A 27-year-old hospital worker has access to the pharmacy when no other workers are around. He is able to find morphine and inject himself with supratherapeutic dose of morphine. He then collapses and is found dead by coworkers 24 h later. What is the most likely explanation for his death?

Correct Answer: D

Rationale: The correct answer is D) Respiratory depression and arrest. In this scenario, the individual injected himself with a supratherapeutic dose of morphine, which is an opioid. Opioids like morphine act on the central nervous system to depress respiratory drive. When taken in high doses, opioids can cause severe respiratory depression, leading to a decrease in the drive to breathe and ultimately respiratory arrest, resulting in death. Option A) Cardiac arrest is incorrect because the primary mechanism of death in opioid overdose is respiratory depression, not cardiac arrest. Option B) Cardiac ischemia is also incorrect as there is no indication in the scenario that the individual experienced a heart attack or ischemic event. Option C) Cardiomyopathy is not the cause of death in this case, as there is no mention of any pre-existing heart condition or heart muscle damage. Educationally, this question highlights the importance of understanding the pharmacological effects of opioids on the body, particularly the risk of respiratory depression associated with opioid overdose. It emphasizes the need for healthcare workers to be vigilant in preventing unauthorized access to controlled substances and to be aware of the potential risks associated with opioid misuse. This knowledge is crucial in clinical practice to ensure patient safety and prevent harm related to drug diversion and overdose.

Correct Answer: D

Rationale: In this question, the correct answer is D) Ramelteon. Ramelteon is the only option that mimics an endogenous hormone, specifically melatonin, which regulates the sleep-wake cycle. Ramelteon acts on melatonin receptors in the brain to help regulate sleep patterns without causing the same risks of dependency or tolerance seen with traditional hypnotics. A) Diazepam and B) Lorazepam are benzodiazepines that act on GABA receptors to induce sedation and are not hormones. These drugs are not recommended for long-term use due to the risk of dependence and potential for cognitive impairment. C) Phenobarbital is a barbiturate with sedative properties but does not mimic an endogenous hormone like melatonin. Barbiturates are associated with a high risk of overdose and are not commonly used for sleep induction due to their safety profile. Educationally, understanding the mechanisms of action of different hypnotic drugs is crucial for healthcare professionals to make informed decisions when treating sleep disorders. Knowing the advantages of melatonin receptor agonists like ramelteon over traditional sedatives can help in selecting the most appropriate treatment for patients with insomnia.

Correct Answer: C

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

Correct Answer: C

Rationale: The correct answer is C) Viral encephalitis. The patient in question developed parkinsonian symptoms as a result of the viral encephalitis he is hospitalized for. Viral encephalitis can lead to damage in the basal ganglia and substantia nigra, resulting in motor symptoms resembling Parkinson's disease. This is known as post-encephalitic parkinsonism. Option A) Carotid arterial atherosclerosis is not a likely cause of parkinsonian symptoms. Atherosclerosis primarily affects blood flow to the brain and is not associated with the development of parkinsonism. Option B) Large brain aneurysm would typically present with symptoms related to increased intracranial pressure or focal neurological deficits, not parkinsonian symptoms. Option D) Use of cocaine can lead to acute movement disorders like tremors and dyskinesias, but in this scenario, the patient's symptoms are more likely related to the viral encephalitis he is hospitalized for. Understanding the link between viral encephalitis and parkinsonian symptoms is crucial for healthcare providers to properly diagnose and manage patients presenting with such manifestations. It highlights the importance of considering secondary causes of parkinsonism in clinical practice, especially in the setting of encephalitis or other neurological conditions.

Correct Answer: D

Rationale: The correct answer is D) Phenytoin. Phenytoin is an antiseizure medication known to cause megaloblastic anemia as a side effect. This condition is characterized by larger-than-normal red blood cells, leading to fatigue and weakness. Phenytoin is a commonly used antiepileptic drug that can interfere with folic acid metabolism, resulting in megaloblastic anemia. Option A) Carbamazepine is not typically associated with megaloblastic anemia. It is more commonly linked to hyponatremia and liver enzyme abnormalities. Option B) Ethosuximide is primarily used for absence seizures and is not known to cause megaloblastic anemia. Option C) Phenobarbital is not commonly associated with megaloblastic anemia. It is known to cause sedation and can lead to physical dependence with prolonged use. Educational Context: Understanding the side effects of antiseizure medications is crucial for healthcare professionals managing patients with epilepsy. Recognizing the adverse effects of these drugs allows for early intervention and management to prevent complications. This case highlights the importance of monitoring patients on antiepileptic medications for potential side effects like megaloblastic anemia associated with phenytoin use.