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Biosignaling and Thyroid Disorders

Total questions: 60

Worksheet time: 33mins

Name
Class
Date
1.

Which of the following best describes a “first messenger”?

a)

Molecule created after receptor binding

b)

Hormone or neurotransmitter that binds a receptor

c)

Enzyme that phosphorylates target proteins

d)

Intracellular molecule that activates PKA

2.

Which signaling type involves a hormone traveling through the bloodstream to act on distant cells?

a)

Autocrine

b)

Paracrine

c)

Endocrine

d)

Synaptic

3.

Where are receptors for nonpolar hormones like steroids typically located?

a)

On the plasma membrane

b)

In the cytoplasm or nucleus

c)

In the endoplasmic reticulum

d)

On ribosomal subunits

4.

Levothyroxin acts by binding to receptors located in the:

a)

Plasma membrane

b)

Cytoplasm

c)

Nucleus

d)

Mitochondria

5.

What event directly activates adenylate cyclase in the cAMP/PKA pathway?

a)

Binding of ATP to the receptor

b)

Activation of the Gα subunit with GTP

c)

Phosphorylation by PKA

d)

Conversion of cAMP to AMP

6.

Which enzyme terminates the action of cAMP by converting it to AMP?

a)

Adenylate cyclase

b)

GTPase

c)

cAMP phosphodiesterase

d)

Protein kinase A

7.

What is the best description of amplification in signaling?

a)

A single receptor activates multiple second messengers

b)

One hormone molecule triggering many consecutive intracellular enzymes

c)

Inhibition of downstream enzymes

d)

G-protein self-deactivation through GTP hydrolysis

8.

Activation of a Gαi-coupled receptor will most likely:

a)

Increase cAMP

b)

Decrease cAMP

c)

Increase IP3 and DAG

d)

Activate PKB

9.

Upon insulin binding, what type of receptor is activated?

a)

G-protein coupled receptor

b)

Ion channel receptor

c)

Tyrosine kinase receptor

d)

Jak-Stat receptor

10.

Which signaling molecule activates PKB (protein kinase B)?

a)

cAMP

b)

PIP3

c)

IP3

d)

DAG

11.

The second messengers that activate protein kinase C (PKC) are:

a)

cAMP and AMP

b)

Ca2+ and DAG

c)

PIP2 and PIP3

d)

cGMP and PKG

12.

Which of the following statements about cGMP is correct?

a)

It is a first messenger

b)

It activates protein kinase G

c)

It inhibits guanylate cyclase

d)

It is broken down by adenylate cyclase

13.

Nitroglycerin acts by generating which signaling molecule?

a)

cAMP

b)

Nitric oxide

c)

IP3

d)

PIP3

14.

The leptin receptor is an example of what kind of receptor?

a)

GPCR

b)

Tyrosine Kinase Receptor

c)

JAK-STAT Receptor

d)

Serine/Threonine Kinase Receptor

15.

After a corticosteroid binds its receptor in the cytoplasm, what happens next?

a)

The complex translocates to the nucleus and activates gene expression

b)

The receptor activates a G-protein to increase cAMP

c)

The complex opens ion channels in the membrane

d)

The receptor activates phospholipase C to form DAG

16.

Nitroglycerin decreases blood pressure primarily through:

a)

Activation of adenylate cyclase → ↑ cAMP

b)

Activation of guanylate cyclase → ↑ cGMP

c)

Stimulation of phospholipase C → ↑ IP₃

d)

Inhibition of phosphodiesterase → ↑ AMP

17.

Which best describes the signaling of GLP-1 receptor agonists?

a)

Bind cytoplasmic receptors to regulate gene transcription

b)

Bind membrane receptors to increase insulin secretion from β-cells

c)

Inhibit guanylate cyclase to lower cGMP

d)

Act on nuclear receptors to slow metabolism

18.

Which statement best describes a receptor?

a)

A lipid molecule that stores energy for signaling

b)

A protein that binds a ligand to initiate a response

c)

An enzyme that catalyzes the breakdown of ATP

d)

A carbohydrate that transports hormones in the blood

19.

The term substrate is most closely associated with:

a)

Molecule upon which an enzyme acts

b)

Hormones that bind to nuclear receptors

c)

Ion channels that open in response to voltage

d)

Ligands that bind to GPCRs

20.

Which of the following is typically considered a ligand?

a)

Sodium ions entering a cell

b)

Enzymes that break down substrates

c)

Hormones, neurotransmitters, or drugs that bind receptors

d)

Phosphorylated proteins inside the cell

21.

