A 49-year-old man is evaluated in hospital after experiencing severe bilateral tinnitus. Physical examination shows severe lethargy and markedly elevated respirations. He has a 1-year history of osteoarthritis. BMI is 35. Which of the following is most likely to improve this patient’s acute presentation?

A) Epley maneuver
B) Increasing chloride channel opening frequency
C) Sodium channel dissociation
D) Stabilization of myocardium
E) Urinary alkalinization

A 24-year-old man comes to the physician for a 2-day history of dry cough and low-grade fever. He plays soccer avidly and had a tournament a few days ago. A chest x-ray is shown. Empiric treatment is initiated. Which of the following is the most likely pharmacotherapy and its most likely adverse effect?

A) Azithromycin; Gastrointestinal disturbance
B) Azithromycin; Photosensitivity
C) Doxycycline; Agranulocytosis
D) Doxycycline; Thyroid suppression
E) Levofloxacin; Disulfiram-like reaction
F) Levofloxacin; Photosensitivity

A 45-year-old man comes to the physician for a follow-up appointment. Two weeks ago, his blood pressure was measured at 150/95. His BMI is 23. He is physically activate and does not smoke or drink. Repeat blood pressure measurement today is 150/95. The physician discusses possible commencement of hydrochlorothiazide. Which of the following is most likely to be seen in this patient as a result of commencement of this pharmacotherapy?

A) Blockade of early-DCT apical antiporter
B) Blockade of late-DCT apical symporter
C) Decreased serum bicarbonate
D) Hypercalciuria
E) Increased distal potassium secretion

A 61-year-old man comes to the physician for a health maintenance check. After consultation, the physician commences him on labetalol. Which of the following combinations of findings is most likely to be seen in this patient as a result of initiation of this pharmacoagent?

A) ↑ Cardiac output (CO); ↑ Left-ventricular end-diastolic volume (LVEDV); ↑ Systemic vascular resistance (SVR)
B) ↑ CO; ↑ LVEDV; ↓ SVR
C) ↑ CO; ↓ LVEDV; ↑ SVR
D) ↑ CO; ↓ LVEDV; ↓ SVR
E) ↓ CO; ↑ LVEDV; ↑ SVR
F) ↓ CO; ↑ LVEDV; ↓ SVR
G) ↓ CO; ↓ LVEDV; ↑ SVR
H) ↓ CO; ↓ LVEDV; ↓ SVR

A 42-year-old man with history of schizophrenia is brought to the ED 4 days after starting a new antipsychotic medication. He’s had progressive confusion, high fever, and severe generalized muscle stiffness during this time. Serum creatine kinase activity is elevated. Following administration of bromocriptine, which of the following is the most appropriate next step in pharmacotherapy?

A) Agonism of dopaminergic receptors
B) Agonism of ryanodine receptors
C) Blockade of sarcoplasmic calcium release
D) Inhibition of sarco/endoplasmic reticulum calcium ATPase
E) Intravenous calcium gluconate

A 28-year-old woman comes to the physician for a 3-day history of increasingly worse vaginal discharge and discomfort. She has recently been sexually active with a new partner. Vitals are: temperature 99 F, HR 100, RR 20, BP 120/80. Laboratory results are pending. Physical examination shows left adnexal tenderness and a yellow-green vaginal discharge. Which of the following is the most appropriate next step in management?

A) Admit to hospital and give IV antibiotics
B) Doxycycline (oral) + ceftriaxone (intramuscular)
C) Doxycyline (oral) + azithromycin (oral) + ceftriaxone (intramuscular)
D) Metronidazole (oral) for patient and partner
E) Metronidazole (oral) for patient only

An 8-year-old boy is brought to the physician for a follow-up appointment. He has a history of acute lymphoblastic leukemia for which he receives 6-mercaptopurine as part of his regimen. Which of the following agents must be used carefully in this case when considering tumor lysis syndrome?

A) Allopurinol
B) Azathioprine
C) Colchicine
D) Hydroxychloroquine
E) Rasburicase

A 49-year-old woman comes to the physician for a 2-week history of progressive muscle soreness. She has a history of hypertension and dyslipidemia managed with hydrochlorothiazide, atorvastatin, and gemfibrozil. Which of the following is the most likely explanation for this patient’s presentation?

A) Decreased activation of PPAR-α
B) Decreased activation of PPAR-γ
C) Increased mevalonate
D) Increased activation of PPAR-γ
E) P-450 interaction

A 25-year-old man comes to the physician for a follow-up appointment. Hydroxyurea therapy is prescribed. Which of the following is most likely to be seen in this patient as a result of this pharmacotherapy?

A) Decreased sickle hemoglobin expression
B) Decreased sickling due to decreased acidification
C) De-repression of fetal globin chain genes
D) Increased HbA2 production
E) Increased thymidine fraction

A 36-year-old man comes to the physician for a follow-up appointment. He has history of HIV managed with multiple medications. Current CD4 count is 550/μL. Physical examination shows a puffy face, an enlarged fat pad at the nape of the neck, central obesity, and diminished muscle mass in the limbs. Which of the following is the most likely explanation for this patient’s presentation?

A) Abacavir
B) Didanosine
C) Efavirenz
D) Ritonavir
E) Zidovudine