A 62-year-old man comes to the physician because of burning pain and tenderness of his right great toe 1 day after heavy ethanol consumption. Physical examination shows erythema, swelling, warmth, and tenderness of the right great toe. After a 2-week course of nonsteroidal anti-inflammatory drug treatment, his symptoms decrease in severity but do not completely resolve. The serum concentration of which of the following is most likely increased in this patient?

Correct Answer: D

Rationale: This presentation is classic for acute gouty arthritis, triggered by ethanol, which inhibits uric acid excretion, leading to hyperuricemia (G). Elevated serum uric acid causes monosodium urate crystal deposition in joints, causing inflammation. NSAIDs reduce inflammation but don’t lower uric acid, explaining incomplete resolution. Calcium relates to hyperparathyroidism, carotene to dietary excess, creatinine to renal failure, iron to hemochromatosis, orotic acid (E) to metabolic disorders, and phosphate (F) to renal issues—none fit this scenario.

Correct Answer: A

Rationale: Methylphenidate, a stimulant for ADHD, can cause insomnia if taken late. Administering before 4:00 pm avoids peak effects at bedtime, improving sleep. 8:00 pm exacerbates insomnia, stopping abruptly risks ADHD symptom rebound, and diphenhydramine adds unnecessary medication. Note: Answer key says (b), but is correct based on pharmacology.

Correct Answer: B

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

Correct Answer: D

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

Correct Answer: B

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