Below 6
B. Below 5
C. Below 4
D. Below 3

Answer 1

Correct answer: Below 5 mmol/L. Explanation: The target total cholesterol level is less than 5 mmol/L.

Question 2

What is the target HDL cholesterol level?
A. Below 1
B. Above 0.5
C. Above 1
D. Above 2

Answer 2

Correct answer: Above 1 mmol/L. Explanation: HDL is the ‘good’ cholesterol and should be above 1 mmol/L.

Question 3

What is the target non-HDL cholesterol level?
A. Below 4
B. Below 3
C. Below 2.6
D. Below 2

Answer 3

Correct answer: Below 2.6 mmol/L. Explanation: Non-HDL cholesterol target is less than 2.6 mmol/L.

Question 4

What is the target LDL cholesterol level?
A. Below 3
B. Below 2.6
C. Below 2
D. Below 1

Answer 4

Correct answer: Below 2 mmol/L. Explanation: LDL cholesterol target is less than 2 mmol/L.

Question 5

What is the target non-fasting triglyceride level?
A. Below 3.5
B. Below 3
C. Below 2.6
D. Below 2.3

Answer 5

Correct answer: Below 2.3 mmol/L. Explanation: The non-fasting triglyceride target is less than 2.3 mmol/L.

Question 6

Which patient should be offered primary prevention lipid-lowering therapy?
A. 45-year-old with QRISK3 score 5%
B. 70-year-old with QRISK3 score 12%
C. 30-year-old with no risk factors
D. 50-year-old with normal cholesterol

Answer 6

Correct answer: 70-year-old with QRISK3 score 12%. Explanation: Primary prevention is offered when 10-year QRISK3 score is over 10%.

Question 7

A patient with type 2 diabetes has a 10-year QRISK3 score of 12%. What is the correct management?
A. Lifestyle advice only
B. Start lipid-lowering therapy
C. Wait until symptoms develop
D. Start ezetimibe

Answer 7

Correct answer: Start lipid-lowering therapy. Explanation: Type 2 diabetes with QRISK3 >10% qualifies for primary prevention.

Question 8

Which patient with type 1 diabetes should be offered lipid-lowering therapy?
A. Newly diagnosed patient aged 20
B. Patient aged 30 with no complications
C. Patient aged 45 with 12 years of diabetes
D. Patient aged 25 with good control

Answer 8

Correct answer: Patient aged 45 with 12 years of diabetes. Explanation: Type 1 diabetes patients over 40, with >10 years duration or nephropathy should be offered treatment.

Question 9

Which condition automatically qualifies a patient for lipid-lowering therapy regardless of QRISK3 score?
A. Asthma
B. Chronic kidney disease
C. Osteoarthritis
D. Migraine

Answer 9

Correct answer: Chronic kidney disease. Explanation: CKD is an indication for primary prevention lipid-lowering therapy.

Question 10

Who should receive secondary prevention lipid-lowering therapy?
A. Patients with QRISK3 >10%
B. Patients with previous cardiovascular events
C. Patients with family history only
D. Patients over 85 only

Answer 10

Correct answer: Patients with previous cardiovascular events. Explanation: Secondary prevention is offered to patients with established cardiovascular disease.

Question 11

Which statin is considered high intensity and used for secondary prevention?
A. Simvastatin 20mg
B. Pravastatin 40mg
C. Atorvastatin 80mg
D. Fluvastatin 20mg

Answer 11

Correct answer: Atorvastatin 80mg. Explanation: Atorvastatin 80mg is the strongest statin and used in secondary prevention.

Question 12

Which statins can be taken at any time of the day?
A. Simvastatin and pravastatin
B. Fluvastatin and pravastatin
C. Atorvastatin and rosuvastatin
D. Simvastatin and fluvastatin

Answer 12

Correct answer: Atorvastatin and rosuvastatin. Explanation: These statins have longer half-lives and can be taken any time of day.

