Disorders of lipid metabolism – Hypercholesterolemia MCQs With Answer

Disorders of lipid metabolism – Hypercholesterolemia MCQs With Answer

Understanding disorders of lipid metabolism, especially hypercholesterolemia, is essential for B. Pharm students who will advise on therapy, drug interactions, and monitoring. This introduction reviews pathophysiology, classification of dyslipidemias, lipid profile interpretation, primary (genetic) and secondary causes, and pharmacological approaches including statins, fibrates, bile acid sequestrants, ezetimibe and PCSK9 inhibitors. Emphasis on mechanisms, adverse effects, and clinical complications such as atherosclerosis and xanthomas will strengthen clinical reasoning. Keywords: Disorders of lipid metabolism, hypercholesterolemia, lipid profile, LDL, HDL, statins, hyperlipidemia, B. Pharm students. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which lipoprotein is the primary carrier of cholesterol to peripheral tissues and is most atherogenic?

• Chylomicron
• VLDL
• LDL
• HDL

Correct Answer: LDL

Q2. Familial hypercholesterolemia most commonly results from a defect in which protein?

• HMG-CoA reductase
• LDL receptor
• Apolipoprotein A-I
• CETP

Correct Answer: LDL receptor

Q3. The Friedewald formula for calculating LDL cholesterol is valid under which condition?

• When triglycerides are < 400 mg/dL
• When HDL > 60 mg/dL
• When total cholesterol < 200 mg/dL
• For fasting and non-fasting samples equally

Correct Answer: When triglycerides are < 400 mg/dL

Q4. Which enzyme is inhibited by statins leading to decreased cholesterol synthesis?

• Acetyl-CoA carboxylase
• HMG-CoA reductase
• Cholesterol ester transfer protein
• Hormone-sensitive lipase

Correct Answer: HMG-CoA reductase

Q5. Which of the following drugs blocks intestinal cholesterol absorption via NPC1L1 transporter?

• Ezetimibe
• Colestipol
• Fenofibrate
• Niacin

Correct Answer: Ezetimibe

Q6. Tendon xanthomas are most characteristically associated with which condition?

• Familial hypercholesterolemia
• Familial combined hyperlipidemia
• Type III dysbetalipoproteinemia
• Hypobetalipoproteinemia

Correct Answer: Familial hypercholesterolemia

Q7. Which lipoprotein contains the highest proportion of triglycerides?

• HDL
• LDL
• VLDL
• IDL

Correct Answer: VLDL

Q8. A major adverse effect of statins that requires monitoring is:

• Hypoglycemia
• Myopathy with elevated creatine kinase
• Hyperuricemia
• Thrombocytopenia

Correct Answer: Myopathy with elevated creatine kinase

Q9. PCSK9 inhibitors lower LDL cholesterol by which mechanism?

• Inhibiting HMG-CoA reductase
• Preventing intestinal cholesterol absorption
• Enhancing LDL receptor recycling by blocking PCSK9
• Increasing CETP activity

Correct Answer: Enhancing LDL receptor recycling by blocking PCSK9

Q10. Which secondary cause commonly leads to hypercholesterolemia?

• Hypothyroidism
• Hyperthyroidism
• Acute pancreatitis
• Vitamin D deficiency

Correct Answer: Hypothyroidism

Q11. Niacin reduces which lipid parameter most reliably?

• Triglycerides exclusively
• HDL cholesterol
• LDL cholesterol only
• Increases HDL and reduces triglycerides and LDL modestly

Correct Answer: Increases HDL and reduces triglycerides and LDL modestly

Q12. Which drug class acts as PPAR-alpha agonists to reduce triglycerides?

• Statins
• Fibrates
• Bile acid sequestrants
• PCSK9 inhibitors

Correct Answer: Fibrates

Q13. Bile acid sequestrants lower LDL cholesterol primarily by:

• Binding bile acids in the intestine and increasing cholesterol catabolism
• Inhibiting HMG-CoA reductase
• Activating LCAT
• Blocking intestinal TG absorption

Correct Answer: Binding bile acids in the intestine and increasing cholesterol catabolism

Q14. Which lipid abnormality pattern is typical of nephrotic syndrome?

• Isolated low HDL
• Elevated LDL and VLDL with hypercholesterolemia
• Isolated hypertriglyceridemia only
• Low total cholesterol

Correct Answer: Elevated LDL and VLDL with hypercholesterolemia

Q15. The most appropriate monitoring test for statin-induced hepatotoxicity is:

• Serum creatinine
• Liver transaminases (ALT/AST)
• Serum amylase
• Serum CK only

Correct Answer: Liver transaminases (ALT/AST)

Q16. Severe hypertriglyceridemia (>1000 mg/dL) primarily increases the risk of:

• Ischemic stroke
• Acute pancreatitis
• Deep vein thrombosis
• Hypoglycemia

Correct Answer: Acute pancreatitis

Q17. Which apolipoprotein is the major structural protein of LDL and recognized by LDL receptors?

