{"id":4136,"date":"2024-08-07T17:22:00","date_gmt":"2024-08-07T17:22:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4136"},"modified":"2025-10-01T11:38:22","modified_gmt":"2025-10-01T19:38:22","slug":"usmle-step-2-question-of-the-day-dry-cough","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough","title":{"rendered":"USMLE\u00ae Step 2 Question of the Day: Dry cough"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Evaluate your knowledge with today&#8217;s USMLE Step 2 Question of the Day! A 55-year-old man presents with a persistent dry cough, and his current medication regimen may be the cause. What\u2019s the next best step in his management?<br><\/strong><\/em><br>A 55-year-old man comes to the office for the evaluation of a dry, nagging cough for the past several weeks. He does not have chest pain, shortness of breath, runny nose, or itchy eyes. The patient does not report recent respiratory or gastrointestinal infections. The rest of the review of systems is within normal limits. Past medical history is significant for type 2 diabetes mellitus, asthma, and hypertension. Current medications include metformin, lisinopril, atorvastatin, and as needed albuterol inhaler. The patient does not use tobacco, alcohol, or illicit drugs. Temperature is 36.6\u00b0C (97.9\u00b0F), pulse is 90\/min, respirations are 18\/min, and blood pressure is 135\/75 mmHg. Lungs are clear to auscultation bilaterally. Heart sounds are normal without any murmurs. &nbsp;Laboratory results show a serum creatinine of 1.2 mg\/dL and potassium of 4.9 mEq\/L. Which of the following is the best next step in the management of this patient?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Start the patient on chlorpheniramine&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Switch the patient from lisinopril to losartan&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Perform a chest x-ray&nbsp;&nbsp;<br><\/strong><br><strong>D.&nbsp;Start the patient on intranasal glucocorticoids&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Reassure the patient and send home&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 2 CK Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.\u00a0Switch the patient from lisinopril to losartan\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s see why the answer wasn&#8217;t A, C, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today&#8217;s incorrect answers are&#8230;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Start the patient on chlorpheniramine\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;First-generation antihistamines such as chlorpheniramine is the suitable treatment option for patients with nonallergic rhinitis. These patients typically present with nasal blockage and postnasal drip in the absence of a trigger factor. This patient\u2019s cough without other symptoms is most likely due to lisinopril.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Perform a chest x-ray&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The patient most likely has a cough secondary to bronchial irritation caused by bradykinin accumulation. The best step is to discontinue the causative medication. A chest x-ray is not indicated at this time.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.&nbsp;Start the patient on intranasal glucocorticoids&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Intranasal glucocorticoids is the first-line treatment for allergic rhinitis. It typically &nbsp;presents with paroxysms of sneezing, rhinorrhea, nasal obstruction, and nasal itching.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Reassure the patient and send home&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>The patient most likely has a cough secondary to bronchial irritation caused by bradykinin accumulation. The best step is to discontinue the causative medication.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s dry nagging cough is most likely a side effect of&nbsp;lisinopril, an&nbsp;angiotensin-converting enzyme (ACE) inhibitor.&nbsp;The best next step is to&nbsp;replace ACE inhibitors with angiotensin receptor blockers&nbsp;(ARBs), which does not affect bradykinin levels and does not cause cough.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ARBs (e.g., losartan and valsartan)&nbsp;bind to angiotensin receptors&nbsp;on vascular smooth muscles and the adrenal glands, which prevent angiotensin II from binding. This results in decreased vasoconstriction and decreased aldosterone synthesis, respectively. They are indicated in the management of&nbsp;hypertension, heart failure,&nbsp;and&nbsp;patients who have had a myocardial infarction.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Unlike ACE inhibitors, ARBs do not increase bradykinin levels in the blood, and therefore, are less likely to cause&nbsp;cough and angioedema.&nbsp;Other than that, the adverse effects of angiotensin II receptor antagonists, just like ACE inhibitors, are&nbsp;hyperkalemia and hypotension.&nbsp;&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"486\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?w=1024\" alt=\"PRINGLE MANEUVER\nLiver\nGallbladder\nHepatoduodenal Ligaments\nLesser Omentum\nStomach\nDuodenum\" class=\"wp-image-4117\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png 1244w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?resize=300,142 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?resize=768,364 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/pringle-maneuver.png?resize=1024,486 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The Pringle maneuver involves manually compressing the hepatoduodenal ligament to minimize blood loss l during hepatic surgery. The hepatoduodenal ligament is composed of the hepatic artery, portal vein, and common bile duct.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Piardi, T., Lhuaire, M., Memeo, R., et al. (2016) Laparoscopic Pringle maneuver: How we do it?. Hepatobiliary Surgery and Nutrition. 5(4), 345-349. Doi:10.21037\/hbsn.2015.11.01.\u00a0<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/osmosis.org\/clinical-sciences\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?w=700\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more \u00a0USMLE\u00ae Step 2 CK practice questions?\u00a0Try Osmosis by Elsevier today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Evaluate your knowledge with today&#8217;s USMLE Step 2 Question of the Day! A 55-year-old man presents with a persistent dry cough, and his current medication regimen may be the cause. What\u2019s the next best step in his management?A 55-year-old man comes to the office for the evaluation of a dry, nagging cough for the past [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":4137,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,29,32,1370],"tags":[],"class_list":["post-4136","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-nclex","category-nursing","category-step-2-questions"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 2 Question of the Day: Dry cough - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 2 Question of the Day: Dry cough - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Evaluate your knowledge with today&#8217;s USMLE Step 2 Question of the Day! A 55-year-old man presents with a persistent dry cough, and his current medication regimen may be the cause. What\u2019s the next best step in his management?A 55-year-old man comes to the office for the evaluation of a dry, nagging cough for the past [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2024-08-07T17:22:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:38:22+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/usmle-dry-cough.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; Team\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-dry-cough\"},\"author\":{\"name\":\"Marina Horiates Kerekes, MD &amp; 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