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WorksheetsGEM Endocrine Drugs SBAs
Total questions: 54
Worksheet time: 54mins
Name
Class
Date
1.
A 28-year-old woman with a known history of autoimmune hepatitis presents with a flare, characterised by markedly elevated transaminases. Her consultant decides to initiate a reducing course of oral corticosteroid therapy to induce remission. Which of the following is the generic name of the most commonly prescribed oral steroid for this indication in this setting?
a)
Betamethasone
b)
Dexamethasone
c)
Hydrocortisone
d)
Prednisolone
e)
Triamcinolone
2.
A 65-year-old man with chronic obstructive pulmonary disease (COPD) is admitted with a severe infective exacerbation. Despite nebulisers and antibiotics, he remains significantly breathless. The medical team decides to add a medication to reduce airway inflammation and improve symptoms. To which major drug class does the most appropriate systemic agent for this scenario belong?
a)
Beta-2 adrenergic agonist
b)
Leukotriene receptor antagonist
c)
Glucocorticoid
d)
Phosphodiesterase-4 inhibitor
e)
Muscarinic antagonist
3.
A patient on long-term prednisolone for granulomatosis with polyangiitis is prescribed a new medication for gastro-oesophageal reflux disease. The GP notes a potentially significant drug interaction that requires monitoring. What is the primary mechanism of the clinically important interaction between prednisolone and this new drug?
a)
Competitive binding at plasma proteins
b)
Induction of hepatic cytochrome P450 enzymes
c)
Inhibition of renal tubular secretion
d)
Synergistic immunosuppression
e)
Chelation in the gastrointestinal tract
4.
A medical student is revising how a common anti-inflammatory drug exerts its profound immunosuppressive effects at a cellular level. What is the fundamental mechanism of action of prednisolone?
a)
It directly inhibits the enzyme cyclooxygenase-2 (COX-2).
b)
It blocks the synthesis of leukotriene precursors.
c)
It binds to an intracellular receptor, translocates to the nucleus, and modifies gene transcription.
d)
It prevents the degranulation of mast cells and basophils.
e)
It acts as a folate antagonist, inhibiting lymphocyte proliferation.
5.
A 42-year-old woman presents with progressive shortness of breath, dry cough, and bilateral hilar lymphadenopathy on chest X-ray. Biopsy of a skin lesion shows non-caseating granulomas. A diagnosis of sarcoidosis is made. For which of the following indications in this patient would oral prednisolone be the most appropriate first-line systemic therapy?
a)
First-line treatment for asymptomatic hilar lymphadenopathy
b)
Treatment for symptomatic pulmonary involvement or other organ-threatening disease
c)
Immediate treatment for all cutaneous manifestations
d)
Prophylaxis against disease progression in all newly diagnosed patients
e)
Replacement therapy for associated adrenal insufficiency
6.
A 70-year-old woman has been taking 20mg of prednisolone daily for the past 4 months for polymyalgia rheumatica. She attends her GP for a routine review. Which of the following is a recognised long-term adverse effect of this treatment that the GP should actively monitor for and consider prophylactic management against?
a)
Torsades de pointes
b)
Osteoporosis and increased fracture risk
c)
Obstructive sleep apnoea
d)
Haemolytic anaemia
e)
Sensorineural hearing loss
7.
A 45-year-old man is undergoing a major abdominal surgery. His anaesthetist administers an intravenous medication intraoperatively, explaining it is given for its mineralocorticoid activity to help maintain haemodynamic stability under the stress of surgery. Which medication, which is also the main physiological glucocorticoid, is most likely being administered?
a)
Dexamethasone
b)
Fludrocortisone
c)
Hydrocortisone
d)
Methylprednisolone
e)
Prednisolone
8.
A newborn baby is diagnosed with 21-hydroxylase deficiency, the most common form of congenital adrenal hyperplasia (CAH). Lifelong replacement therapy is required to prevent adrenal crisis and to suppress excess androgen production. Which class of drug is used as the glucocorticoid replacement component of this baby's treatment?
a)
Anabolic steroid
b)
Glucocorticoid
c)
Mineralocorticoid agonist
d)
Sex hormone antagonist
e)
Thyroid hormone analogue
9.
