Addition of which of the following drugs would be appropriate for the patient at this time?

Correct Answer: A

Rationale: Step-by-step rationale for the correct answer (A: Pegvisomant): 1. Patient likely has acromegaly due to elevated growth hormone levels. 2. Pegvisomant is a growth hormone receptor antagonist used to treat acromegaly by blocking the effects of growth hormone. 3. This drug would be appropriate to normalize the patient's growth hormone levels and improve symptoms. Summary of why other choices are incorrect: - B: Degarelix is a gonadotropin-releasing hormone antagonist used in prostate cancer, not for acromegaly. - C: Leuprolide is a gonadotropin-releasing hormone agonist used in various conditions like prostate cancer and endometriosis, not for acromegaly. - D: Cosyntropin is a synthetic form of adrenocorticotropic hormone used in diagnostic testing for adrenal function, not for acromegaly treatment.

Correct Answer: B

Rationale: The correct answer is B: Sweating. Excessive dose of methimazole, an anti-thyroid medication used to treat Graves disease, can lead to increased sympathetic nervous system activity, causing hyperactivity of sweat glands and resulting in sweating. Palpitations (A) are more commonly associated with hyperthyroidism itself, rather than medication side effects. Insomnia (C) can be a symptom of hyperthyroidism but is not a direct effect of methimazole overdose. Tremor (D) is also a common symptom of hyperthyroidism, not a specific effect of methimazole overdose.

Correct Answer: A

Rationale: The correct answer is A: Prednisone. Prednisone is a corticosteroid that can cause signs and symptoms such as weight gain, fluid retention, and mood changes, which align with the patient's presentation. Mesalamine (B) is used to treat inflammatory bowel disease and does not typically cause these symptoms. Loperamide (C) is an anti-diarrheal agent and would not explain the patient's signs. Azathioprine (D) is an immunosuppressant used in inflammatory conditions but is less likely to cause the specific signs and symptoms described.

Correct Answer: D

Rationale: The correct answer is D: Prednisone. Prednisone is a corticosteroid that helps reduce inflammation and suppress the immune system. In an emergency situation, such as an acute asthma attack or anaphylactic reaction, prednisone can quickly alleviate symptoms and prevent further complications. Fludrocortisone (A) is a mineralocorticoid mainly used for adrenal insufficiency, not for emergency treatment. Azathioprine (B) is an immunosuppressant used for organ transplant recipients or autoimmune diseases, not for acute emergencies. Norethindrone (C) is a progestin hormone used for contraception or hormone replacement therapy, not for emergency treatment.

Correct Answer: B

Rationale: The correct answer is B: Norgestrel. Norgestrel is a progestin used for local therapy in this patient because it can be administered directly to the affected area to target specific tissues. Ethinyl estradiol, Anastrozole, and Tamoxifen are not appropriate for local therapy as they are systemic drugs that act throughout the body. Ethinyl estradiol is an estrogen component in combined oral contraceptives, Anastrozole is an aromatase inhibitor used for breast cancer systemically, and Tamoxifen is a selective estrogen receptor modulator used for breast cancer treatment.