USMLE Step 1 Question 387
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A 54-year-old man with newly diagnosed essential hypertension develops a painful right knee after taking his anti-hypertensive medication. Joint aspiration reveals needle shaped crystals that are negatively birefringent. What was the likely agent that precipitated his knee pain?
Correct Answer: C. Hydrochlorothiazide
Hydrochlorothiazide (HCTZ) (choice C) is a common initial therapy for uncomplicated hypertension.
It is a diuretic that inhibits the Na+/Cl- transporter in the early segment of the distal convoluted tubule. HCTZ is associated with hyperuricemia, along with hypercalcemia, hyperglycemia, and hyperlipidemia. Increased uric acid can precipitate an episode of gout, which this man experienced.Clonidine (choice A) is an agonist of presynaptic alpha2-adrenoceptors on sympathetic neurons. Enalapril (choice B) is an ACE inhibitor. Metoprolol (choice D) is a beta1-adrenoceptor selective beta-blocker. Nifedipine (choice E) is a calcium channel blocker.
All these choices are used as antihypertensives, but only HCTZ is associated with hyperuricemia.
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Category: PharmacologyA 54-year-old man with newly diagnosed essential hypertension develops a painful right knee after taking his anti-hypertensive medication. Joint aspiration reveals needle shaped crystals that are negatively birefringent. What was the likely agent that precipitated his knee pain?
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