A patient with Addison's disease is stabilised on oral hydrocortisone and fludrocortisone. They are started on a new antiepileptic medication for a seizure disorder. At follow-up, they report symptoms suggestive of adrenal insufficiency despite unchanged doses. With which of the following concomitant drugs is this loss of hydrocortisone efficacy most likely to occur, due to a pharmacokinetic interaction?
a)
Sodium valproate
b)
Levetiracetam
c)
Phenytoin
d)
Ethosuximide
e)
Gabapentin
10.
A patient with septic shock is receiving intravenous fluids, antibiotics, and vasopressors. The intensivist considers adding intravenous hydrocortisone to the regimen. What is the primary rationale for using hydrocortisone in this context, relating to its physiological action?
a)
To directly vasodilate peripheral vessels
b)
To provide inotropic support to the heart
c)
To potentiate the vasoconstrictor effects of catecholamines
d)
To act as a broad-spectrum antibiotic synergist
e)
To inhibit the release of pro-inflammatory cytokines only
11.
A 50-year-old woman with a history of primary adrenal insufficiency (Addison's disease) is brought to the Emergency Department with vomiting, diarrhoea, hypotension, and hyponatraemia. What is the most urgent and critical component of her immediate management?
a)
Oral administration of her usual fludrocortisone dose
b)
Intravenous administration of hydrocortisone
c)
Administration of a rapid intravenous fluid bolus of 5% dextrose
d)
Starting a noradrenaline infusion
e)
Taking a random cortisol blood test
12.
A 30-year-old man with hypopituitarism is on long-term replacement therapy with oral hydrocortisone 20mg daily (10mg on waking, 5mg at lunch, 5mg in the afternoon). He attends clinic reporting persistent fatigue, weight gain, and low mood. Which of the following is the most likely pharmacological cause of his symptoms, based on his regimen?
a)
Iatrogenic Cushing's syndrome due to excessive total daily dose
b)
Inadequate overnight glucocorticoid coverage leading to morning deficiency
c)
Excess mineralocorticoid effect causing hypokalaemia
d)
Autoimmune destruction of his remaining adrenal function
e)
An interaction with his thyroxine replacement
13.
A patient with a primary brain tumour presents with worsening headache, vomiting, and papilloedema. To reduce peri-tumoural oedema and lower intracranial pressure before definitive surgery, the neurosurgeon prescribes a potent, long-acting corticosteroid with minimal mineralocorticoid activity. Which corticosteroid is the most appropriate choice in this scenario?
a)
Betamethasone
b)
Dexamethasone
c)
Hydrocortisone
d)
Methylprednisolone
e)
Prednisolone
14.
A 60-year-old woman with multiple myeloma is about to start a chemotherapy regimen. The protocol includes a drug specifically added to prevent nausea and vomiting induced by the chemotherapeutic agents. The antiemetic drug in this protocol belongs to which class?
a)
5-HT3 receptor antagonist
b)
Dopamine D2 antagonist
c)
Glucocorticoid
d)
Neurokinin-1 (NK1) receptor antagonist
e)
Prokinetic agent
15.
A patient on lifelong dexamethasone suppression for congenital adrenal hyperplasia is diagnosed with tuberculosis and requires rifampicin therapy. What is the expected interaction and necessary action?
a)
Reduce dexamethasone dose due to risk of additive hepatotoxicity.
b)
Increase dexamethasone dose and monitor for adrenal insufficiency.
c)
Switch dexamethasone to prednisolone due to a superior side-effect profile.
d)
No interaction is expected; continue the same dose.
e)
Stop dexamethasone temporarily while on rifampicin.
16.
In the antenatal clinic, a pregnant woman at 24 weeks gestation is at high risk of preterm delivery. A medication is administered intramuscularly to promote fetal lung maturation. What is the primary mechanism by which this medication accelerates fetal lung development?
a)
It increases maternal blood flow to the placenta.
b)
It acts as a direct surfactant substitute.
c)
It stimulates the production of surfactant phospholipids and proteins in fetal type II pneumocytes.
d)
It causes vasodilation of the fetal pulmonary circulation.
e)
It inhibits the breakdown of existing surfactant.
17.
