Endocrine PP questions (Exam 1) Flashcards
1
Q
Insulin’s actions include all of the following EXCEPT:
A. Decreased conversion of amino acids to glucose
B. Increased protein synthesis
C. Increased glucose transport into cells
D. Inhibition of lipolysis
E. Stimulation of glycogenolysis
A
E. Stimulation of glycogenolysis
2
Q
A 24y/o woman with type 1 diabetes wishes to try tight control of her diabetes to improve her long-term prognosis. Which of the following insulin regimens would be most appropriate?
A. Morning injections of insulin lispro mixed with insulin aspart
B. Evening injections of regular insulin mixed with insulin glargine
C. Morning and evening injections of regular insulin with small amounts of NPH insulin at mealtimes
D. Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes
A
D. Morning injections of insulin glargine, supplemented by small amounts of insulin lispro at mealtimes
3
Q
Compared to NPH insulin, the main advantage of the recombinant insulin analogs glargine, detemir, and degludec is that they: A. Do not cause weight gain B. Cause less nocturnal hypoglycemia C. Have a more rapid peak D. All of the above
A
B. Cause less nocturnal hypoglycemia
4
Q
The inhaled form of insulin (Afrezza):
A. Has an earlier maximal effect than injected insulin lispro
B. Has a longer duration of action than injected insulin lispro
C. Does not cause hypoglycemia
D. All of the above
A
A. Has an earlier maximal effect than injected insulin lispro
5
Q
Which of the following statements is correct regarding insulin glargine? (multiple correct)
A. It is primarily used to control postprandial hyperglycemia
B. It is considered a “peakless” insulin
C. It is commonly used in a regimen with insulin lispro or insulin aspart
D. It may be administered intravenously in emergency cases.
A
B. It is considered a “peakless” insulin
C. It is commonly used in a regimen with insulin lispro or insulin aspart
6
Q
WD is 40y/o patient with type 2 DM who has a blood glucose of 400mg/dL today at his office visit. The PA would like to give some insulin to bring the glucose down before he leaves the office. Which of the following would lower the glucose in the quickest manner in WD? A. Insulin glargine B. NPH insulin C. Regular insulin D. Insulin lispro
A
D. Insulin lispro
7
Q
An unconscious patient wearing a diabetes alert bracelet is admitted to the ED. Blood sugar as measured by a glucometer was found to be very low. Before receiving stat lab results, which of the following is most likely to be immediately administered? A. Bicarbonate solution B. Dextrose solution 5% C. Hypotonic saline D. Normal saline E. Potassium chloride solution
A
B. Dextrose solution 5%
8
Q
An unconscious patient wearing a diabetes alert bracelet is admitted to the ED. Blood sugar as measured by a glucometer was found to be very HIGH and the patient has skin turgor suggestive of dehydration. Before receiving stat lab results and in addition to IV administration of rapid-acting insulin, which of the following is most likely to be immediately administered? A. Bicarbonate solution B. Dextrose solution 5% C. Hypotonic saline D. Normal saline E. Potassium chloride solution
A
D. Normal saline
9
Q
The target of drug therapy to DM2 is generally an A1C of less than: A. 6.8% B. 7.0% C. 7.2% D. 7.4%
A
B. 7.0%
10
Q
A 58y/o man with DM2 had a MI 12 years ago and is concerned about the effect of diabetes treatment on his heart disease. You could tell him that a number of the drugs used to treat diabetes have been associated with a lower risk of cardiovascular disease. These include: A. Metformin B. Liraglutide C. Empagliflozin D. All of the above
A
D. All of the above
11
Q
Metformin: A. Reduces A1C by 1.0-2.0% B. May decrease both microvascular and microvascular complications of diabetes C. Does not cause weight gain D. All of the above
A
D. All of the above
12
Q
Which of the following statements is characteristic of metformin?
A. Decreases pancreatic insulin release
B. Undergoes significant metabolism by the CYP450 system
C. Should not be combined with sulfonylureas or insulin
D. Most common adverse effects are GI in nature
A
D. Most common adverse effects are GI in nature
13
Q
A 54y/o obese patient with DM2 has a history of alcoholism. In this patient, metformin should be avoided or used with extreme caution because the combination of ethanol and metformin increases the risk of which of the following? A. Antabuse-like reaction B. Hypoglycemia C. Lactic acidosis D. Serious hepatotoxicity
A
C. Lactic acidosis
14
Q
Which of the following agents promotes the release of endogenous insulin? A. Acarbose B. Canagliflozin C. Glipizide D. Metformin E. Pioglitazone
A
C. Glipizide
15
Q
Sulfonylureas: A. Reduce A1C by 1-1.5% B. Increase the risk of stroke C. Do not cause weight gain D. All of the above
A
A. Reduce A1C by 1-1.5%
16
Q
The PPAR-y receptor that is activated by thiazolidinediones (pioglitazone) increases tissue sensitivity to insulin by which of the following mechanisms?
