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A 55-year-old woman presents with severe hot flashes and night sweats that significantly impair sleep. She has a past medical history of unprovoked deep vein thrombosis (DVT) at age 50, hypertension controlled on lisinopril, and obesity (BMI 32). She underwent a total abdominal hysterectomy for fibroids 8 years ago. She asks about starting hormone replacement therapy (HRT) because her sister found relief with oral estrogen. Her labs show normal renal and liver function. Which is the most appropriate evidence-based management for this patient’s vasomotor symptoms? 

A 60-year-old woman on gentamicin for Pseudomonas bacteremia develops dizziness and imbalance. Which structure is most likely affected? 

A 64-year-old woman undergoing treatment for gastroparesis associated with long-standing type 2 diabetes is prescribed metoclopramide. At follow-up, she reports some improvement in postprandial fullness and nausea but is now experiencing involuntary facial grimacing and repetitive tongue movements. Which best describes the drug’s mechanism of action and associated risk? 

A 55-year-old woman with type 2 diabetes and chronic kidney disease (eGFR 42 mL/min) has been taking ibuprofen 600 mg three times daily for back pain. Labs show worsening renal function. Which agent is the safest alternative for pain relief? 

A 62-year-old man with diabetes and CAD is prescribed sildenafil for ED. Which concurrent medication is an absolute contraindication? 

A 35-year-old male recreational bodybuilder presents with progressive breast enlargement, decreased libido, and infertility. Exam reveals bilateral gynecomastia, testicular atrophy, and reduced muscle tone. He admits to long-term use of intramuscular anabolic steroids obtained without prescription. Which mechanism best explains these findings? 

A 65-year-old man with atrial fibrillation and weight loss is diagnosed with hyperthyroidism. Which drug controls adrenergic symptoms (palpitations, tremor)? 

A 29-year-old man with HIV presents with recurrent painful genital ulcers. PCR confirms HSV-2. He reports 8 outbreaks in the past year and a new HSV-seronegative partner. Which is the most effective strategy to reduce both recurrence frequency and transmission? 

A 52-year-old man presents with sudden-onset severe pain, swelling, and erythema of the right great toe that began overnight. He describes the pain as “unbearable.” Past medical history includes stage 3 chronic kidney disease (eGFR 45 mL/min) and hypertension, currently treated with lisinopril. Labs show uric acid 9.0 mg/dL, WBC 9,000/µL, and creatinine 1.8 mg/dL. He has no fever or systemic symptoms. Which pharmacologic option is most appropriate for management of his acute flare? 

A 30-year-old pregnant woman is newly diagnosed with hyperthyroidism. Which drug is preferred in the first trimester?