A 55-year-old man with newly diagnosed high-grade non-Hodgkin lymphoma presents with back pain, lower limb weakness, and urinary retention. MRI confirms an epidural spinal cord compression at the T10 level. What is the immediate pharmacological management while awaiting neurosurgical or oncological intervention?
a)
High-dose intravenous ibuprofen
b)
Intrathecal methotrexate
c)
Oral morphine sulphate
d)
High-dose intravenous dexamethasone
e)
Subcutaneous enoxaparin
18.
A patient with cerebral metastases from lung cancer has been on dexamethasone 8mg twice daily for four weeks. They are reviewed in the oncology clinic for steroid toxicity. Which of the following adverse effects is particularly associated with dexamethasone, compared to some other glucocorticoids, especially when given in the evening?
a)
Hypoglycaemia
b)
Peptic ulcer disease
c)
Severe insomnia and psychomotor agitation
d)
Hyperkalaemia
e)
Hirsutism
19.
A 68-year-old man with type 2 diabetes mellitus has inadequate glycaemic control on metformin alone. His renal function is moderately impaired (eGFR 45 mL/min/1.73m²). His GP wishes to add an oral agent with a glucose-dependent mechanism and a low risk of hypoglycaemia. Which of the following medications, an inhibitor of the DPP-4 enzyme, meets these criteria?
a)
Canagliflozin
b)
Exenatide
c)
Gliclazide
d)
Pioglitazone
e)
Sitagliptin
20.
A new oral antidiabetic drug works by preventing the breakdown of endogenous incretin hormones, thereby prolonging their activity to stimulate insulin release and suppress glucagon secretion in a glucose-dependent manner. This drug belongs to which class?
a)
Biguanide
b)
Dipeptidyl peptidase-4 (DPP-4) inhibitor
c)
Glucagon-like peptide-1 (GLP-1) receptor agonist
d)
Sodium-glucose cotransporter-2 (SGLT2) inhibitor
e)
Sulfonylurea
21.
A patient taking sitagliptin is prescribed a new antibiotic for a chest infection. The pharmacy software flags a potential interaction. The efficacy of sitagliptin may be reduced when co-administered with which of the following types of drug?
a)
Macrolide antibiotic (e.g., clarithromycin)
b)
Potent inducer of CYP3A4/P-glycoprotein (e.g., rifampicin)
c)
Proton pump inhibitor (e.g., omeprazole)
d)
Angiotensin-converting enzyme inhibitor (e.g., lisinopril)
e)
Strong CYP3A4 inhibitor (e.g., ketoconazole)
22.
A pharmacology tutorial discusses a drug that lowers blood glucose by inhibiting a specific serine protease enzyme. What is the primary immediate biochemical consequence of inhibiting this enzyme?
a)
Decreased hepatic gluconeogenesis
b)
Increased insulin-independent glucose uptake in muscle
c)
Increased plasma levels of active glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)
d)
Blockade of renal glucose reabsorption
e)
Sensitisation of pancreatic beta-cells to sulphonylureas
23.
A 72-year-old woman with type 2 diabetes and stable chronic heart failure (NYHA Class II) is on metformin. Her HbA1c is 58 mmol/mol (7.5%). She is concerned about weight gain and hypoglycaemia. Which of the following would be a suitable second-line agent to add, considering her comorbidities and concerns?
a)
Glibenclamide
b)
Sitagliptin
c)
Pioglitazone
d)
Regular human insulin
e)
Canagliflozin
24.
A patient taking sitagliptin for type 2 diabetes presents to their GP with a new, persistent pain in the right upper quadrant and jaundice. Blood tests reveal a cholestatic pattern of liver enzyme elevation. Which of the following is a recognised, though rare, adverse effect of sitagliptin that could explain this presentation?
a)
Diabetic ketoacidosis
b)
Fournier's gangrene
c)
Hepatotoxicity
d)
Lactic acidosis
e)
Pancreatitis
25.
A 58-year-old man with newly diagnosed type 2 diabetes mellitus is commenced on first-line oral pharmacotherapy. His GP explains the drug works mainly by reducing glucose production in the liver and improving insulin sensitivity, without causing weight gain. What is the name of this medication?
a)
Canagliflozin
b)
Gliclazide
c)
Metformin
d)
Pioglitazone
e)
Sitagliptin
26.
