WBR0726

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 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::