Cardiovascular Drugs USMLE Step 1 Practice Question
A 72-year-old man with a history of hypertension and chronic kidney disease (stage 3) presents to his primary care physician complaining of a persistent dry, nonproductive cough that began approximately 3 weeks ago. He denies fever, chills, wheezing, shortness of breath, or recent upper respiratory infection. His blood pressure today is 148/92 mmHg, heart rate is 76 bpm, respiratory rate is 16 breaths per minute, and oxygen saturation is 98% on room air. Lung auscultation reveals clear breath sounds bilaterally with no wheezes or crackles. He has been taking lisinopril 10 mg daily for 2 years, which had previously provided adequate blood pressure control. His current serum creatinine is 2.1 mg/dL, slightly above his baseline of 1.9 mg/dL, and his potassium is 4.8 mEq/L. A chest radiograph shows no infiltrates or pulmonary edema. Which of the following best explains his cough?
Answer choices
- AIncreased sympathetic nervous system activity
- BDirect stimulation of cough receptors in the bronchial epithelium
- CWorsening of chronic kidney disease causing uremic pneumonitis
- DInhibition of angiotensin II-mediated bradykinin degradationCorrect answer
- EActivation of renin-angiotensin-aldosterone system
- FIncreased pulmonary capillary wedge pressure leading to interstitial edema
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