Cardiology: ACE inhibitor cough: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: ACE inhibitor cough

Sample item

A 55-year-old man takes ramipril for hypertension. He has had a persistent dry, tickling cough for 6 weeks. Examination and chest radiograph are normal. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Switch to an angiotensin receptor blocker

ACE inhibitors prevent breakdown of bradykinin, which sensitises airway sensory nerves and causes a dry cough in a minority of patients. It is a class effect, so changing to another ACE inhibitor does not help. An angiotensin receptor blocker gives similar benefit without the cough.

Option by option

  • A. Continue and add codeine linctus

    Suppressing the cough with codeine treats the symptom while continuing the cause.

  • B. Add an inhaled corticosteroid for cough

    An inhaled steroid treats airway inflammation, which is not the mechanism of this cough.

  • C. Switch to an angiotensin receptor blocker (correct)

    Correct. Angiotensin receptor blockers do not raise bradykinin and so avoid the cough.

  • D. Change to a different ACE inhibitor

    The cough is a class effect and will persist with another ACE inhibitor.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Switch to an angiotensin receptor blocker. ACE inhibitors prevent breakdown of bradykinin, which sensitises airway sensory nerves and causes a dry cough in a minority of patients.

Why is "Continue and add codeine linctus" not the answer?

Suppressing the cough with codeine treats the symptom while continuing the cause.

Why is "Add an inhaled corticosteroid for cough" not the answer?

An inhaled steroid treats airway inflammation, which is not the mechanism of this cough.

Why is "Change to a different ACE inhibitor" not the answer?

The cough is a class effect and will persist with another ACE inhibitor.

What concept does this question test?

It tests Cardiology: ACE inhibitor cough in General Medicine. It is a class effect, so changing to another ACE inhibitor does not help. An angiotensin receptor blocker gives similar benefit without the cough.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: ACE inhibitor cough?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.