View source for WBR0726

 {{WBRQuestion
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal
|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?
|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: <br>
1- Medications: Spironolactone, digitalis, cimetidine, ketoconazole, dopamine, anti-psychotic drugs<br>
2- Substances: Alcohol, heroin, marijuana <br>
3- Diseases: Klinefelter syndrome, cirrhosis, testicular tumors<br>
4- Physiological conditions: Puberty, old age, estogen
|AnswerA=Ramipril
|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.
|AnswerB=Furosemide
|AnswerBExp=Furosemide is a loop diuretic indicated for symptomatic congestive heart failure.  Gynecomastia is not a typical adverse effect of loop diuretics.
|AnswerC=Cimetidine
|AnswerCExp=Cimetidine is an H2 receptor blocker indicated for GERD. Gynecomastia is a known adverse effect of cimetidine.
|AnswerD=Omeprazole
|AnswerDExp=Omeprazole is a proton pump inhibitor indicated for GERD. Gynecomastia is not a typical adverse effect of PPI.
|AnswerE=Fenofibrate
|AnswerEExp=Fenofibrate is indicated for dyslipidemia, especially hypertriglyceridemia.  Gynecomastia is not a typical adverse effect of fenofibrate therapy.
|EducationalObjectives=Gynecomastia is an adverse effect of cimetidine.
|References=First Aid 2014 page 586
|RightAnswer=C
|WBRKeyword=Cimetidine, Gynecomastia, Side, Effect, Adverse, Drug, Reaction
|Approved=Yes
}}