USMLE (United States Medical Licensing Examination): Step 1: Basic sciences assessment Practice Exam 05
Practice exam for USMLE (United States Medical Licensing Examination): Step 1: Basic sciences assessment.
Question 1
MEDIUMA 62-year-old man presents to the emergency department with progressive shortness of breath and wheezing for 2 days. He has chronic obstructive pulmonary disease and hypertension. Medications include albuterol inhaler as needed and a new antihypertensive started 1 week ago. He has smoked 1 pack of cigarettes daily for 40 years. Temperature is 37.0°C (98.6°F), blood pressure is 148/88 mm Hg, pulse is 92/min, and respiratory rate is 22/min. Diffuse expiratory wheezes are heard bilaterally. Which of the following medications is most likely responsible for this patient’s acute worsening of symptoms?
Nonselective and, at higher doses, even relatively β1-selective beta-blockers can worsen bronchospasm in patients with COPD/asthma by blocking β2-mediated bronchodilation. Metoprolol is the most likely culprit among the options. Lisinopril can cause cough/angioedema but does not typically cause wheezing from bronchoconstriction. Amlodipine and prazosin do not precipitate bronchospasm.
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