A 34-year-old woman complains of fever, fatigue, weight loss, arthralgia, and transient patchy alopecia during the last 3 months. Her review of systems is notable for occasional rhinorrhea and cough that responds well to oral decongestant therapy. Her prior surgical history is notable for cesarean section and tubal ligation at age 31 years. A similar constellation of symptoms occurred 6 months ago during treatment for a cardiovascular disease. Antinuclear antibody testing was positive at her last visit 6 months ago and is still positive at the present time. Presently, her hematocrit is 36% and creatinine is 1.2 mg/dL. The most likely etiology of this constellation of symptoms and findings is related to

Correct Answer: D

Rationale: The correct answer is D) Procainamide. Procainamide is a medication commonly used for cardiac arrhythmias. However, it is known to cause drug-induced lupus erythematosus (DILE), which presents with symptoms similar to those described in the case. Symptoms such as fever, fatigue, weight loss, arthralgia, and positive antinuclear antibody testing are characteristic of DILE. Option A) Ethosuximide is used to treat absence seizures and is not associated with the symptoms described in the case. Option B) Oral contraceptives are not typically associated with drug-induced lupus or the constellation of symptoms described. Option C) Hydralazine is another medication known to cause drug-induced lupus, but in this case, the patient's history of cardiovascular disease treatment with procainamide makes procainamide a more likely culprit. Educationally, understanding the side effects and adverse reactions of medications is crucial for healthcare providers to make accurate diagnoses, provide appropriate treatment, and prevent harm to patients. Recognizing drug-induced conditions like DILE is essential in clinical practice to ensure patient safety and optimal care.

Correct Answer: C

Rationale: The correct answer to this question is C) 5-HT3 receptors. Chemotherapy-induced nausea and vomiting (CINV) is a common side effect of many chemotherapeutic agents. 5-HT3 receptors are specifically targeted to alleviate this symptom because they are located both centrally in the chemoreceptor trigger zone and peripherally on vagal afferents in the gastrointestinal tract. By blocking these receptors, the pharmacologic agent can effectively reduce nausea and vomiting in the patient. Option A) 5-HT1 receptors are not primarily involved in the pathophysiology of CINV. These receptors are more associated with vasoconstriction, modulation of neurotransmitter release, and other functions. Option B) 5-HT2 receptors are also not the main target for treating CINV. They are involved in various physiological processes such as smooth muscle contraction and mood regulation. Option D) Dopamine receptors are more closely related to the stimulation of the chemoreceptor trigger zone and are targeted in other types of antiemetic treatments, such as those used for postoperative nausea and vomiting. In an educational context, understanding the mechanisms of action of different pharmacologic agents used in managing chemotherapy side effects is crucial for healthcare professionals involved in oncology care. By grasping the specific receptor targets and pathways involved in CINV, healthcare providers can tailor treatment plans to optimize patient comfort and quality of life during cancer therapy.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Ketoconazole. Ketoconazole is an antifungal medication known to cause gynecomastia as a side effect due to its antiandrogenic properties. Gynecomastia is the abnormal enlargement of male breast tissue. Ketoconazole inhibits the synthesis of testosterone, leading to hormonal imbalances that can result in this side effect. Regarding the other options: A) Amphotericin B is an antifungal medication commonly used for systemic fungal infections. It is not associated with causing gynecomastia. B) Caspofungin is a different class of antifungal medication known as an echinocandin. It does not typically cause gynecomastia. C) Flucytosine is an antifungal agent used in combination therapy. It does not have a known association with gynecomastia. Educationally, understanding the side effects of medications is crucial for healthcare professionals to make informed decisions when prescribing and managing patient care. Recognizing the potential side effects of medications can help prevent and manage adverse reactions, ensuring patient safety and well-being.

Correct Answer: D

Rationale: In this scenario, the correct medication to stimulate bone marrow production of platelets for the 68-year-old man with prostate cancer undergoing chemotherapy is option D) Oprelvekin. Oprelvekin is a thrombopoietic growth factor that stimulates the production of platelets from the bone marrow. Option A) Aldesleukin is a cytokine used to treat certain types of cancer but does not specifically target platelet production. Option B) Erythropoietin stimulates red blood cell production, not platelets. Option C) Filgrastim is a granulocyte colony-stimulating factor that primarily stimulates white blood cell production and is not indicated for platelet production. Educationally, it is important to understand the specific mechanisms of action of different medications to appropriately treat patients. In this case, knowing that Oprelvekin is a thrombopoietic growth factor helps in selecting the right medication to address the low platelet count caused by chemotherapy-induced bone marrow suppression. Understanding these concepts is crucial for healthcare providers to make informed decisions in patient care.

Correct Answer: D

Rationale: The correct answer is D) Vincristine. Vincristine is a chemotherapy drug that disrupts microtubule assembly, specifically targeting tubulin polymerization. This action inhibits the formation of the mitotic spindle, leading to cell cycle arrest and ultimately cell death. Option A) Cisplatin is a platinum-based chemotherapy drug that acts by forming DNA crosslinks, leading to DNA damage. It does not disrupt microtubule assembly like Vincristine. Option B) Docetaxel is a taxane chemotherapy drug that also interferes with microtubules but acts by stabilizing microtubules rather than disrupting their assembly. Option C) Erlotinib is a tyrosine kinase inhibitor that targets the epidermal growth factor receptor pathway and is not associated with microtubule disruption. Educationally, understanding the mechanisms of action of chemotherapy drugs is crucial for healthcare providers to make informed treatment decisions for patients with cancer. Knowing how specific drugs target different cellular processes allows for personalized and effective treatment strategies, minimizing side effects and optimizing outcomes for patients undergoing chemotherapy.