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ACE inhibitor cough — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareACE inhibitor coughUSMLE Step 3

A 57-year-old woman started lisinopril for hypertension 6 weeks ago. Blood pressure is now 126/74 mm Hg. She reports a persistent dry cough without fever, dyspnea, wheezing, reflux symptoms, or postnasal drip. Chest examination is normal and oxygen saturation is 99%. 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.

Reveal the answer and explanation

Correct answer: B — Bradykinin accumulation from ACE inhibition

ACE inhibitors can cause dry cough due to increased bradykinin; switching to an ARB is reasonable if symptoms are troublesome.

Reference: ACC/AHA hypertension guidance: https://www.heart.org/