Quiz: Pharmacology

Questions 1-3. A 24-year-old woman was found to have mild hyperthyroidism due to Graves' disease. She appears to be in good health otherwise. 1. In Graves’disease, the cause of the hyperthyroidism is the production of an antibody that does which of the following?

A A) Activates the pituitary thyrotropin-releasing hormone(TRH) receptor andstimulates TSH release B (B) Activates the thyroid gland TSH receptor and stimulates thyroid hormone synthesis and release. C (C) Activates thyroid hormone receptors in periphera D D) Binds to thyroid gland thyroglobulin and accelerates its proteolysis and the release of its supply of T4 and T3

2. The decision is made to begin treatment with methimazole. Methimazole reduces serum concentration of T3 primarily by which of the following mechanisms?

A (A) Accelerating the peripheral metabolism of T3 B (B) Inhibiting the proteolysis of thyroid-binding globulin C (C) Inhibiting the secretion of TSH D (E) Preventing the addition of iodine to tyrosine residues on thyroglobulin

3-Though rare, a serious toxicity associated with the thioamides is which of the following?

A (A) Agranulocytosis B (B) Lupus erythematosus-like syndrome C (C) Myopathy D (D) Torsades de pointes arrhythmia

4-. A 65-year-old man with multinodular goiter is scheduled for a near-total thyroidectomy. Which of the following drugs will be administered for 10-14 d before surgery to reduce the vascularity of his thyroid gland?

A (A) Levothyroxine B (B) Liothyronine C (C) Lugol's solution D (D) Prednisone

5-Which of the following is a sign or symptom that would be expected to occur in the event of chronic overdose with exogenous T4?

A (A) Bradycardia B (B) Dry, puffy skin C (C) Large tongue and drooping of the eyelids D (E) Weight loss

6- When initiating T4 therapy for an elderly patient with longstanding hypothyroidism, it is important to begin with small doses to avoid which of the following?e-up of exophthalmos

A (A) A flaree-up of exophthalmos B (B) Acute renal failure C (C) Hemolysis D (D) Overstimulation of the heart

7-A 27-year-old woman underwent near total thyroidectomy. She was started on levothyroxine. What hormone is produced in the peripheral tissues when levothyroxine is administered?

A (A) Methimazole B (B) T3 C (C) T4 D (D) TSH

8-A 25-year-old woman presents with insomnia and fears she may have "something wrong with her heart." She describes "her heart jumping out of her chest." She feels healthy otherwise and reports she has lots of energy. Lab tests confirm hyperthyroidism. Which of the following is a drug that produces a permanent reduction in thyroid activity?

A (A) 1311 B (B) Methimazole C (C) Propylthiouracil D (D) Thiocyanate (SCN-)

9-The treatment of myxedema coma can include which of the following agents?

A a. Thyroglobulin B b. Levothyroxine C c. Lithium D d. Propylthiouracil (PTU)

10-A 40-year-old male with a symmetrically enlarged thyroid gland associated with elevated levels of T3 and T4 is treated with PTU. What is the principal mechanism of action of PTU?

A a. Iodide transport into the cell B b. Release of T4 and T3 to the blood C c. Inhibition of thyroidal peroxidase D d. Inhibition of proteolysis of thyroglobulin

11-A 35-year-old male with primary adrenal insufficiency would best be treated with which of the following?

A a. Mifepristone B b. Methandrostenolone C c. Misoprostol D e. Fludrocortisone

12-A 37-year-old female with Graves' disease who requires antithyroid therapy becomes pregnant. Which antithyroid drug is safest?

A a. Potassium iodide (KI) B b. Methimazole C c. PTU D d. Potassium perchlorate (KCIO4)

13-A 36-year-old male has had a thyroidectomy and now requires maintenance therapy. Which of the following is the drug of choice?

A A.the WHO B b. PTU C c. Triiodothyronine D d. T4

14-A patient becomes markedly tetanic following a recent thyroidectomy.This symptom can be rapidly reversed by the administration of

A a. Vitamin D B b. Calcitonin C d. Plicamycin (mithramycin) D e. Calcium gluconate (CaG

5. Chronic use of which of the following medications is most likely to have contributed to this woman's osteoporosis?

A (A) Lovastatin B (B) Metformin C (C) Prednisone D (D) Propranolol

6-. If this patient began oral therapy with alendronate, she would be advised to drink large quantities of water with the tablets and remain in an upright position for at least 30 min and until eating the first meal of the day. These instructions would be given to decrease the risk of which of the following?

A (A) Cholelithiasis B (B) Diarrhea C (C) Constipation D (D) Erosive esophagitis

7-. A 54-year-old man with advanced tuberculosis has developed signs of severe acute adrenal insufficiency. The patient should be treated immediately. Which of the following combinations is most rational?

A (A) Aldosterone and fludrocortisone B (B) Cortisol and fludrocortisone C (C) Dexamethasone and metyrapone D (D) Fludrocortisone and metyrapone

18-A 60-year-old male presents with severe hyperthyroidism and multinodular goiter. It was decided to treat him with 1311. The most appropriate course of treatment would be:

A A. Immediate 1311 dosing with no other drug before or after B B. Propranolol for 1 week followed by 1311 C C. Propranolol carbimazole till severe thyrotoxicosis is controlled-1 week gap-1311-resume carbimazole after 1 week for 2-3 months D D. Propranolol + Lugol's iodine for 2 weeks 1311-continue Lugol's iodine for 2-3 months-

19-In the treatment of hyperthyroidism, carbimazole has the following advantage over radioactive iodine:

A A. Cost of treatment is lower B B. It is preferable in uncooperative patient C C. It is better tolerated by the patients D D. Hypothyroidism when induced is reversible

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