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|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 62 year old male patient 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), 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 or alcohol intake. The physician suspects his condition is a side effect of a medication he is taking.  Which of medications the patient is taking is most likely causing his condition?
|Prompt=A 62 year old male patient 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), 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 or alcohol intake. The physician suspects his condition is a side effect of a medication he is taking.  Which of the medications the patient is taking is most likely causing his condition?
|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 might cause gynecomastia:  
|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 might cause gynecomastia:  
Medications: Spironolactone, digitalis, cimetidine, ketoconazole
Medications: Spironolactone, digitalis, cimetidine, ketoconazole

Revision as of 22:13, 24 October 2013

 
Author [[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 62 year old male patient 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), 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 or alcohol intake. The physician suspects his condition is a side effect of a medication he is taking. Which of the medications the patient is taking is most likely causing 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 side 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 side effect of loop diuretics.
Answer C AnswerC::Cimetidine
Answer C Explanation AnswerCExp::Cimetidine is a H2 receptor blocker indicated for GERD. Gynecomastia is a side 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 side effect of PPI.
Answer E AnswerE::Fenofibrate
Answer E Explanation AnswerEExp::Fenofibrate is indicated for dyslipidemia, especially hypertriglyceridemia. Gynecomastia is not a typical side 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 might cause gynecomastia:

Medications: Spironolactone, digitalis, cimetidine, ketoconazole Substances: Alcohol Diseases: Klinefelter syndrome, cirrhosis, testicular tumors Physiological conditions: Puberty, old age

Mnemonic: "Some Drugs Create Awesome Knockers" = Spironolactone, Digitalis, Cimetidine, Alcohol, Ketoconazole.

Educational Objective: Gynecomastia is a side effect of cimetidine.
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::cimetidine, WBRKeyword::gynecomastia, WBRKeyword::side, WBRKeyword::effect
Linked Question Linked::
Order in Linked Questions LinkedOrder::