Specificity in receptor binding means:

a)

Only certain ligands with the correct shape can bind the receptor

b)

Any molecule can activate the receptor if the concentration is high enough

c)

Receptors can only exist in one cell type

d)

Binding occurs randomly without structural restrictions

22.

Which of the following would be considered a first messenger?

a)

Cyclic AMP

b)

Epinephrine

c)

Transcription factor inside the nucleus

d)

Protein kinase A

23.

What is a second messenger?

a)

The receptor itself

b)

A molecule produced inside the cell after receptor activation

c)

The ligand that binds to the receptor

d)

protein that phosphorylates substrates

24.

Signal transduction refers to:

a)

The electrical transmission of impulses along a neuron

b)

The specific cellular effects resulting from receptor binding

c)

The breakdown of ligands after receptor binding

d)

The movement of ions across the plasma membrane only

25.

What is the main difference between ionotropic and metabotropic receptors?

a)

Ionotropic receptors alter gene expression; metabotropic receptors open channels directly

b)

Ionotropic receptors open ion channels directly; metabotropic receptors use second messengers

c)

Both activate G-proteins

d)

Metabotropic receptors require voltage to activate

26.

Which pathway is most directly associated with increased cAMP production?

a)

Insulin receptor activation

b)

β-adrenergic receptor stimulation

c)

α₁-adrenergic receptor activation

d)

IP₃–DAG signaling

27.

Match the receptor to its pathway:

a)

β-adrenergic

1.

Gs → cAMP → PKA

b)

α₁-adrenergic

2.

Gq → PLC → DAG/IP₃ → PKC

c)

Insulin

3.

Tyrosine kinase → RAS → PIP3 → PKB

d)

Nitric oxide

4.

cGMP → PKG

e)

Glucagon

5.

Glucagon receptor → Gs → cAMP → PKA

28.

Which clinical drug binds a receptor inside the cytoplasm that later activates gene transcription?

a)

Albuterol

b)

Hydrocortisone

c)

Propranolol

d)

Insulin

29.

Which hormone binds directly to receptors located in the nucleus?

a)

Glucagon

b)

Epinephrine

c)

Thyroid hormone

d)

Insulin

30.

Which of the following hormones must bind a receptor located on the plasma membrane?

a)

Cortisol

b)

Estrogen

c)

Thyroid hormone

d)

Glucagon

31.

Which hormone is secreted in greater quantities by the thyroid gland?

a)

T3

b)

T4

c)

Calcitonin

d)

TRH

32.

What enzyme oxidizes iodide and binds it to tyrosine residues within thyroglobulin?

a)

Thyroid peroxidase

b)

Monoamine oxidase

c)

5′-monodeiodinase

d)

Iodinase kinase

33.

Which combination forms T3?

a)

MIT + MIT

b)

DIT + DIT

c)

MIT + DIT

d)

DIT + MIT + MIT

34.

Which lab pattern is most consistent with overt hypothyroidism?

a)

↓TSH, ↓Free T4

b)

↑TSH >10 mIU/L, ↓Free T4

c)

↑TSH <10 mIU/L, Normal Free T4

d)

Normal TSH, ↓Free T4

35.

Which antibody is most associated with Hashimoto’s thyroiditis?

a)

TPOAb

b)

TRAb

c)

TgAb

d)

ANA

36.

Which of the following is not a common symptom of hypothyroidism?

a)

Cold intolerance

b)

Weight gain

c)

Tremor

d)

Constipation

37.

Which is the drug of choice for hypothyroidism?

a)

Liothyronine

b)

Levothyroxine

c)

Liotrix

d)

Desiccated thyroid

38.

What is the usual full replacement dose of levothyroxine in healthy adults <50 years old?

a)

0.8 mcg/kg/day

b)

1.0 mcg/kg/day

c)

1.6 mcg/kg/day

d)

2.0 mcg/kg/day

39.

What is the oral-to-IV conversion ratio for levothyroxine?

a)

1:1

b)

0.75:1

c)

1.25:1

d)

1.5:1

40.

A patient taking iron and calcium supplements should separate these from levothyroxine by:

a)

30 minutes

b)

1 hour

c)

2 hours

d)

4 hours

41.

Which of the following is a boxed warning for levothyroxine?

a)

Hepatotoxicity

b)

Agranulocytosis

c)

Use for weight loss in euthyroid patients

d)

Osteoporosis

42.

During pregnancy, what change should be made to levothyroxine dosing?

a)

Decrease by 20-30%

b)

No change

c)

Increase by 20-30%

d)

Switch to liothyronine

43.

