WBR0726
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Cardiology |
| 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 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. |
| Approved | Approved::No |
| Keyword | WBRKeyword::cimetidine, WBRKeyword::gynecomastia, WBRKeyword::side, WBRKeyword::effect |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |