question: Q:A 55-year-old man comes to the physician for a follow-up examination. He feels well. He has hyperlipidemia and type 2 diabetes mellitus. He takes medium-dose simvastatin and metformin. Four months ago, fasting serum studies showed a LDL-cholesterol of 136 mg/dL and his medications were adjusted. Vital signs are within normal limits. On physical examination, there is generalized weakness of the proximal muscles. Deep tendon reflexes are 2+ bilaterally. Fasting serum studies show:
  Total cholesterol 154 mg/dL
  HDL-cholesterol 35 mg/dL
  LDL-cholesterol 63 mg/dL
  Triglycerides 138 mg/dL
  Glucose 98 mg/dL
  Creatinine 1.1 mg/dL
  Creatine kinase 260 mg/dL
  Which of the following is the most appropriate next step in management of this patient's hyperlipidemia?"? 
  {'A': 'Discontinue simvastatin, start pravastatin in 3 weeks', 'B': 'Continue simvastatin, add niacin', 'C': 'Discontinue simvastatin, start fenofibrate now', 'D': 'Increase the dose of simvastatin', 'E': 'Discontinue simvastatin, start niacin in 3 weeks'},