WBR0726

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Gastrointestinal
Prompt	[[Prompt::A 62-year-old man presents to the physician's office for bilateral breast enlargement. He has a past medical history significant for coronary artery disease, status-post coronary artery bypass graft (CABG), advanced congestive heart failure, gastroesophageal reflux disease (GERD), dyslipidemia, and hypertension. He is currently taking aspirin, ramipril, metoprolol, furosemide, omeprazole, cimetidine, simvastatin, and fenofibrate. He denies smoking, alcohol intake, or use of illicit drugs. The physician suspects his condition is an adverse effect of a medication he is taking. Which of the patient's medications is most likely responsible for his condition?]]
Answer A	AnswerA::Ramipril
Answer A Explanation	AnswerAExp::Ramipril is an ACE-inhibitor that has several indications, such as hypertension, diabetic nephropathy, and cardiac left ventricular dysfunction. Gynecomastia is not a typical adverse effect of ACE-inhibitors.
Answer B	AnswerB::Furosemide
Answer B Explanation	AnswerBExp::Furosemide is a loop diuretic indicated for symptomatic congestive heart failure. Gynecomastia is not a typical adverse effect of loop diuretics.
Answer C	AnswerC::Cimetidine
Answer C Explanation	AnswerCExp::Cimetidine is an H2 receptor blocker indicated for GERD. Gynecomastia is a known adverse effect of cimetidine.
Answer D	AnswerD::Omeprazole
Answer D Explanation	AnswerDExp::Omeprazole is a proton pump inhibitor indicated for GERD. Gynecomastia is not a typical adverse effect of PPI.
Answer E	AnswerE::Fenofibrate
Answer E Explanation	AnswerEExp::Fenofibrate is indicated for dyslipidemia, especially hypertriglyceridemia. Gynecomastia is not a typical adverse effect of fenofibrate therapy.
Right Answer	RightAnswer::C
Explanation	[[Explanation::The patient is presenting with gynecomastia. Use of several medications are associated with gynecomastia. Knowing these medications is important for the USMLE. The following is a list of medications and conditions that are associated with gynecomastia: 1- Medications: Spironolactone, digitalis, cimetidine, ketoconazole, dopamine, anti-psychotic drugs 2- Substances: Alcohol, heroin, marijuana 3- Diseases: Klinefelter syndrome, cirrhosis, testicular tumors 4- Physiological conditions: Puberty, old age, estogen Educational Objective: Gynecomastia is an adverse effect of cimetidine. References: First Aid 2014 page 586]]
Approved	Approved::Yes
Keyword	WBRKeyword::Cimetidine, WBRKeyword::Gynecomastia, WBRKeyword::Side, WBRKeyword::Effect, WBRKeyword::Adverse, WBRKeyword::Drug, WBRKeyword::Reaction
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Order in Linked Questions	LinkedOrder::