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ACE inhibitor cough — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareACE inhibitor coughUSMLE Step 3

A 41-year-old nonsmoking woman has dry cough for 4 months. Chest x-ray is normal and spirometry is normal. She has mild reflux and postnasal drip symptoms, but lisinopril was started 5 months ago. Lungs are clear. Which of the following is the most likely explanation for this patient's findings?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — ACE inhibitor-associated cough

A dry chronic cough beginning after ACE inhibitor initiation with normal chest imaging suggests ACE inhibitor-associated cough.

Reference: Current US clinical practice standards and USMLE Step 3 content outline, https://www.usmle.org/exam-resources/step-3-materials