A 26-year-old woman came to her physician complaining of hyperpigmentation of her face. Physical examination revealed a poorly defined, blotchy, masklike zone of facial pigmentation with almost equal involvement of her cheeks, temples, and forehead. Skin biopsy showed increased melanin pigment in basal layers. The woman had been taking a hormonal contraceptive for 6 years. She was a long-distance runner and admitted the use of oxandrolone, erythropoietin, and methamphetamine while training. Which of the following drugs most likely caused the hyperpigmentation in this woman?

Correct Answer: B

Rationale: The correct answer is B: Oxandrolone. Oxandrolone is an anabolic steroid known to cause hyperpigmentation due to increased melanin production. The patient's history of taking oxandrolone aligns with the presentation of hyperpigmentation on her face. Ethinyl estradiol (choice A) is a common component of hormonal contraceptives but is not known to cause hyperpigmentation. Erythropoietin (choice C) is a hormone used to stimulate red blood cell production and is not associated with hyperpigmentation. Norethindrone (choice D) is another hormonal contraceptive component that does not typically cause hyperpigmentation. In this case, the patient's use of oxandrolone is the most likely culprit for her hyperpigmentation.

Correct Answer: C

Rationale: The correct answer is C: Pamidronate. This drug is used in the management of conditions like hypercalcemia, Paget's disease, and osteoporosis, which are commonly associated with cancer patients. It inhibits bone resorption and helps lower calcium levels. Sodium phosphate (A) is a laxative, not indicated for this patient. Hydrochlorothiazide (B) is a diuretic used for hypertension, not for managing the conditions mentioned. Mannitol (D) is an osmotic diuretic mainly used for reducing intracranial pressure, not indicated in this case. Pamidronate is the best choice due to its mechanism of action and relevance to the patient's condition.

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.