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

A 62-year-old man comes to the physician for a 3-day history of a sore left ankle. He has a history of chronic kidney disease due to granulomatosis with polyangiitis for which he takes prednisone. The agent responsible for this patient’s acute presentation inhibits which of the following, and what condition was he most likely treated for?

A) DNA gyrase; cellulitis
B) DNA gyrase; septic arthritis
C) DNA polymerase; aseptic meningitis
D) DNA polymerase; retinitis
E) Nicking of DNA; pyelonephritis
F) Topoisomerase II; squamous cell carcinoma

A 34-year-old woman is evaluated at the outpatient clinic. Vitals are normal.

Which of the following is the mechanism of action of the most appropriate pharmacotherapy?

A) 30S inhibitor
B) 50S inhibitor
C) Dihydrofolate reductase inhibitor
D) DNA gyrase inhibitor
E) Forms toxic metabolites

A 2-year-old boy is brought to the physician by his mother for a 3-day history of worsening redness on his left hand. She cannot recall any specific trauma or incident that precipitated the lesion. Physical examination demonstrates erythema and desquamation along the dorsomedial aspect of the right hand. Temperature is 99.5 F. Which of the following is the most appropriate initial pharmacotherapy?

A) Amoxicillin
B) Ceftriaxone
C) Flucloxacillin
D) Gentamicin
E) Vancomycin

A 52-year-old man comes to the physician for a health maintenance examination. He has no past medical history. One month ago, his blood pressure was recorded at 150/92. Two weeks ago, two blood pressure measurements, 15 minutes apart, were 150/90 and 148/91. Today, his blood pressure is 150/90. His BMI is 23. He does not drink or smoke. HbA1c is 5%. Urinalysis and blood work are both normal. Hydrochlorothiazide is commenced. Which of the following is most likely to be seen in this patient as a result of this pharmacotherapy?

A) Decreased TRPV5 channel activity
B) Decreased apical sodium/calcium symport activity
C) Increased apical calcium antiport activity
D) Increased basolateral calcium reabsorption
E) Increased basolateral sodium reabsorption

A 46-year-old man comes to the physician for a follow-up appointment. Two weeks ago, his blood pressure was recorded at 150/95. Today, repeat blood pressure measurement is 151/95. BMI is 24. The patient is commenced on enalapril. Which of the following is most likely to be seen in this patient as a result of this pharmacotherapy?

A) Decreased efferent arteriolar diameter
B) Increased ejection fraction
C) Increased proximal convoluted tubule sodium reabsorption
D) Increased serum bicarbonate
E) Kaliuresis