A. Activating adenylyl cyclase and increasing the intracellular concentration of cAMP
B. Inactivating a cellular inhibitor of the GLUT2 glucose transporter
C. Inhibiting acid glucosidase, a key enzyme in glycogen breakdown pathways
D. Regulating transcription of genes involved in glucose utilization
A
D. Regulating transcription of genes involved in glucose utilization
17
Q
GLP-1 receptor agonists (-tides): A. Reduce A1C by 0.5% B. Cause more weight gain than insulin C. Have been shown to increase the risk of MI D. Must be injected
A
D. Must be injected
18
Q
A 68y/o woman with a BMI of 35, systolic HTN, and DM2 has not achieved an A1C <8% on maximum doses of metformin and eventide. You are considering whether to start her on insulin of an SGLT2 inhibitor (-gliflozins). Factors that you might consider could include which of the following?
A. SGLT2 inhibitors cause weight loss
B. SGLT2 inhibitors reduce systolic BP
C. Empagliflozin has been found to reduce the risk of cardiovascular events
D. All of the above
A
D. All of the above
19
Q
A 55y/o menopausal woman was recently diagnosed with DM2 based on her fasting blood glucose levels. Her HbA1c levels average ~7% so that diet, exercise, and a single drug (monotherapy) may be sufficient to regulate her fasting glucose levels. Which of the following should be prescribed? A. Acarbose B. Dapagliflozin C. Insulin lispro D. Metformin E. Glipizide
A
D. Metformin
20
Q
Which of the following drugs is most likely to cause hypoglycemia when used as monotherapy in the treatment of DM2? A. Acarbose B. Canagliflozin C. Glyburide D. Insulin lispro E. Metformin
A
C. Glyburide
21
Q
Which of the following can cause hypovolemia, dehydration, and cause acute renal injury? A. Sulfonylureas B. DPP-4 inhibitors (-gliptins) C. SGLT2 inhibitors (-gliflozins) D. GLP1 receptor agonists (-tides)
A
C. SGLT2 inhibitors (-gliflozins)
22
Q
A 3y/o boy with failure to thrive and metabolic disturbances was found to have an inactivating mutation in the gene that encodes the growth hormone receptor. Which of the following drugs is most likely to improve his metabolic function and promote growth? A. Dopamine B. Bromocriptine C. Recombinant IGF D. Ocreotide E. Somatropin
A
C. Recombinant IGF
23
Q
A 3y/o girl was referred to the genetic counselor by her pediatrician. She presents with short stature (3 SDs below norm) and appears to have loose skin on her neck. Cytogenic testing reveals an XO karyotype (Turner’s syndrome). Which of the following drugs will allow her to achieve a higher adult height?
A. Growth hormone releasing hormone (GHRH)
B. Somatropin
C. Insulin-like growth factor (IGF)
D. Somatostatin
E. Bromocriptine
A
B. Somatropin
24
Q
All of the following drugs may be beneficial in the treatment of patients with acromegaly EXCEPT: A. Lancreotide B. Ocreotide C. Pegvisomant D. Somatostatin E. Somatropin
A
E. Somatropin
25
Regarding treatment of deficiencies and excesses of growth hormone:
A. Risk of Creutzfeldt-Jacob disease must be considered when using currently available GH preparations
B. Patients receiving cabergoline for acromegaly must be monitored for parkinsonian symptoms
C. For patients who choose not to have surgery for acromegaly, long-acting SST analogs are preferred over dopamine agonists
D. Patients initiating GH replacement therapy should be monitored for hypoglycemia
E. Use of GH for anti-aging properties has approval by the FDA
C. For patients who choose not to have surgery for acromegaly, long-acting SST analogs are preferred over dopamine agonists
26
```
A 27y/o women with amenorrhea, infertility, and galactorrhea was treated with a drug that successfully restored ovulation and menstruation. Before being given the drug, the woman was carefully questioned about previous mental health problems (which she had none). She was advised to take the drug orally. Which of the following drugs is most likely to be the drug given to this patient?
A. Dopamine
B. Ocreotide
C. Bromocriptine
D. Cabergoline
E. Prolactin
```
D. Cabergoline
27
True statement regarding the physiology and pharmacology of prolactin include:
A. Drugs used in the management of Parkinson's disease can cause hyperprolactinemia
B. Recombinant human prolactin (hPRL) is the treatment of choice for failure to lactate during pregnancy
C. Haloperidol can cause hypoprolactinemia
D. Dopamine agonists are useful in the medical treatment of prolactinomas
E. Cabergoline and bromocriptine use are associated with elevated BP and GI discomfort in some patients
D. Dopamine agonists are useful in the medical treatment of prolactinomas
28
```
A 42y/o woman developed a syndrome of polyuria, thirst, and hypernatremia after surgical removal of part of her pituitary gland. These signs and symptoms can be treated with which of the following?
