WBR0455
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| Author | PageAuthor::Neeraja Danda M.B.B.S |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Cardiovascular |
| Prompt | [[Prompt::A 46 year old male came to his physician’s office for an annual physical. His past medical history is significant for hypertension, congestive heart failure secondary to myocardial infarction and diabetes mellitus. His current medications are aspirin, atenolol, glibenclamide , spirinolactone, captopril and atorvastatin. Vitals are: pulse rate 82/min, blood pressure 130/80 mm Hg and respiratory rate 19/min. He eats vegetables and meat and walks for an hour, 3 times a week.On further questioning he expresses concern regarding the appearance of his breasts over the past several months.
Inspection of the breasts shows the following findings. 
Which of the following medication change is necessary in this patient?]] |
| Answer A | AnswerA::Atorvastatin to niacin |
| Answer A Explanation | AnswerAExp::'''Incorrect''' Atorvastatin is a lipid lowering drug with mortality benefits in myocardial infarction, it has no relation with gynecomastia. |
| Answer B | AnswerB::Spirinolactone to eplerenone |
| Answer B Explanation | AnswerBExp::Eplerenone can be substituted for spironolactone in these cases, as it does not have anti- androgenic side effects. |
| Answer C | AnswerC::Captopril to losartan |
| Answer C Explanation | AnswerCExp::'''Incorrect''' Captopril is an angiotensin converting enzyme inhibitor , it should be replaced with losartan ( angiotensin receptor blocker) only if the patient suffers cough as a side effect |
| Answer D | AnswerD::Glibenclamide to Insulin |
| Answer D Explanation | AnswerDExp::'''Incorrect''' Changing from glibenclamide to insulin is necessary only if the patient’s blood sugar levels are not controlled, there is no such indication in this question |
| Answer E | AnswerE::Spirinolactone to digoxin |
| Answer E Explanation | AnswerEExp::'''Incorrect''' Spirinolactone should be replaced, but not with digoxin |
| Right Answer | RightAnswer::B |
| Explanation | [[Explanation::The above image demonstrates male breast enlargement known as gynecomastia. Gynecomastia is a side effect of spirinolactone due to its anti androgenic effect. Sprinolactone can be replaced with eplerenone , which is also a potassium sparing diuretic. Eplerenone also confers a mortality benefit in heart failure but does not cause gynecomastia.
Educational Objective: Gynecomastia is a side effect of spirinolactone use. Eplerenone can be substituted for spironolactone in these cases, as it does not have anti- androgenic side effects. References: Page 79, 80 Master the boards Step 2 CK second edition |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Heart failure, WBRKeyword::Spirinolactone, WBRKeyword::Eplerenone, WBRKeyword::Gynecomastia |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |