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Thyroid Medications and Adrenal Disorders

Total questions: 60

Worksheet time: 32mins

Name
Class
Date
1.

Which hormone is synthesized in the hypothalamus and stimulates the release of TSH from the anterior pituitary?

a)

Thyroxine

b)

Thyrotropin-releasing hormone

c)

Triiodothyronine

d)

Dopamine

2.

Which of the following inhibits TSH secretion?

a)

TRH

b)

Dopamine

c)

Low plasma T₃ and T₄

d)

Somatotropin

3.

Which enzyme catalyzes both the iodination of tyrosine and the coupling reactions to form T₃ and T₄?

a)

Thyroidal peroxidase

b)

5′-deiodinase

c)

Sodium/iodide symporter

d)

Tyrosine hydroxylase

4.

The sodium/iodide symporter (NIS) is responsible for:

a)

Transporting iodine into the follicular lumen

b)

Transporting iodide from plasma into thyroid follicular cells

c)

Coupling MIT and DIT to form T₄

d)

Converting T₄ to T₃ in peripheral tissues

5.

Peripheral conversion of T₄ to T₃ occurs mainly via:

a)

5′-deiodinase

b)

Thyroidal peroxidase

c)

Tyrosinase

d)

Na⁺/K⁺-ATPase

6.

Thyroid hormone receptors (TRα and TRβ) belong to which receptor family?

a)

G protein–coupled receptors

b)

Nuclear receptor family

c)

Ligand-gated ion channels

d)

Tyrosine kinase receptors

7.

Which of the following is not a physiologic effect of thyroid hormone?

a)

Increased basal metabolic rate

b)

Decreased protein degradation

c)

Enhanced cardiac output

d)

Increased lipolysis

8.

Hashimoto’s thyroiditis is primarily characterized by:

a)

Excessive secretion of T₃ and T₄

b)

Autoimmune destruction of the thyroid gland

c)

Iodine-induced thyrotoxicosis

d)

Pituitary adenoma causing TSH overproduction

9.

Graves’ disease results from:

a)

TSH receptor-blocking antibodies

b)

Iodine deficiency

c)

TSH receptor–stimulating antibodies

d)

Pituitary tumor producing ACTH

10.

Which thyroid preparation is preferred for replacement therapy in hypothyroidism?

a)

Liothyronine

b)

Liotrix

c)

Levothyroxine

d)

Desiccated thyroid

11.

Which agent is used to block iodide uptake in iodide-induced hyperthyroidism?

a)

Perchlorate

b)

Methimazole

c)

Propylthiouracil

d)

Lugol’s iodine

12.

Radioactive iodine (¹³¹I) should be avoided in which condition?

a)

Thyroid storm

b)

Hashimoto’s disease

c)

Pregnancy

d)

Toxic nodular goiter

13.

Which best describes the feedback control of the HPT axis?

a)

TRH stimulates TSH and T₄, which directly inhibit cortisol release

b)

T₄ and T₃ inhibit TRH and TSH secretion through negative feedback

c)

TSH inhibits TRH and enhances ACTH secretion

d)

Dopamine stimulates TSH release

14.

Which statement about iodide is TRUE?

a)

Small amounts inhibit T₄ synthesis

b)

Large doses stimulate thyroglobulin proteolysis

c)

Small amounts are necessary for hormone formation; large amounts inhibit synthesis and release

d)

Iodine deficiency decreases TSH secretion

15.

Which of the following statements regarding thyroglobulin is correct?

a)

It stores thyroid hormones as colloid

b)

It directly converts T₄ to T₃

c)

It acts as a transporter in plasma

d)

It inhibits peroxidase activity

16.

Which statement correctly describes thyroid hormone receptors (TRs)?

a)

They are cytoplasmic receptors that activate G proteins

b)

They form dimers with retinoid X receptors

c)

They act by phosphorylating enzymes directly

d)

They are found on the outer cell membrane

17.

A patient with congenital hypothyroidism presents with mental retardation and dwarfism. This condition is called:

a)

Myxedema

b)

Cretinism

c)

Graves’ disease

d)

Thyroiditis

18.

Which is a disadvantage of desiccated thyroid preparations?

a)

Low antigenicity

b)

Stable and uniform dosing

c)

Variable hormone content and protein antigenicity

d)

High bioavailability and long half-life

19.

Which thyroid preparation has the shortest half-life and greatest cardiotoxic potential?

a)

Levothyroxine

b)

Liothyronine

c)

Liotrix

d)

Desiccated thyroid

20.

Which adverse effect is common to all thioamides?

a)

Aplastic anemia

b)

Agranulocytosis

c)

Hepatic necrosis

d)

Tremors

21.

Which agent works by blocking iodide uptake through competitive inhibition?

a)

Methimazole

b)

Perchlorate

c)

Potassium iodide

d)

Propylthiouracil

22.

Which describes the “escape phenomenon” related to iodide therapy?

a)

The thyroid resumes normal hormone synthesis after 2–8 weeks despite high iodide intake

b)

Iodide suddenly increases TSH secretion

c)

Iodine accumulates irreversibly in follicular cells

d)

Perchlorate prevents iodide escape

23.

Which of the following statements about radioactive iodine (¹³¹I) is correct?

a)

It stimulates thyroid hormone release

b)

It is used safely in pregnancy

c)

It destroys thyroid follicles and causes painless ablation

d)

It acts within hours

24.

Beta blockers are used in hyperthyroidism mainly to:

a)

Decrease thyroid hormone synthesis

b)

Increase T₄ to T₃ conversion

c)

Tachycardia

d)

Increase iodine uptake

25.

Which of the following beta-blockers also decreases peripheral conversion of T₄ to T₃?

a)

Metoprolol

b)

Propranolol

c)

Atenolol

d)

Bisoprolol

26.

Type I 5′-deiodinase is primarily located in:

a)

Pituitary gland

b)

Liver and kidney

c)

Adipose tissue

d)

Heart

27.

Which thyroid replacement has a composition ratio most similar to human thyroid secretion?

a)

Liothyronine

b)

Liotrix

c)

Levothyroxine

d)

Desiccated thyroid

28.

Thioamides act primarily by:

a)

Inhibiting iodide uptake

b)

Blocking the release of preformed hormone

c)

Inhibiting thyroid peroxidase-mediated organification

d)

Inhibiting TSH receptor antibodies

29.

Which adverse effect is rare but potentially fatal in thioamide therapy?

a)

Tremors

b)

Agranulocytosis

c)

Bradycardia

d)

Hypotension

30.

Most T₃ in the body originates from:

a)

Direct thyroid secretion

b)

Peripheral conversion of T₄

c)

Degradation of TBG

d)

Reverse T₃ metabolism

31.

Cushing syndrome results from:

a)

Low cortisol

b)

Excess cortisol

c)

Low aldosterone

d)

Excess aldosterone

32.

Which of the following is a first-line treatment for Cushing syndrome?

a)

Ketoconazole

b)

Mifepristone

c)

Surgical resection of the offending tumor

d)

Mitotane

33.

What is the main pharmacologic treatment for bilateral adrenal hyperplasia?

a)

Ketoconazole

b)

Spironolactone

c)

Fludrocortisone

d)

Prednisone

34.

Primary adrenal insufficiency involves deficiency of:

a)

Cortisol only

b)

Aldosterone only

c)

ACTH

d)

Cortisol, aldosterone, and androgens

35.

The most common cause of adrenal crisis is:

a)

Tuberculosis

b)

Autoimmune destruction

c)

Abrupt withdrawal of glucocorticoids

d)

ACTH-secreting tumor

36.

Which is a major adverse effect of long-term corticosteroid therapy?

a)

Hypoglycemia

b)

Weight loss

c)

Osteoporosis

d)

Hypotension

37.

When should corticosteroids be taken to mimic the body’s natural rhythm?

a)

Before bedtime

b)

With every meal

c)

In the morning

d)

After lunch

38.

Patients taking ≥20 mg prednisone daily for ≥14 days are considered:

a)

Immunocompetent

b)

At risk for adrenal insufficiency

c)

Immunosuppressed

d)

Hypermetabolic

39.

A patient with increased sympathetic output and elevated catecholamine levels likely has hyperactivity in which adrenal region?

a)

Zona fasciculata

b)

Zona reticularis

c)

Adrenal medulla

d)

Zona glomerulosa

40.

Which statement best distinguishes primary from secondary hyperaldosteronism?

a)

Primary is caused by pituitary ACTH excess

b)

Secondary results from renin-independent aldosterone release

c)

Primary originates within the adrenal gland; secondary results from RAAS activation

d)

Secondary is due to aldosterone-producing adenoma

41.

Spironolactone adverse effects include:

a)

Hyponatremia and hypotension

b)

Gynecomastia and hyperkalemia

c)

Hypokalemia and tachycardia

d)

Insomnia and anxiety

42.

What is the bolus dose of hydrocortisone for a patient in Adrenal Crisis?

a)

100 mg IV

b)

100 mg PO

c)

50mg IV every 6-8 hours

d)

50mg PO every 6-8 hours

43.

Which of the following is NOT an adverse effect of Corticosteroid therapy?

a)

Delayed healing

b)

Adrenal suppression

c)

Hyperglycemia

d)

Mood swings

e)

Weight loss

44.

Match the Glucocorticoid with its Equivalent Potency:

a)

Cortisone

1.

25

b)

Hydrocortisone

2.

20

c)

Prednisone

3.

5

d)

Triamcinolone

4.

4

e)

Dexamethasone

5.

0.75

45.

Primary adrenal insufficiency is most commonly caused by:

a)

Autoimmune destruction

b)

Chronic steroid use

c)

Pituitary tumor

d)

Adrenal hyperplasia

46.

Which electrolyte abnormalities are most consistent with Addison disease?

a)

Hypernatremia and hypokalemia

b)

Hyponatremia and hyperkalemia

c)

Hypokalemia and hyperglycemia

d)

Hypernatremia and hyperglycemia

47.

Always use of Fludrocortisone in Addison's disease regardless of electrolyte status.

a)

True

b)

False

48.

How should daily glucocorticoid dosing be divided in Addison disease?

a)

Evenly throughout the day

b)

67% in the morning and 33% later

c)

All at bedtime

d)

Half in the morning and half before dinner

49.

Which best describes secondary adrenal insufficiency?

a)

Decreased ACTH secretion from pituitary suppression

b)

Autoimmune destruction of adrenal cortex

c)

Aldosterone deficiency

d)

Increased androgen production

50.

Equivalent anti-inflammatory doses: which of the following is most potent per milligram?

a)

Hydrocortisone

b)

Prednisone

c)

Dexamethasone

d)

Methylprednisolone

e)

Betamethasone

51.

Which guidance aligns with general steroid principles?

a)

Take at bedtime for better tolerance

b)

Give highest dose possible to avoid flare

c)

Take in the morning with food

d)

Discontinue abruptly after 2 weeks

52.

Match each zone to its hormone:

a)

Zona glomerulosa

1.

Aldosterone

b)

Zona fasciculata

2.

Cortisol

c)

Zona reticularis

3.

Testosterone and estradiol

d)

Medulla

4.

Norepinephrine and Epinephrine

53.

What stimulates ACTH release from the anterior pituitary?

a)

Cortisol

b)

Aldosterone

c)

Corticotropin-releasing hormone

d)

Angiotensin II

54.

A pituitary disorder leading to low ACTH is considered a _____ problem

a)

Primary

b)

Secondary

c)

Tertiary

d)

Quaternary

55.

Androgen secretion increases during:

a)

Older age

b)

Fasting

c)

Puberty

d)

Anorexia nervosa

56.

Which drug blocks glucocorticoid receptors?

a)

Ketoconazole

b)

Mifepristone

c)

Mitotane

d)

Cabergoline

57.

Which drug can induce primary adrenal insufficiency?

a)

Hydrocortisone

b)

Mifepristone

c)

Phenytoin

d)

Etomidate

58.

Which symptom is typical of Cushing but not Addison?

a)

Buffalo hump

b)

Weakness

c)

Amenorrhea

d)

Fever

59.

Preferred pharmacologic treatment for hirsutism in women is:

a)

Dexamethasone

b)

Oral contraceptives

c)

Mitotane

d)

Fludrocortisone

60.

Corticosteroids are indicated for all of the following except:

a)

Rheumatoid arthritis

b)

Prevention of transplant rejection

c)

Allergic reaction treatment

d)

Improving blood glucose regulation

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