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NBME 20 Answers

nbme20/Block 3/Question#27 (13.8 difficulty score)
A 55-year-old man with type 2 diabetes ...

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submitted by shirafune(6),

Classic statin-induced myopathy. As a side note, when patients started on commonly used statins such as atorvastatin, rosuvastatin, and simvastatin and present with rhabdomyolysis, it is not always an absolute contraindication to statins. Example would be 30yo male with long life-expectancy in which statin therapy would still have a large benefit.

Instead, a more hydrophilic statin (i.e. less lipophilic) would be selected. These include pravastatin and fluvastatin. The more lipophilic a statin is, the greater the risk of rhabdomyolysis. In fact, cerivastatin was pulled off the market for an unacceptably high-rate of rhabdomyolysis.

submitted by hayayah(1056),
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lilyo  Statins have an increased risk of myopathy, specially when combined with other medications like Fibrates. This patient presents with muscle pain along with an elevated CK and + myoglobin test in urine. Consistent with myopathy. +2