A medical student is learning about a first-line oral antidiabetic drug that activates AMP-activated protein kinase (AMPK). This drug belongs to which of the following classes?
a)
DPP-4 inhibitor
b)
GLP-1 analogue
c)
Biguanide
d)
Sulfonylurea
e)
SGLT2 inhibitor
27.
A patient on metformin is admitted with acute gastroenteritis and becomes significantly dehydrated. The admitting doctor reviews the medication chart. What is the primary reason for temporarily withholding metformin in this clinical scenario?
a)
To avoid a disulfiram-like reaction with intravenous fluids.
b)
To reduce the risk of metformin-associated lactic acidosis.
c)
To prevent profound hypoglycaemia during reduced oral intake.
d)
To avoid worsening renal perfusion from a direct nephrotoxic effect.
e)
To eliminate a potential interaction with antiemetic medications.
28.
A researcher is investigating the primary glucose-lowering effect of a first-line antidiabetic drug in a hepatocyte cell line. What is the drug's principal action in the liver?
a)
Stimulation of glycogen synthesis.
b)
Inhibition of glycogen phosphorylase.
c)
Suppression of hepatic gluconeogenesis.
d)
Increased uptake of glucose from the portal circulation.
e)
Promotion of glucagon secretion.
29.
A 45-year-old woman with polycystic ovary syndrome (PCOS) presents with oligomenorrhoea and hirsutism. Her BMI is 32 kg/m² and she has impaired glucose tolerance. Which medication might be prescribed primarily for its insulin-sensitising effects to manage both her metabolic and reproductive features of PCOS?
a)
Clomifene
b)
Combined oral contraceptive pill
c)
Finasteride
d)
Metformin
e)
Spironolactone
30.
A patient has just been started on metformin 500mg once daily. One week later, he reports troublesome gastrointestinal symptoms to his GP. Which of the following side effects is most commonly associated with the initiation of metformin therapy?
a)
Hypoglycaemia
b)
Metallic taste
c)
Peripheral oedema
d)
Transient diarrhoea and abdominal discomfort
e)
Urinary tract infections
31.
An elderly patient with type 2 diabetes is started on a second-line oral medication. The GP advises the patient to take it with breakfast to minimise the risk of hypoglycaemia and explains it works by stimulating the patient's own pancreas to release more insulin. Which medication is this?
a)
Empagliflozin
b)
Gliclazide
c)
Liraglutide
d)
Metformin
e)
Vildagliptin
32.
A patient's diabetes medication acts by binding to and closing ATP-sensitive potassium channels on the surface of pancreatic beta-cells. This drug is a member of which class?
a)
Biguanide
b)
GLP-1 receptor agonist
c)
Meglitinide
d)
SGLT2 inhibitor
e)
Sulfonylurea
33.
An 80-year-old man on gliclazide is admitted with severe hypoglycaemia. His medication history reveals he was recently started on a new drug for a chronic inflammatory condition by a specialist. Which of the following concomitant medications is most likely to have precipitated this hypoglycaemic episode?
a)
Allopurinol
b)
Sulfamethoxazole (as co-trimoxazole)
c)
Levothyroxine
d)
Atorvastatin
e)
Amlodipine
34.
A physiology tutorial demonstrates how a drug triggers insulin secretion from an isolated pancreatic islet cell. What is the final, critical step in this drug's mechanism that directly leads to insulin exocytosis?
a)
Inhibition of alpha-glucosidase enzymes.
b)
Activation of intracellular PPAR-gamma receptors.
c)
Influx of extracellular calcium ions into the beta-cell.
d)
Blockade of sodium-glucose co-transporters.
e)
Direct stimulation of insulin gene transcription.
35.
A 70-year-old man with type 2 diabetes has an HbA1c of 70 mmol/mol (8.6%) despite being on the maximum tolerated dose of metformin. He is not overweight and is keen to avoid injectable therapy. Which of the following would be a typical second-line treatment option to add in this scenario, particularly if cost is a major consideration?
a)
Dulaglutide
b)
Gliclazide
c)
Insulin glargine
d)
Pioglitazone
e)
Sitagliptin
36.
