A 38-year-old man with hypertension experiences a first ever attack of acute pain, redness and tenderness in the left first metatarsophalangeal joint ('podagra'). His medication is furosemide, calcium carbonate and irbesartan. Serum uric acid is 0.78 mmol/L (upper limit of normal for men 0.48 mmol/L). Which of the following is most appropriate pharmacotherapy?

Correct Answer: D

Rationale: Acute gout (podagra) requires rapid inflammation relief. Paracetamol offers analgesia but no anti-inflammatory effect, inadequate here. Aspirin, at low doses, retains uric acid, worsening gout; at high doses, it's uricosuric but not ideal acutely. Probenecid lowers uric acid long-term, not for acute attacks. Allopurinol prevents gout but can precipitate attacks if started now. Diclofenac, an NSAID, reduces inflammation and pain fast, the most appropriate acute treatment. Its efficacy targets gout's pathophysiology, critical for symptom control.

Correct Answer: B

Rationale: High-dose androgens in females are used palliatively for certain breast cancers, especially hormone-sensitive ones, to suppress estrogen-driven tumor growth, easing symptoms in advanced disease. Athletic performance enhancement via androgens, while feasible, isn't clinically indicated and is illegal in regulated contexts. Brain cancer lacks evidence for androgen treatment, as it doesn't target neurological tumors. Sexual reassignment uses testosterone for masculinization, but high doses in clinical settings typically tie to cancer care, not transition. Breast cancer aligns with a recognized therapeutic use, leveraging androgens' anti-estrogenic effects, making it the most valid clinical rationale here.

Correct Answer: D

Rationale: Administering antibiotics through an infected central venous access device (CVAD) is often done to attempt to sterilize the catheter and salvage it, avoiding the need for removal and replacement. This approach is particularly useful for certain types of infections. While peripheral IV administration may be less painful or reduce infiltration risks, the primary goal in this scenario is to treat the infection directly at the source. Therefore, the correct rationale is to sterilize the catheter.

Correct Answer: D

Rationale: Clopidogrel is a drug that has a therapeutic effect in preventing thromboembolic events. It is an antiplatelet agent that works by inhibiting platelet aggregation, thus reducing the risk of blood clot formation. Clopidogrel is commonly used in patients at risk for cardiovascular events such as heart attacks and strokes. Warfarin is an anticoagulant medication that also helps prevent blood clots, but it works by a different mechanism than clopidogrel. Amlodipine is a calcium channel blocker used to treat hypertension and angina, while nitroglycerine is a vasodilator used in the treatment of angina.

Correct Answer: A

Rationale: Escitalopram, an SSRI, boosts serotonin, easing both anxiety and depression-shared neurochemistry (e.g., limbic dysregulation), per psychiatry. Calling it masked depression assumes unstated symptoms. Doctor's choice plus safety is true but less explanatory. Disorders don't always coexist-serotonin explains use, answering directly.