Which lab pattern is most consistent with overt hyperthyroidism?

a)

↑TSH, ↑Free T4

b)

↓TSH, ↑Free T4 and T3

c)

↓TSH, Normal Free T4

d)

Normal TSH, ↑Free T4

44.

Presence of which antibody confirms Graves’ disease?

a)

TPOAb

b)

TRAb

c)

TgAb

d)

ANA

45.

Which β-blocker is preferred for nursing or pregnant mothers?

a)

Atenolol

b)

Metoprolol

c)

Propranolol

d)

Nadolol

46.

Which antithyroid medication is preferred in the first trimester of pregnancy?

a)

Methimazole

b)

Propylthiouracil

c)

Liothyronine

d)

Liotrix

47.

Which emergency results from severe, untreated hypothyroidism?

a)

Thyroid storm

b)

Myxedema coma

c)

Adrenal crisis

d)

SIADH

48.

What is the first-line treatment for thyroid storm?

a)

PTU

b)

Methimazole

c)

RAI

d)

Levothyroxine

49.

Which beta blocker is preferred for use in severe thyrotoxicosis or storm in an ICU setting?

a)

Propranolol

b)

Labetalol

c)

Atenolol

d)

Esmolol

50.

Match the strength to its color:

a)

Orange

1.

25 mcg

b)

Pink

2.

200 mcg

c)

Blue

3.

150 mcg

d)

Brown

4.

125 mcg

e)

Violet

5.

75 mcg

51.

Match the strength to the Levothyroxine tablet color:

a)

White

1.

50 mcg

b)

Olive

2.

88 mcg

c)

Turquoise

3.

137 mcg

d)

Yellow

4.

100 mcg

e)

Lilac

5.

175 mcg

52.

A 47-year-old woman presents with fatigue, dry skin, weight gain, and constipation. Labs show:

  • TSH: 12 mIU/L

  • Free T4: 0.6 ng/dL

  • TPOAb: Positive

Which diagnosis best fits her presentation?

a)

Subclinical hypothyroidism

b)

Overt hypothyroidism due to Hashimoto’s thyroiditis

c)

Subclinical hyperthyroidism

d)

Euthyroid syndrome

53.

A healthy 35-year-old woman (IBW = 60 kg) is newly diagnosed with primary hypothyroidism. No cardiac history.
What is the most appropriate initial full levothyroxine dose?

a)

25 mcg once daily

b)

50 mcg once daily

c)

75 mcg once daily

d)

100 mcg once daily

54.

A 70-year-old man (CAD history) is diagnosed with hypothyroidism (IBW = 55).
Which starting regimen is most appropriate?

a)

1.6 mcg/kg/day based on IBW

b)

50 mcg once daily

c)

75 mcg once daily

d)

25 mcg once daily

55.

A 30-year-old woman stabilized on 100 mcg levothyroxine daily reports a positive pregnancy test.
What is the best action?

a)

Decrease dose by 25%

b)

Continue same dose and re-check after delivery

c)

Increase dose by 20–30% immediately

d)

Switch to liothyronine (T3)

56.

A patient on levothyroxine reports recently adding calcium carbonate and multivitamins to her routine.
Two months later her TSH is elevated. Which explanation is most likely?

a)

Enhanced T4 conversion

b)

Decreased levothyroxine absorption

c)

Increased metabolism by CYP induction

d)

TSH assay error

57.

An 82-year-old woman with long-standing hypothyroidism presents with delirium, hypothermia, bradycardia, and hypotension.
Which initial treatment is most appropriate?

a)

IV methimazole

b)

IV levothyroxine ± IV liothyronine plus hydrocortisone

c)

Oral levothyroxine only

d)

Radioactive iodine ablation

58.

A 29-year-old woman has weight loss despite increased appetite, heat intolerance, and tremor.
Labs:

  • TSH 0.05 mIU/L

  • Free T4 2.8 ng/dL

  • Positive TRAb

Which diagnosis best fits?

a)

Subclinical hyperthyroidism

b)

Graves’ disease

c)

Toxic multinodular goiter

d)

Thyroiditis

59.

What lab values should you monitor when treating with PTU?

a)

CBC with differential

b)

Liver Function Tests

c)

Urinalysis

d)

Blood pressure

60.

A 35-year-old woman (10 weeks pregnant) is diagnosed with Graves’ disease.
Which therapy is preferred?

a)

Methimazole

b)

Propylthiouracil

c)

Radioactive iodine

d)

Thyroidectomy

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