A 35-year-old man with nonseminomatous germ cell tumor of the testis and bulky lymphadenopathy undergoes orchiectomy followed by multiagent chemotherapy with high-dose methotrexate. His serum creatinine rises from 1.10 mg/dL at baseline to 3.50 mg/dL after 4 weeks of therapy. What is the most likely explanation for this finding?

A 35-year-old man with nonseminomatous germ cell tumor of the testis and bulky lymphadenopathy undergoes orchiectomy followed by multiagent chemotherapy with high-dose methotrexate. His serum creatinine rises from 1.10 mg/dL at baseline to 3.50 mg/dL after 4 weeks of therapy. What is the most likely explanation for this finding?

A 19-year-old man cuts his hand while slicing a bagel. He sustains a 4-cm laceration of the palmar aspect of his hand. The wound will be sutured with absorbable sutures. Prior to beginning the procedure, the wound is injected with lidocaine containing 1:100,000 parts epinephrine. The rationale behind the use of epinephrine is which of the following?

A 58-year-old man with a long history of depression is evaluated for treatment by his primary care physician. The physician begins treatment with sertraline. The patient is concerned about the possibility of sexual dysfunction. Which of the following changes is possible?

A 74-year-old man with bladder cancer and refractory depression is tried on a new agent to help his depression. Tranylcypromine is begun by his primary care physician. Which of the following adverse reactions may be expected in this patient?

A 34-year-old man with a seizure disorder presents to the emergency department with severe left-sided flank pain. The pain began suddenly this morning and has not improved. His urinalysis shows microscopic hematuria, and a KUB confirms a kidney stone. Which pain medication should be avoided in this patient?