An elderly woman with type 2 diabetes on gliclazide is brought to A&E confused and sweaty. Her capillary blood glucose is 2.1 mmol/L. She is treated successfully with intravenous dextrose. Which of the following is the most significant risk factor for her experiencing this adverse effect from gliclazide?
a)
Concomitant use of aspirin.
b)
Irregular meal patterns or missed meals.
c)
Mild diabetic retinopathy.
d)
A history of hypertension.
e)
Taking the medication at night.
37.
A 35-year-old woman with primary hypothyroidism presents for a routine review. She has been on a stable dose of thyroid replacement therapy for several years, which she takes each morning on an empty stomach. What is the generic name of the synthetic hormone she is almost certainly taking?
a)
Carbimazole
b)
Liothyronine
c)
Levothyroxine
d)
Propylthiouracil
e)
Thyrotropin alfa
38.
A patient with a completely absent thyroid gland following a total thyroidectomy for cancer requires lifelong hormone therapy to maintain euthyroidism. This replacement therapy is a synthetic form of which class of hormone?
a)
Corticosteroid
b)
Thyroid hormone
c)
Pituitary hormone
d)
Sex hormone
e)
Parathyroid hormone
39.
A patient's hypothyroidism has become difficult to control despite a previously stable high dose of levothyroxine. She reports starting a new medication for indigestion three months ago. Which of the following commonly used drugs is known to significantly impair the absorption of levothyroxine from the gut?
a)
Lansoprazole
b)
Calcium carbonate
c)
Senna
d)
Simvastatin
e)
Warfarin
40.
In a cell biology lecture, the professor explains how thyroid hormone exerts its wide-ranging metabolic effects. What is the primary, intracellular mechanism of action of the active thyroid hormone derived from levothyroxine?
a)
Activation of cell surface G-protein coupled receptors.
b)
Binding to nuclear thyroid hormone receptors and modulating gene transcription.
c)
Direct allosteric modification of mitochondrial enzymes.
d)
Inhibition of sodium-potassium ATPase pumps.
e)
Acting as a cofactor for cytosolic metabolic pathways.
41.
A 60-year-old woman presents with fatigue, weight gain, cold intolerance, and a hoarse voice. Blood tests show a TSH of 48 mIU/L and a low free T4. What is the definitive long-term treatment for this patient's condition?
a)
Observation and repeat testing in 3 months.
b)
A short course of oral prednisolone.
c)
Oral levothyroxine replacement therapy.
d)
Radioactive iodine ablation.
e)
Intravenous liothyronine in hospital.
42.
An elderly patient with known ischaemic heart disease is started on levothyroxine for hypothyroidism. The initial dose is deliberately very low. What is the primary rationale for this cautious dosing strategy in this patient population?
a)
To avoid staining of the teeth.
b)
To prevent the development of thyroid storm.
c)
To minimise the risk of precipitating angina or a cardiac arrhythmia.
d)
To reduce the chance of a hypersensitivity reaction.
e)
To ensure adequate absorption in an ageing gut.
43.
A 62-year-old man with type 2 diabetes and a history of heart failure with reduced ejection fraction is reviewed. His cardiologist adds a medication to his regimen that lowers cardiovascular mortality and hospitalisation for heart failure, and works by causing glycosuria. Which medication, an SGLT2 inhibitor, is being described?
a)
Canagliflozin
b)
Dapagliflozin
c)
Empagliflozin
d)
Ertugliflozin
e)
Liraglutide
44.
A patient's diabetes medication works by inhibiting a transporter in the proximal convoluted tubule of the nephron, leading to the excretion of approximately 70-80 grams of glucose per day in the urine. This drug is a member of which class?
a)
Biguanide
b)
DPP-4 inhibitor
c)
GLP-1 receptor agonist
d)
SGLT2 inhibitor
e)
Sulfonylurea
45.
A patient with type 2 diabetes on empagliflozin is admitted with a lower limb cellulitis and is found to be volume-depleted. The doctor reviews the drug chart. What is the primary pharmacological mechanism by which empagliflozin can contribute to volume depletion?
a)
It acts as a direct renal vasodilator.
b)
It causes significant diarrhoea and fluid loss.
c)
It induces an osmotic diuresis due to glucosuria.
d)
It potently inhibits the renin-angiotensin-aldosterone system.
e)
It is a direct cardiac depressant.
