Cardiology: BNP and neprilysin inhibition: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: BNP and neprilysin inhibition

Sample item

A patient with heart failure is switched from enalapril to sacubitril-valsartan. Which biomarker interpretation is correct afterwards?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. BNP may rise because neprilysin degrades it, so NT-proBNP is preferred for monitoring

Neprilysin breaks down BNP, so inhibition raises BNP levels without worsening disease. NT-proBNP is not a neprilysin substrate and remains reliable for monitoring. Sacubitril-valsartan must not be combined with ACE inhibitors because of angioedema risk.

Option by option

  • A. BNP may rise because neprilysin degrades it, so NT-proBNP is preferred for monitoring (correct)

    Correct. Use NT-proBNP when on an ARNI.

  • B. Troponin rises predictably

    Troponin is unrelated to the drug.

  • C. Both BNP and NT-proBNP are unaffected

    BNP is affected, so they are not both unaffected.

  • D. NT-proBNP rises because neprilysin degrades it

    NT-proBNP is not degraded by neprilysin.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, BNP may rise because neprilysin degrades it, so NT-proBNP is preferred for monitoring. Neprilysin breaks down BNP, so inhibition raises BNP levels without worsening disease.

Why is "Troponin rises predictably" not the answer?

Troponin is unrelated to the drug.

Why is "Both BNP and NT-proBNP are unaffected" not the answer?

BNP is affected, so they are not both unaffected.

Why is "NT-proBNP rises because neprilysin degrades it" not the answer?

NT-proBNP is not degraded by neprilysin.

What concept does this question test?

It tests Cardiology: BNP and neprilysin inhibition in General Medicine. NT-proBNP is not a neprilysin substrate and remains reliable for monitoring. Sacubitril-valsartan must not be combined with ACE inhibitors because of angioedema risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: BNP and neprilysin inhibition?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.