Question 13

What should be checked before starting a statin?
A. ECG only
B. Lipids, thyroid, renal and liver function
C. Blood pressure only
D. INR

Answer 13

Correct answer: Lipids, thyroid, renal and liver function. Explanation: Baseline tests are required before starting statins.

Question 14

When should liver function tests be monitored after starting statin therapy?
A. Only once
B. Monthly
C. At baseline, 3 months and 12 months
D. Every week

Answer 14

Correct answer: At baseline, 3 months and 12 months. Explanation: LFTs are monitored at these time points for statin safety.

Question 15

When should statin therapy be stopped due to liver enzyme elevation?
A. Any increase
B. Twice the upper limit
C. Three times the upper limit
D. Five times the upper limit

Answer 15

Correct answer: Three times the upper limit. Explanation: Statins should be stopped if transaminases exceed three times the upper limit.

Question 16

A patient reports muscle pain before starting a statin. Creatine kinase is five times the upper limit. What should be done?
A. Start statin at normal dose
B. Start at lower dose
C. Wait 7 days and remeasure CK
D. Ignore CK result

Answer 16

Correct answer: Wait 7 days and remeasure CK. Explanation: If CK is ≥5 times upper limit, delay and recheck before starting.

Question 17

Which statin side effect requires urgent medical attention?
A. Mild headache
B. Muscle pain and weakness
C. Dry mouth
D. Constipation

Answer 17

Correct answer: Muscle pain and weakness. Explanation: These may indicate myopathy or rhabdomyolysis.

Question 18

Which respiratory symptom may indicate statin-induced interstitial lung disease?
A. Wheezing
B. Shortness of breath and cough
C. Chest tightness only
D. Runny nose

Answer 18

Correct answer: Shortness of breath and cough. Explanation: Interstitial lung disease presents with dyspnoea, cough and weight loss.

Question 19

Why are statins avoided in pregnancy?
A. Cause hypotension
B. Cause bleeding
C. Teratogenic effects
D. Cause renal failure

Answer 19

Correct answer: Teratogenic effects. Explanation: Statins are teratogenic and should be stopped three months before conception.

Question 20

Which drug interaction requires statin therapy to be stopped temporarily?
A. Amoxicillin
B. Macrolide antibiotics
C. Paracetamol
D. Metformin

Answer 20

Correct answer: Macrolide antibiotics. Explanation: Macrolides increase statin levels and risk of rhabdomyolysis.

Question 21

Which medication must not be combined with statins and requires statins to be stopped and restarted 7 days later?
A. Metronidazole
B. Fusidic acid
C. Clarithromycin
D. Ciprofloxacin

Answer 21

Correct answer: Fusidic acid. Explanation: Oral fusidic acid greatly increases the risk of rhabdomyolysis.

Question 22

What is the maximum simvastatin dose when used with amlodipine?
A. 10mg
B. 20mg
C. 40mg
D. 80mg

Answer 22

Correct answer: 20mg. Explanation: Simvastatin dose must be limited to 20mg with amlodipine.

Question 23

What is second-line treatment if statins are not tolerated or insufficient?
A. Fibrates
B. Ezetimibe
C. PCSK9 inhibitors
D. Aspirin

Answer 23

Correct answer: Ezetimibe. Explanation: Ezetimibe is used as second-line therapy.

Question 24

Why should ezetimibe be used cautiously with statins?
A. Reduced efficacy
B. Increased bleeding
C. Increased risk of myopathy
D. Renal toxicity

Answer 24

Correct answer: Increased risk of myopathy. Explanation: Combined use increases the risk of muscle toxicity.

Question 25

Which statement about fibrates is correct? A. Safe with statins B. No muscle risk C. Increase risk of muscle side effects with statins D. Only used in pregnancy

Answer 25

Correct answer: Increase risk of muscle side effects with statins. Explanation: Statin–fibrate combinations increase the risk of myopathy and rhabdomyolysis.