• ApoA-I
• ApoB-100
• ApoC-II
• ApoE

Correct Answer: ApoB-100

Q18. A key lab parameter representing non-HDL cholesterol is calculated as:

• Total cholesterol minus LDL
• Total cholesterol minus HDL
• Total cholesterol plus TG/5
• LDL plus HDL

Correct Answer: Total cholesterol minus HDL

Q19. Which statin has the highest potency for LDL lowering at usual doses?

• Pravastatin
• Simvastatin
• Atorvastatin
• Fluvastatin

Correct Answer: Atorvastatin

Q20. Combination of a statin with a fibrate increases risk of which adverse effect?

• Hepatotoxicity only
• Myopathy and rhabdomyolysis
• QT prolongation
• Pancytopenia

Correct Answer: Myopathy and rhabdomyolysis

Q21. Which marker reflects reverse cholesterol transport and is considered protective against atherosclerosis?

• LDL cholesterol
• VLDL cholesterol
• HDL cholesterol
• Chylomicrons

Correct Answer: HDL cholesterol

Q22. Which inherited pattern best describes heterozygous familial hypercholesterolemia?

• Autosomal recessive
• Autosomal dominant
• X-linked recessive
• Mitochondrial inheritance

Correct Answer: Autosomal dominant

Q23. Which drug class may reduce absorption of fat-soluble vitamins as a side effect?

• Statins
• Bile acid sequestrants
• PCSK9 inhibitors
• Fibrates

Correct Answer: Bile acid sequestrants

Q24. Cholesteryl ester transfer protein (CETP) facilitates transfer between which particles?

• HDL to VLDL/LDL
• LDL to HDL only
• Chylomicrons to HDL only
• VLDL to chylomicrons only

Correct Answer: HDL to VLDL/LDL

Q25. In patients with very high cardiovascular risk, an LDL target often recommended is:

• <190 mg/dL
• <130 mg/dL
• <70 mg/dL
• <160 mg/dL

Correct Answer: <70 mg/dL

Q26. Which of the following drugs is contraindicated in pregnancy due to teratogenicity and lipid effects?

• Pravastatin
• Atorvastatin
• Colestyramine
• Omega-3 fatty acids

Correct Answer: Atorvastatin

Q27. Which clinical sign is associated with prolonged severe hypercholesterolemia and deposits in skin?

• Palmar xanthomas
• Tendon xanthomas
• Cherry red spots
• Hepatosplenomegaly only

Correct Answer: Tendon xanthomas

Q28. Which laboratory change is expected with fibrate therapy?

• Marked HDL decrease
• Reduction in triglycerides and increase in HDL
• Increase in LDL only
• No change in lipids

Correct Answer: Reduction in triglycerides and increase in HDL

Q29. Which drug class directly increases LDL receptor expression by lowering intracellular cholesterol?

• Bile acid sequestrants
• Statins
• Fibrates
• Niacin

Correct Answer: Statins

Q30. The primary mechanism by which omega-3 fatty acids reduce triglycerides is:

• Increasing intestinal cholesterol absorption
• Decreasing hepatic VLDL synthesis and secretion
• Inhibiting LPL activity
• Blocking HMG-CoA reductase

Correct Answer: Decreasing hepatic VLDL synthesis and secretion

Q31. Elevated remnant lipoproteins (IDL) are strongly associated with which dyslipidemia type?

• Type I hyperlipoproteinemia
• Type III dysbetalipoproteinemia (broad β disease)
• Familial hypoalphalipoproteinemia
• Type V hyperlipoproteinemia

Correct Answer: Type III dysbetalipoproteinemia (broad β disease)

Q32. Which medication can increase statin blood levels via CYP3A4 inhibition leading to higher myopathy risk?

• Rifampin
• Grapefruit juice
• St. John’s wort
• Carbamazepine

Correct Answer: Grapefruit juice

Q33. Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis due to its similarity to which molecule?

• Fibrinogen
• Apo(a) similar to plasminogen
• ApoC-II similar to lipase
• HDL similar to ApoA-I

Correct Answer: Apo(a) similar to plasminogen

Q34. Which diagnostic feature on a fasting lipid profile indicates isolated hypercholesterolemia?

