Which of the following drugs most likely caused the patient's signs and symptoms?

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: 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.

Correct Answer: B

Rationale: The correct answer is B: Ethinyl estradiol and norethindrone. This combination is a safer choice for the woman due to her history of disseminated intravascular coagulation following an abortion. Ethinyl estradiol and norethindrone have a lower risk of venous thromboembolism compared to other estrogen-containing contraceptives, making it a suitable option for this patient. Rationale for other choices: A: Diethylstilbestrol is contraindicated due to its association with an increased risk of thromboembolic events. C: Mestranol and norethindrone combination may also increase the risk of thromboembolic events, making it unsuitable for this patient. D: Mifepristone is not a hormonal contraceptive; it is used for medical abortion and emergency contraception, not for regular contraception.

Correct Answer: C

Rationale: The correct answer is C: Norgestrel. Nausea is a common side effect of contraceptive pills, especially when initially starting them. Norgestrel is a component of the contraceptive pill the patient started one week ago, which aligns with the timing of the onset of her nausea symptoms. Ciprofloxacin and omeprazole are less likely to cause nausea in this case, as the patient has been taking them for some time without issues. Ethinyl estradiol is also a component of the contraceptive pill but is less likely to be the primary cause of the nausea compared to norgestrel.

Correct Answer: C

Rationale: The correct answer is C: Add calcitonin to the current regimen. Calcitonin helps to increase bone density and reduce bone loss in osteoporosis. This would address the significant decrease in bone mass. Choice A (substitute hydrochlorothiazide with propranolol) is incorrect as propranolol does not have a direct impact on bone mass. Choice B (substitute raloxifene with ethinyl estradiol) is incorrect as ethinyl estradiol is not typically used for osteoporosis and may not be effective. Choice D (increase the daily dose of calcium carbonate) is incorrect as simply increasing calcium intake may not be sufficient to address the bone loss, especially in the presence of inadequate bone formation. Adding calcitonin addresses the root cause of bone loss in osteoporosis and is therefore the appropriate change in the treatment plan.