A 14-year-old girl is brought to the emergency department following a suicide attempt.  She swallowed several of her grandfather’s theophylline tablets after an intense argument with her parents a few hours ago.  The patient reports nausea and headache.  She has no other prior medical problems and takes no medications.  Her temperature is 37 C (98.6 F), blood pressure is 114/76 mm Hg, pulse is 88/min, and respirations are 16/min.  This patient should be carefully monitored for which of the following?

A pharmaceutical researcher is studying a new drug being developed for treatment of asthma that works by reversing irritant-induced bronchoconstriction.  Laboratory guinea pigs are divided into 2 groups: a postvagotomy (complete transection of the vagus nerve) group and a normal study group.  Both groups are exposed to irritants without receiving the study medication, and changes in bronchial diameters are recorded.  Subsequently, both groups are exposed again to the irritants but are also given the study drug.

The study drug is most likely similar to which of the following medications?

A 32-year-old woman is brought to the emergency department due to severe shortness of breath.  She has no chest pain.  The patient does not use tobacco.  Temperature is 36.7 C (98 F), blood pressure is 132/81 mm Hg, pulse is 102/min, and respirations are 30/min.  During physical examination, her condition deteriorates and she is emergently intubated due to acute respiratory failure.  Shortly after intubation, she goes into cardiac arrest and dies despite resuscitation efforts.  Review of the patient’s medical records shows that she had been prescribed multiple medications but had a history of noncompliance.  Autopsy shows hyperinflated lungs, airway mucus plugging, and cellular infiltration of the bronchial wall.  Long-term use of which of the following drugs would have best prevented the cellular reaction in this patient’s airways?

A 63-year-old man comes to the office due to blurred vision in both eyes for the last 2 days.  The blurriness is worse when he reads but is not noticeable when he drives.  The patient has no associated headache, double vision, or weakness.  However, he did start taking diphenhydramine several days ago for seasonal allergies.  Past medical history is unremarkable.  Vital signs are normal.  On physical examination, there is edema and clear drainage affecting the nasal mucosa.  Funduscopic examination is normal.  This patient’s visual symptoms are most likely due to blockade of which of the following mediators?

A 36-year-old woman comes to the office due to dyspnea and weakness that are brought on while doing ordinary chores around the house.  The patient has no other medical conditions and takes no medications.  She does not use tobacco, alcohol, or illicit drugs.  Her mother had similar symptoms and died at age 42.  After an extensive workup, a lung biopsy is performed.  Light microscopy of the tissue sample shows medial hypertrophy, intimal fibrosis, and decreased intraluminal diameter of the small branches of the pulmonary artery.  Which of the following is the most appropriate pharmacotherapy for this patient’s current condition?

A 78-year-old woman is brought to the hospital due to 2 days of nausea, vomiting, abdominal pain, and headache.  She was recently hospitalized due to a stroke, and the hospitalization was complicated by a urinary tract infection and delirium.  The patient has a history of chronic obstructive pulmonary disease and her treatment regimen includes theophylline.  Temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, pulse is 118/min, and respirations are 22/min.  On physical examination, the patient appears agitated and restless.  There is a coarse tremor of the outstretched arms.  Chest auscultation reveals mild expiratory wheezing.  Serum theophylline levels are markedly elevated.  Treatment with which of the following agents most likely precipitated this patient’s current symptoms?

A 21-year-old man with asthma comes to the office for follow-up.  His asthma symptoms are not adequately controlled with albuterol as needed, and a daily inhaled therapy was added at the previous visit.  The patient says he feels much better and has been using his rescue inhaler less frequently.  He has no other medical conditions.  The patient does not use tobacco or illicit drugs and drinks one or two 12-oz cans of beer daily.  He received childhood vaccinations but has refused the flu and pneumococcal vaccines.  Vital signs are within normal limits, and lungs are clear to auscultation.  White mucosal plaques that can be easily scraped off using a tongue depressor are present in the oropharynx.  The remainder of the physical examination shows no abnormalities.  Which of the following measures would have been most effective in preventing this patient’s abnormal oropharyngeal findings?

A 41-year-old man comes to the emergency department due to 3 weeks of low-grade fever, productive cough, and a 4.5-kg (10-lb) weight loss.  The patient drinks 10-12 beers a day.  On physical examination, he appears cachectic.  Poor dentition and clubbing of the fingers are noted.  A foul-smelling sputum sample is expectorated and sent for Gram stain and culture.  CT scan of the chest is shown in the image below:

Empiric antimicrobial therapy should include coverage against which of the following pathogens?

A 42-year-old woman is evaluated due to frequent episodes of shortness of breath, chest tightness, and cough.  The patient has been hospitalized on several occasions because of these symptoms and recently required mechanical ventilation due to respiratory failure.  She takes multiple inhaled and systemic medications.  The patient does not use tobacco, alcohol, or illicit drugs.  Physical examination reveals scattered expiratory wheezes in both lungs.  Peak expiratory flow rate is decreased from baseline.  The treatment regimen is expanded to include a monoclonal antibody that binds circulating IgE, with the resulting complexes being subsequently cleared by reticuloendothelial cells.  This medication is most likely to help this patient through which of the following mechanisms?

A 45-year-old man comes to the office due to a sore throat for the past 3 months.  The patient also has pain with swallowing.  He has never smoked, drinks alcohol occasionally, and does not use illicit drugs.  On physical examination, the right tonsil is enlarged with a small area of ulceration.  The rest of the physical examination is unremarkable.  Biopsy of the right tonsil is shown in the image below:

Which of the following most likely played the most significant role in the pathogenesis of this patient’s condition?

A 10-year-old boy with a history of mild, persistent asthma is brought to the office for follow-up.  His asthma symptoms are controlled with an inhaled beta-agonist and inhaled glucocorticoid therapy.  There is no family history of asthma, but both his parents and older brother have short stature.  The patient’s mother is concerned about the use of glucocorticoids because she read on the Internet that they cause growth retardation.  The patient’s glucocorticoid medication is stopped, and he is started on a trial of inhaled cromolyn.  Which of the following is the most likely site of action of this new medication?