Correct Answer: A

Rationale: Somatic hypermutation is the mechanism responsible for generating diversity in the antigen-binding sites of immunoglobulins. During somatic hypermutation, point mutations are introduced into the variable regions of immunoglobulin genes in B cells. These mutations occur randomly and lead to a wide range of amino acid changes in the antigen-binding sites of antibodies. As a result, a diverse repertoire of antibodies with varying specificities for different antigens is created. Gene rearrangement and isotype switching are other mechanisms that contribute to antibody diversity but do not specifically target the antigen-binding sites. Clonal expansion, on the other hand, refers to the proliferation of specific B cell clones after activation by antigens, which amplifies the immune response but does not directly impact the diversity of antigen-binding sites.

Correct Answer: C

Rationale: Incident reports are a crucial tool for capturing data on adverse events, near misses, and other incidents within a healthcare institution. These reports help in analyzing patterns, identifying areas for improvement, and implementing quality and safety measures. Therefore, incident reports themselves are not something that needs to be prevented; instead, they are a critical part of the risk management process to enhance patient safety and quality of care.

Correct Answer: A

Rationale: Statement II is correct because the use of corticosteroids for multiple immune conditions can lead to the development of Cushing's disease.

Correct Answer: D

Rationale: The symptoms described - muscle weakness, fatigue, constipation, hyperpigmentation of the skin, low serum cortisol levels, and elevated ACTH levels - are classic findings in Addison's disease. Addison's disease is a primary adrenal insufficiency characterized by the insufficient production of cortisol and, to some extent, aldosterone. The low cortisol levels result in symptoms such as muscle weakness, fatigue, and skin hyperpigmentation due to increased levels of ACTH stimulating melanin production. In contrast, in conditions like hyperthyroidism, hypothyroidism, and diabetes mellitus, the symptoms and laboratory findings would not fully align with those described in the patient in this scenario.

Correct Answer: C

Rationale: When a patient with terminal cancer experiences dyspnea (difficulty breathing) and anxiety, opioid medications are often prioritized by palliative care providers for symptom management. Opioids are effective in relieving dyspnea by acting as respiratory depressants and reducing the feeling of air hunger. Additionally, opioids have sedative effects that can help alleviate anxiety and promote relaxation. Therefore, in this situation, prescribing opioid medications would be the most appropriate intervention to address both the dyspnea and anxiety symptoms simultaneously. Oxygen therapy, relaxation techniques, and breathing exercises may also be useful adjunctive interventions, but opioid medications are typically prioritized for immediate symptom relief in this context.