A 54-year-old man with an attack of gout approximately 4 months ago was placed on allopurinol. He now presents to his primary care physician complaining of a skin rash on his arms. Allopurinol was discontinued 3 months ago. What is the most likely explanation for this finding?

Correct Answer: A

Rationale: Rash 3 months after stopping allopurinol suggests contact dermatitis . Allopurinol's hypersensitivity resolves faster. Dermatitis herpetiformis , carcinoma , and telangiectasia (E) don't fit. An external allergen likely caused this delayed presentation.

Correct Answer: B

Rationale: Styptics and astringents are hemostatic agents that work by precipitating tissue proteins in the immediate area of a small vessel to stop bleeding. Styptics such as alum, silver nitrate, and ferric subsulfate directly induce coagulation at the site of bleeding, forming a protective scab to stop the flow of blood. Astringents like tannic acid work by tightening the tissue proteins around the blood vessel to create a seal and halt bleeding. These agents are commonly used in the management of minor cuts and wounds to promote hemostasis.

Correct Answer: B

Rationale: Omeprazole, a proton pump inhibitor (PPI), is most effective when taken 30 minutes before meals. This allows the medication to inhibit proton pumps during meal-stimulated acid production. Taking it after (A) or with meals (C) reduces its effectiveness. While it can be taken without regard to meals (D), taking it before meals is optimal.

Correct Answer: A

Rationale: Rash 3 months after stopping allopurinol suggests contact dermatitis . Allopurinol's hypersensitivity resolves faster. Dermatitis herpetiformis , carcinoma , and telangiectasia (E) don't fit. An external allergen likely caused this delayed presentation.

Correct Answer: A

Rationale: ACE (Angiotensin-Converting Enzyme) inhibitors are known to act on the Renin-Angiotensin-Aldosterone System (RAAS) by blocking the conversion of angiotensin I to the active angiotensin II. Angiotensin II is a potent vasoconstrictor and also stimulates the release of aldosterone, leading to increased blood pressure. By inhibiting ACE, ACE inhibitors help to lower blood pressure and reduce the secretion of aldosterone, thereby decreasing the overall vasoconstriction and volume expansion effects of the RAAS. Examples of ACE inhibitors include medications such as lisinopril, enalapril, and captopril.

Correct Answer: D

Rationale: Metoprolol selectively blocks beta-1 adrenergic receptors, reducing heart rate and cardiac output.

Correct Answer: C

Rationale: Hair loss is a known but temporary side effect of azathioprine, an immunosuppressant used to treat autoimmune conditions. It occurs due to the drug's impact on rapidly dividing cells, including hair follicles. While distressing, this side effect is usually reversible once the medication is discontinued or the body adjusts to it. Hair loss is not typically a sign of toxicity, and reassuring the client about its temporary nature can help alleviate anxiety.

Correct Answer: D

Rationale: Sinusitis treatment often involves OTC antihistamines. Diphenhydramine , an H1 antihistamine, causes sedation, explaining the student's sleepiness during the exam. Doxycycline , an antibiotic, doesn't sedate. Doxylamine , another sedating antihistamine, is possible but less commonly linked to sinusitis OTC use. Doxazosin , an α-blocker, isn't for sinusitis. Hydroxyzine (E) sedates but is prescription-based. Diphenhydramine's widespread OTC availability and drowsiness side effect fit the scenario, impacting the student's performance.

Correct Answer: D

Rationale: In a patient who is severely anemic, the primary goal is to raise the hemoglobin and hematocrit levels. Packed red blood cells (PRBCs) contain a concentrated dose of red blood cells and are given to increase oxygen-carrying capacity in cases of significant anemia. Fresh frozen plasma, albumin, and whole blood do not specifically address the issue of low hemoglobin levels, making them less appropriate choices for this scenario.