Question 26

A patient has a total cholesterol of 5.8 mmol/L. What is the target total cholesterol level? A. Below 6 B. Below 5 C. Below 4 D. Below 3

Answer 26

Correct answer: Below 5 mmol/L. Explanation: The target total cholesterol level is less than 5 mmol/L.

Question 27

What is the target HDL cholesterol level? A. Below 1 B. Above 0.5 C. Above 1 D. Above 2

Answer 27

Correct answer: Above 1 mmol/L. Explanation: HDL is the ‘good’ cholesterol and should be above 1 mmol/L.

Question 28

What is the target non-HDL cholesterol level? A. Below 4 B. Below 3 C. Below 2.6 D. Below 2

Answer 28

Correct answer: Below 2.6 mmol/L. Explanation: Non-HDL cholesterol target is less than 2.6 mmol/L.

Question 29

What is the target LDL cholesterol level? A. Below 3 B. Below 2.6 C. Below 2 D. Below 1

Answer 29

Correct answer: Below 2 mmol/L. Explanation: LDL cholesterol target is less than 2 mmol/L.

Question 30

What is the target non-fasting triglyceride level? A. Below 3.5 B. Below 3 C. Below 2.6 D. Below 2.3

Answer 30

Correct answer: Below 2.3 mmol/L. Explanation: The non-fasting triglyceride target is less than 2.3 mmol/L.

Question 31

Which patient should be offered primary prevention lipid-lowering therapy? A. 45-year-old with QRISK3 score 5% B. 70-year-old with QRISK3 score 12% C. 30-year-old with no risk factors D. 50-year-old with normal cholesterol

Answer 31

Correct answer: 70-year-old with QRISK3 score 12%. Explanation: Primary prevention is offered when 10-year QRISK3 score is over 10%.

Question 32

A patient with type 2 diabetes has a 10-year QRISK3 score of 12%. What is the correct management? A. Lifestyle advice only B. Start lipid-lowering therapy C. Wait until symptoms develop D. Start ezetimibe

Answer 32

Correct answer: Start lipid-lowering therapy. Explanation: Type 2 diabetes with QRISK3 >10% qualifies for primary prevention.

Question 33

Which patient with type 1 diabetes should be offered lipid-lowering therapy? A. Newly diagnosed patient aged 20 B. Patient aged 30 with no complications C. Patient aged 45 with 12 years of diabetes D. Patient aged 25 with good control

Answer 33

Correct answer: Patient aged 45 with 12 years of diabetes. Explanation: Type 1 diabetes patients over 40, with >10 years duration or nephropathy should be offered treatment.

Question 34

Which condition automatically qualifies a patient for lipid-lowering therapy regardless of QRISK3 score? A. Asthma B. Chronic kidney disease C. Osteoarthritis D. Migraine

Answer 34

Correct answer: Chronic kidney disease. Explanation: CKD is an indication for primary prevention lipid-lowering therapy.

Question 35

Who should receive secondary prevention lipid-lowering therapy? A. Patients with QRISK3 >10% B. Patients with previous cardiovascular events C. Patients with family history only D. Patients over 85 only

Answer 35

Correct answer: Patients with previous cardiovascular events. Explanation: Secondary prevention is offered to patients with established cardiovascular disease.

Question 36

Which statin is considered high intensity and used for secondary prevention? A. Simvastatin 20mg B. Pravastatin 40mg C. Atorvastatin 80mg D. Fluvastatin 20mg

Answer 36

Correct answer: Atorvastatin 80mg. Explanation: Atorvastatin 80mg is the strongest statin and used in secondary prevention.

Question 37

Which statins can be taken at any time of the day? A. Simvastatin and pravastatin B. Fluvastatin and pravastatin C. Atorvastatin and rosuvastatin D. Simvastatin and fluvastatin

Answer 37

Correct answer: Atorvastatin and rosuvastatin. Explanation: These statins have longer half-lives and can be taken any time of day.

