Autonomic Pharmacology USMLE Step 1 Practice Question
A 58-year-old woman with open-angle glaucoma has been taking timolol 0.5% eye drops twice daily for 2 years. She presents to clinic with a 3-week history of maculopapular rash on her trunk and extremities, low-grade fever (38.3°C), arthralgias in bilateral knees and wrists, and myalgias. She denies recent infections, new medications, or sun exposure. Vital signs are stable (BP 132/85 mmHg, HR 68/min). Laboratory evaluation reveals ESR 72 mm/hr, ANA 1:160 (homogeneous pattern), anti-histone antibodies positive, anti-dsDNA negative, and normal complement C3 and C4 levels. Chest X-ray is unremarkable. Which of the following best explains this patient's clinical presentation?
Answer choices
- ADrug-induced lupus erythematosus from chronic timolol useCorrect answer
- BAcute rheumatoid arthritis unrelated to her glaucoma therapy
- CIdiopathic systemic lupus erythematosus with coincidental timolol therapy
- DSerum sickness-like reaction from timolol preservatives (benzalkonium chloride)
- EAllergic contact dermatitis from timolol with secondary systemic symptoms
- FProstaglandin analog-induced immune complex disease
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