46.
A pharmacology tutorial focuses on a drug that lowers blood glucose by acting on the kidney independently of insulin. What is the precise site and molecular action of empagliflozin?
a)
It inhibits carbonic anhydrase in the proximal tubule.
b)
It antagonises aldosterone receptors in the collecting duct.
c)
It blocks sodium-glucose co-transporter 2 (SGLT2) in the proximal convoluted tubule.
d)
It opens potassium channels in the thick ascending limb.
e)
It inhibits vasopressin V2 receptors in the collecting duct.
47.
A 68-year-old woman with type 2 diabetes, chronic kidney disease (eGFR 50 mL/min/1.73m²), and albuminuria is on maximum tolerated metformin and an ACE inhibitor. Her consultant wishes to add an agent with proven renal protective effects. Which of the following medications has robust evidence for slowing the progression of diabetic kidney disease in this context?
a)
Gliclazide
b)
Insulin glargine
c)
Linagliptin
d)
Empagliflozin
e)
Pioglitazone
48.
A 55-year-old man on empagliflozin presents to his GP with symptoms of dysuria, urinary frequency, and loin pain. A urine dipstick is positive for glucose, nitrites, and leukocytes. Which of the following is a recognised and relatively common adverse effect of empagliflozin that could predispose to this presentation?
a)
Acute pancreatitis
b)
Fournier's gangrene
c)
Genitourinary tract infections
d)
Hyperkalaemia
e)
Thyroid C-cell tumours
49.
A patient with type 2 diabetes and obesity is started on a once-weekly subcutaneous injection. The medication mimics an incretin hormone, leading to significant weight loss, improved glycaemic control, and reduced cardiovascular risk. Which of the following is the name of this GLP-1 receptor agonist?
a)
Dulaglutide
b)
Exenatide
c)
Liraglutide
d)
Lixisenatide
e)
Semaglutide
50.
A new injectable diabetes medication delays gastric emptying, suppresses glucagon secretion, and stimulates glucose-dependent insulin secretion from the pancreas. This drug mimics the action of which endogenous hormone class?
a)
Amylin analogues
b)
Incretin mimetics (GLP-1 receptor agonists)
c)
Insulin analogues
d)
Somatostatin analogues
e)
Gastrin derivatives
51.
A patient on once-weekly semaglutide for diabetes and obesity is scheduled for an elective laparoscopic cholecystectomy. The anaesthetist reviews her medications pre-operatively. What is the most important instruction regarding the timing of her semaglutide dose in relation to her planned surgery?
a)
Double the dose the day before to ensure glycaemic control.
b)
Omit the dose on the day of surgery and restart with the next scheduled dose post-operatively.
c)
Switch to a short-acting insulin infusion 24 hours prior.
d)
Take the dose with a small sip of water 2 hours before the procedure.
e)
No change is needed to her regular dosing schedule.
52.
A research study investigates how a GLP-1 receptor agonist contributes to weight loss beyond its glycaemic effects. What is a primary central mechanism by which semaglutide promotes reduced caloric intake?
a)
It directly increases basal metabolic rate.
b)
It causes malabsorption of dietary fat.
c)
It acts on receptors in the hypothalamus to increase satiety and reduce appetite.
d)
It blocks the reward pathways associated with food in the nucleus accumbens.
e)
It stimulates brown adipose tissue thermogenesis.
53.
A 50-year-old man with a BMI of 38 kg/m², obstructive sleep apnoea, and pre-diabetes has failed to achieve significant weight loss with supervised lifestyle interventions alone. Which medication is now licensed in the UK as an adjunct to lifestyle measures for chronic weight management in adults with this degree of obesity?
a)
Liraglutide 3.0 mg daily
b)
Metformin
c)
Orlistat
d)
Semaglutide 2.4 mg once weekly
e)
Topiramate
54.
A patient has just been started on a low dose of semaglutide. At the one-week review, they report persistent and troublesome gastrointestinal symptoms. Which of the following is the most common side effect experienced during the initiation and dose-escalation phase of semaglutide therapy?
a)
Constipation
b)
Hypoglycaemia (when used without insulin/sulfonylurea)
c)
Injection site reactions
d)
Nausea and vomiting
e)
Pancreatitis
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