• High TG with low LDL
• High total cholesterol and high LDL with normal TG
• Low HDL with normal LDL and TG
• Very low total cholesterol

Correct Answer: High total cholesterol and high LDL with normal TG

Q35. The most appropriate first-line pharmacotherapy for most patients with primary hypercholesterolemia is:

• Bile acid sequestrant alone
• High-intensity statin therapy
• Niacin monotherapy
• Fibrate monotherapy

Correct Answer: High-intensity statin therapy

Q36. An increase in CK is most concerning when combined with which symptom in a patient on statin therapy?

• Joint stiffness
• Muscle pain and weakness
• Headache
• Constipation

Correct Answer: Muscle pain and weakness

Q37. Which genetic mutation leads to gain-of-function causing increased LDL levels through enhanced PCSK9 activity?

• Loss-of-function PCSK9 mutation
• Gain-of-function PCSK9 mutation
• Mutation in HDL receptor gene
• Mutation in LPL gene

Correct Answer: Gain-of-function PCSK9 mutation

Q38. What is the primary therapeutic effect of colesevelam compared with older bile acid sequestrants?

• Higher systemic absorption
• Less GI side effects and better tolerability
• Direct HMG-CoA reductase inhibition
• Inactivation of lipoprotein lipase

Correct Answer: Less GI side effects and better tolerability

Q39. Which laboratory change would you expect in hypothyroidism related hypercholesterolemia?

• Decrease in LDL receptor activity leading to elevated LDL
• Increase in LPL activity reducing TG
• Marked decrease in total cholesterol
• Significant increase in HDL only

Correct Answer: Decrease in LDL receptor activity leading to elevated LDL

Q40. Which lipid parameter should be specifically monitored when combining statins with fibrates?

• Platelet count
• Serum creatine kinase (CK)
• Blood glucose
• Serum sodium

Correct Answer: Serum creatine kinase (CK)

Q41. Which of the following is true about HDL function?

• HDL promotes cholesterol efflux from peripheral tissues to the liver
• HDL is the main transporter of triglycerides to adipose tissue
• Higher HDL universally guarantees no cardiovascular risk
• HDL oxidizes LDL directly

Correct Answer: HDL promotes cholesterol efflux from peripheral tissues to the liver

Q42. When treating severe hypertriglyceridemia to prevent pancreatitis, which drug class is preferred?

• Statins
• Fibrates
• Bile acid sequestrants
• Niacin

Correct Answer: Fibrates

Q43. Which of the following medications lowers LDL but may increase triglycerides slightly?

• Bile acid sequestrants
• Statins
• Fibrates
• Niacin

Correct Answer: Bile acid sequestrants

Q44. A homozygous familial hypercholesterolemia patient typically presents with which feature?

• Mild LDL elevation in late adulthood
• Severe LDL elevation and early-onset atherosclerosis in childhood
• Isolated hypertriglyceridemia only
• Low risk of coronary disease

Correct Answer: Severe LDL elevation and early-onset atherosclerosis in childhood

Q45. Which lab value indicates an atherogenic lipid profile despite normal LDL?

• Low non-HDL cholesterol
• High triglycerides with low HDL yielding high non-HDL cholesterol
• Isolated low HDL with low TG
• High HDL with low LDL

Correct Answer: High triglycerides with low HDL yielding high non-HDL cholesterol

Q46. Which medication reduces hepatic VLDL production by inhibiting DGAT2 or via other mechanisms and is used for hypertriglyceridemia?

• Statins only
• Omega-3 fatty acids
• Colesevelam
• Ezetimibe

Correct Answer: Omega-3 fatty acids

Q47. Which of the following is a common side effect of niacin that can be mitigated by aspirin pre-treatment?

• Hepatotoxicity
• Flushing due to prostaglandin release
• Hypotension
• Renal failure

Correct Answer: Flushing due to prostaglandin release

Q48. Which transporter deficiency leads to abetalipoproteinemia with fat malabsorption and low plasma cholesterol?

• ApoB-100 deficiency
• Microsomal triglyceride transfer protein (MTP) deficiency
• NPC1L1 transporter excess
• PCSK9 overexpression

Correct Answer: Microsomal triglyceride transfer protein (MTP) deficiency

Q49. Which assessment is most useful to estimate overall atherosclerotic risk beyond LDL alone?

• Non-HDL cholesterol and apoB levels
• Serum amylase
• Blood urea nitrogen
• Serum iron

Correct Answer: Non-HDL cholesterol and apoB levels

Q50. Which therapeutic approach is most appropriate for a patient with familial hypercholesterolemia not reaching LDL goals on maximal statin therapy?

• Discontinue statin and start fibrate only
• Add ezetimibe and/or PCSK9 inhibitor to statin therapy
• Switch to bile acid sequestrant monotherapy
• Advise high-cholesterol diet

Correct Answer: Add ezetimibe and/or PCSK9 inhibitor to statin therapy

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com