Cardiology: PCSK9 inhibitors: 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: PCSK9 inhibitors

Sample item

A 30-year-old with heterozygous familial hypercholesterolaemia has an LDL of 190 mg/dL despite a maximal statin dose plus ezetimibe. Evolocumab injections are added. How does this drug lower LDL cholesterol?

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

The answer and the reasoning

D. Stops PCSK9 from degrading hepatic LDL receptors

Evolocumab is a monoclonal antibody against PCSK9. Without PCSK9 more LDL receptors are recycled to the hepatocyte surface, so more LDL is cleared from plasma. It is used in familial hypercholesterolaemia and in high-risk patients not controlled with statins and ezetimibe.

Option by option

  • A. Inhibits microsomal triglyceride transfer protein

    Inhibition of microsomal triglyceride transfer protein is the action of lomitapide.

  • B. Binds bile acids to deplete hepatic cholesterol

    Bile acid binding is the action of resins and has a modest effect on LDL.

  • C. Blocks cholesterol absorption through NPC1L1

    NPC1L1 blockade is the action of ezetimibe, which this patient already takes.

  • D. Stops PCSK9 from degrading hepatic LDL receptors (correct)

    Correct. Neutralising PCSK9 preserves LDL receptors, so LDL clearance rises.

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 D, Stops PCSK9 from degrading hepatic LDL receptors. Evolocumab is a monoclonal antibody against PCSK9.

Why is "Inhibits microsomal triglyceride transfer protein" not the answer?

Inhibition of microsomal triglyceride transfer protein is the action of lomitapide.

Why is "Binds bile acids to deplete hepatic cholesterol" not the answer?

Bile acid binding is the action of resins and has a modest effect on LDL.

Why is "Blocks cholesterol absorption through NPC1L1" not the answer?

NPC1L1 blockade is the action of ezetimibe, which this patient already takes.

What concept does this question test?

It tests Cardiology: PCSK9 inhibitors in General Medicine. Without PCSK9 more LDL receptors are recycled to the hepatocyte surface, so more LDL is cleared from plasma. It is used in familial hypercholesterolaemia and in high-risk patients not controlled with statins and ezetimibe.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: PCSK9 inhibitors?

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.