An otherwise healthy 78-year-old man is found to have a blood pressure (BP) of 168/80 at a routine check, and similar pressures are confirmed on three separate occasions despite adhering to dietary advice. Investigations including an ECG and creatinine/electrolytes are normal. Which of the following is the most appropriate next step in management?

Correct Answer: D

Rationale: Systolic hypertension (168 mmHg) in the elderly increases cardiovascular risk, despite normal diastolic (80 mmHg). Echo isn't first-line without organ damage signs (normal ECG). Reassurance ignores systolic risk; treatment is indicated (>160 mmHg). Doxazosin, an alpha-blocker, is less preferred initially due to hypotension risk. Ramipril, an ACE inhibitor, is effective, but amlodipine, a calcium channel blocker, is most appropriate per guidelines (e.g., NICE) for isolated systolic hypertension in the elderly, offering vascular protection and tolerability. Its efficacy reduces stroke and MI risk, critical at this age.

Correct Answer: D

Rationale: Myeloablation refers to the destruction of bone marrow, which is a critical step in preparing a patient for a bone marrow or stem cell transplant. This process eliminates both cancerous and healthy bone marrow cells, creating space for the transplanted cells to engraft and repopulate the marrow. While myeloablation can reduce tumor size, its primary purpose is to prepare the body for transplantation. It is not related to destroying muscle cells or reducing postoperative chemotherapy requirements.

Correct Answer: A

Rationale: Methanol, a toxic alcohol, is metabolized by alcohol dehydrogenase into formaldehyde, then by aldehyde dehydrogenase into formic acid, causing severe metabolic acidosis and blindness via optic nerve damage. This initial step—formation of formaldehyde—is the critical toxic event, distinguishing methanol poisoning from ethanol's safer metabolism. Nephrotoxicity isn't primary; formic acid affects mitochondria and eyes more. Hypotension and vomiting occur secondary to acidosis but aren't the defining process. Glycolic acid is a metabolite of ethylene glycol, not methanol. Methanol inhibits aldehyde dehydrogenase minimally; its danger lies in metabolite accumulation. Formaldehyde production initiates the cascade, making it the most direct and accurate consequence of methanol ingestion.

Correct Answer: A

Rationale: Butoxamine (β2 antagonist) and terbutaline (β2 agonist) target the same receptor, a true pair. Phenoxybenzamine (α-adrenergic antagonist) and cyclopentolate (muscarinic antagonist) act on different receptors. Pilocarpine and bethanechol are both muscarinic agonists, not antagonist-agonist. Oxymetazoline (α-agonist) and dobutamine (β1-agonist) differ in receptor specificity. Bromocriptine and pramipexole are dopamine agonists. The β2 pair is a classic example in pharmacology, illustrating receptor-specific antagonism and agonism.

Correct Answer: C

Rationale: Androgens, mainly testosterone, are secreted by the testes' Leydig cells, activated by pituitary LH, making the testes the source. FSH regulates sperm, not androgens. GnRH from the hypothalamus triggers LH/FSH release, indirectly affecting androgens. The pituitary releases LH/FSH, not androgens. The testes' direct secretion role is fundamental, driven by LH, distinguishing it from regulatory hormones.