Correct Answer: B

Rationale: The correct answer is B: Lifestyle modification and metformin. When managing type 2 diabetes mellitus, initial treatment often involves lifestyle changes such as adopting a healthy diet and increasing physical activity, along with the oral medication metformin. Insulin therapy (choice
A) is usually reserved for cases where lifestyle changes and oral medications are not sufficient to control blood sugar levels. Sulfonylureas (choice
C) and thiazolidinediones (choice
D) are also oral medications used in diabetes management, but they are not typically recommended as first-line treatments due to various side effects and considerations in type 2 diabetes management.

Correct Answer: B

Rationale: The correct answer is B: Systemic lupus erythematosus. Joint pain, a malar rash, and photosensitivity are classic symptoms of systemic lupus erythematosus.
Choice A, Rheumatoid arthritis, is incorrect as it typically presents with symmetric joint involvement and morning stiffness. Psoriatic arthritis (
Choice
C) is characterized by joint pain associated with psoriasis, which is not described in the case. Dermatomyositis (
Choice
D) presents with muscle weakness, skin rash, and elevated muscle enzymes, different from the symptoms presented in the case.

Correct Answer: C

Rationale: A patient with a history of hypertension presenting with a severe headache, confusion, and visual disturbances, along with a blood pressure of 220/120 mm Hg, likely has a hypertensive emergency. In this situation, the severely elevated blood pressure can lead to end-organ damage, causing symptoms such as headache and confusion. Migraine and tension headaches are not associated with such high blood pressure levels. Cluster headaches typically do not present with visual disturbances and confusion in the setting of severe hypertension.

Correct Answer: B

Rationale: In chronic kidney disease, anemia commonly occurs due to decreased erythropoietin production. Erythropoiesis-stimulating agents, such as erythropoietin or darbepoetin, are the mainstay of treatment to stimulate red blood cell production. Iron supplementation is more appropriate for iron-deficiency anemia, not the anemia of chronic kidney disease. Blood transfusion is reserved for severe cases or acute blood loss. Vitamin B12 supplementation is indicated for megaloblastic anemia caused by vitamin B12 deficiency, not specifically in chronic kidney disease-related anemia.

Correct Answer: A

Rationale: The correct answer is A: live and can cause infection. In patients like the one described with a history of heart transplant and receiving long-term steroids, who are immunocompromised, live attenuated vaccines are contraindicated. Live vaccines contain weakened (attenuated) forms of the virus or bacteria, which can replicate and cause mild infections in healthy individuals but can lead to serious infections in immunocompromised individuals.

Choices B, C, and D are incorrect because attenuated vaccines are not mutated, not inactive, and not pathogenic in healthy individuals, respectively.