Question 38

What should be checked before starting a statin? A. ECG only B. Lipids, thyroid, renal and liver function C. Blood pressure only D. INR

Answer 38

Correct answer: Lipids, thyroid, renal and liver function. Explanation: Baseline tests are required before starting statins.

Question 39

When should liver function tests be monitored after starting statin therapy? A. Only once B. Monthly C. At baseline, 3 months and 12 months D. Every week

Answer 39

Correct answer: At baseline, 3 months and 12 months. Explanation: LFTs are monitored at these time points for statin safety.

Question 40

When should statin therapy be stopped due to liver enzyme elevation? A. Any increase B. Twice the upper limit C. Three times the upper limit D. Five times the upper limit

Answer 40

Correct answer: Three times the upper limit. Explanation: Statins should be stopped if transaminases exceed three times the upper limit.

Question 41

A patient reports muscle pain before starting a statin. Creatine kinase is five times the upper limit. What should be done? A. Start statin at normal dose B. Start at lower dose C. Wait 7 days and remeasure CK D. Ignore CK result

Answer 41

Correct answer: Wait 7 days and remeasure CK. Explanation: If CK is ≥5 times upper limit, delay and recheck before starting.

Question 42

Which statin side effect requires urgent medical attention? A. Mild headache B. Muscle pain and weakness C. Dry mouth D. Constipation

Answer 42

Correct answer: Muscle pain and weakness. Explanation: These may indicate myopathy or rhabdomyolysis.

Question 43

Which respiratory symptom may indicate statin-induced interstitial lung disease? A. Wheezing B. Shortness of breath and cough C. Chest tightness only D. Runny nose

Answer 43

Correct answer: Shortness of breath and cough. Explanation: Interstitial lung disease presents with dyspnoea, cough and weight loss.

Question 44

Why are statins avoided in pregnancy? A. Cause hypotension B. Cause bleeding C. Teratogenic effects D. Cause renal failure

Answer 44

Correct answer: Teratogenic effects. Explanation: Statins are teratogenic and should be stopped three months before conception.

Question 45

Which drug interaction requires statin therapy to be stopped temporarily? A. Amoxicillin B. Macrolide antibiotics C. Paracetamol D. Metformin

Answer 45

Correct answer: Macrolide antibiotics. Explanation: Macrolides increase statin levels and risk of rhabdomyolysis.

Question 46

Which medication must not be combined with statins and requires statins to be stopped and restarted 7 days later? A. Metronidazole B. Fusidic acid C. Clarithromycin D. Ciprofloxacin

Answer 46

Correct answer: Fusidic acid. Explanation: Oral fusidic acid greatly increases the risk of rhabdomyolysis.

Question 47

What is the maximum simvastatin dose when used with amlodipine? A. 10mg B. 20mg C. 40mg D. 80mg

Answer 47

Correct answer: 20mg. Explanation: Simvastatin dose must be limited to 20mg with amlodipine.

Question 48

What is second-line treatment if statins are not tolerated or insufficient? A. Fibrates B. Ezetimibe C. PCSK9 inhibitors D. Aspirin

Answer 48

Correct answer: Ezetimibe. Explanation: Ezetimibe is used as second-line therapy.

Question 49

Why should ezetimibe be used cautiously with statins? A. Reduced efficacy B. Increased bleeding C. Increased risk of myopathy D. Renal toxicity

Answer 49

Correct answer: Increased risk of myopathy. Explanation: Combined use increases the risk of muscle toxicity.

Question 50

Which statement about fibrates is correct? A. Safe with statins B. No muscle risk C. Increase risk of muscle side effects with statins D. Only used in pregnancy

Answer 50

Correct answer: Increase risk of muscle side effects with statins. Explanation: Statin–fibrate combinations increase the risk of myopathy and rhabdomyolysis.