Cardiology: spironolactone gynaecomastia: 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: spironolactone gynaecomastia

Sample item

A 58-year-old man with heart failure and a low ejection fraction takes spironolactone and develops painful breast enlargement. Serum potassium is 4.6 mmol/L. What is the most appropriate change?

AReplace with eplerenoneBReplace with amilorideCStop all mineralocorticoid blockadeDReplace with furosemide

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

The answer and the reasoning

A. Replace with eplerenone

Spironolactone also blocks androgen and progesterone receptors, causing gynaecomastia and breast pain. Eplerenone is a more selective mineralocorticoid antagonist with a survival benefit in heart failure after infarction, so it keeps the benefit without these effects.

Option by option

A. Replace with eplerenone (correct)
Correct. Eplerenone is selective for the mineralocorticoid receptor and spares sex hormone receptors.
B. Replace with amiloride
Amiloride lacks the outcome evidence of mineralocorticoid receptor antagonists in heart failure.
C. Stop all mineralocorticoid blockade
Stopping blockade would forfeit a drug that reduces mortality in this condition.
D. Replace with furosemide
A loop diuretic relieves congestion but does not give the survival benefit.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Replace with eplerenone. Spironolactone also blocks androgen and progesterone receptors, causing gynaecomastia and breast pain.

Why is "Replace with amiloride" not the answer?

Amiloride lacks the outcome evidence of mineralocorticoid receptor antagonists in heart failure.

Why is "Stop all mineralocorticoid blockade" not the answer?

Stopping blockade would forfeit a drug that reduces mortality in this condition.

Why is "Replace with furosemide" not the answer?

A loop diuretic relieves congestion but does not give the survival benefit.

What concept does this question test?

It tests Cardiology: spironolactone gynaecomastia in General Medicine. Eplerenone is a more selective mineralocorticoid antagonist with a survival benefit in heart failure after infarction, so it keeps the benefit without these effects.

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: spironolactone gynaecomastia?

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.