A pt with a prominent apical impulse, laterally displaced, a

Discussion in 'USMLE Step 2 CK' started by Guest, Aug 3, 2010.

  1. Guest

    Guest Guest

    A 47-year-old lawyer presents to his physician for evaluation of difficulty voiding for the past few years. He describes a delay when he "attempts to go" and that he often wets his underwear with additional urine after he has finished. He is married and has one teenage child. His past medical history is remarkable for essential hypertension that he claims is diet controlled. His blood pressure is 170/92 mm Hg, and his pulse is 82/min. His physical examination is remarkable for a prominent apical impulse, laterally displaced, and a faint abdominal bruit. His prostate is non-tender and appears large with no palpable nodules or irregularities. Which of the following is the most appropriate antihypertensive therapy for this patient?

    A. Lisinopril

    B. Metoprolol

    C. Nifedipine

    D. Terazosin

    E. Verapamil
  2. Guest

    Guest Guest

    The answer is D.

    An important concept to recognize in the treatment of medical conditions is that certain medications overlap syndromes and are efficacious in many areas. This "co-treatment" option maximizes the benefits of each drug in a regimen and often addresses two or more issues simultaneously. This drug is an alpha-1 receptor antagonist that is very efficacious in the treatment of hypertension. This class of drugs is also useful in the treatment of benign prostatic hypertrophy (BPH).

    Lisinopril (choice A) is an ACE inhibitor. These drugs have excellent efficacy in treating blood pressure. In addition, they are very useful in delaying the progression of renal disease in diabetics (diabetic nephropathy).

    Metoprolol (choice B) is a beta blocker. This class of drugs is recommended as first-line monotherapy for hypertension. Use of these agents has been associated with improved survival in a number of clinical trials.

    Nifedipine (choice C) is a calcium channel blocker that has reasonable efficacy in treating hypertension. It has no known protective benefit in patients with BPH.

    Verapamil (choice E) is also a calcium channel blocker. In addition to its use as a therapy for hypertension, is also used as a rate control agent in patients with atrial fibrillation.

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