A. Bromocriptine
B. Desmopressin
C. Ocreotide
D. Somatropin
E. Vasopressin
```
B. Desmopressin
29
```
Corticosteroids are useful in the treatment of all of the following disorders EXCEPT:
A. Adrenal gland crisis
B. Allergic rhinitis
C. Asthma
D. Congenital adrenal hyperplasia
E. Cushing's disease
F. Myasthenia Gravis
```
E. Cushing's disease
30
```
All of the following adverse effects are associated with glucocorticoid therapy EXCEPT:
A. Increased risk of infection
B. Hyperglycemia
C. Hypotension
D. Peripheral edema
E. Muscle wasting
```
C. Hypotension
31
Adverse effects of pharmacologic doses unlikely to be seen with dexamethasone but possible with prednisone include:
A. Secondary adrenal insufficiency resulting from block of pituitary ACTH release
B. Hyperglycemia
C. Hypokalemia
D. Centripetal obesity
E. Muscle wasting
C. Hypokalemia
32
```
A patient with Addison's disease is being treated with hydrocortisone (cortisol) but is still having problems with dehydration and hyponatremia. Which of the following drugs would be best to add to the patient's therapy?
A. Dexamethasone
B. Prednisone
C. Triamcinolone
D. Fludrocortisone
E. Dehydroepiandosterone (DHEA)
```
D. Fludrocortisone
33
Considerations for safe and effective use of corticosteroids in management of adrenal insufficiency include:
A. Prednisone requires hepatic activation and is only effective given via the oral route
B. High doses of fludrocortisone can result in hyperkalemia
C. Acute adrenal crisis requires volume repletion with NS, K+ supplementation, and high-dose IV hydrocortisone
D. Some men may require DHEA supplementation to improve mood and sense of well being
E. Hydrocortisone in once daily dosing is sufficient for most patients with Addison's disease
A. Prednisone requires hepatic activation and is only effective given via the oral route
34
The diagnosis of congenital adrenal hyperplasia (symptoms of virilizing hypotension) is confirmed in a child. This condition can be effectively treated by:
A. Administration of an androgen antagonist
B. Surgical removal of the adrenal gland
C. Administration of ketoconzaole to decrease cortisol
D. Administration of a glucocorticoid receptor agonist
E. Administration of a glucocorticoid receptor antagonist
F. Administration of ACTH
D. Administration of a glucocorticoid receptor agonist
35
```
A newborn girl exhibited ambiguous genitalia, hyponatremia, Hyperkalemia, and hypotension as a result of 21a hydroxyls activity. Treatment consisted of fluid and salt replacement and hydrocortisone administration. In this type of adrenal hyperplasia in which there is an excess production of cortisol precursors, which of the following describes the primary therapeutic effect of glucocorticoid administration?
A. Increased adrenal estrogen synthesis
B. Inhibition of aldosterone synthesis
C. Prevention of hypoglycemia
D. Recovery of normal immune function
E. Suppression of ACTH secretion
```
E. Suppression of ACTH secretion
36
Women who take combination oral contraceptives:
A. Have a higher risk of ovarian cancer
B. Have a higher risk of endometrial cancer
C. Have a reduced risk of both ovarian and endometrial cancer
D. Have a higher incidence of benign breast disease
C. Have a reduced risk of both ovarian and endometrial cancer
37
```
A 70y/o woman is being treated with raloxifene for osteoporosis. Which of the following is a concern with this therapy?
A. Breast cancer
B. Endometrial cancer
C. Hot flashes
D. Hypercholesterolemia
```
C. Hot flashes
38
A thin, dry vaginal lining and thin urethral mucosa can cause:
A. Vaginal and vulvar burning and irritation
B. Pain during intercourse
C. An increased risk of UTIs
D. All of the above
D. All of the above
39
```
The most effective treatment for vasomotor symptoms of menopause is:
A. Systemic estrogen
B. Low-dose vaginal estrogen
C. Ospemifene
D. Paroxetine
```
A. Systemic estrogen
40
```
Which of the following is recommended for women with genitourinary syndrome of menopause without vasomotor symptoms?
A. Oral estrogen
B. Low-dose vaginal estrogen
C. Oral progestin
D. Low-dose paroxetine
```
B. Low-dose vaginal estrogen
41
Which of the following would be appropriate for treatment of a 52y/o menopausal woman with an intact uterus and a history of venous thromboembolism who is complaining of severe hot flashes that are keeping her awake at night?
A. Transdermal estrogen/progestin
B. Ospemifene (SERM)
C. Conjugated estrogens/bazadoxifene (SERM)
D. Low-dose paroxetine
A. Transdermal estrogen/progestin
42
A 54y/o woman with severe hot flashes asks for advice about choosing treatments for menopausal vasomotor symptoms. You could tell her that:
A. Oral, transdermal, and vaginal formulations are all equally effective
B. Transdermal estrogens are probably as effective as oral estrogens
C. Vaginal estrogen products are as effective as transdermal products
D. All of the above are true
B. Transdermal estrogens are probably as effective as oral estrogens
43
Compounded personalized doses of bioidentical hormones are:
A. More effective than conjugated or fully synthetic hormones
B. Safer than conjugated or fully synthetic hormones
C. Not regulated by the FDA
D. All of the above
C. Not regulated by the FDA
44
You are planning to prescribe an oral estrogen for a 56y/o woman with menopausal vasomotor symptoms and an intact uterus and are considering whether to add a progestin. Which of the following statement about use of these hormones in this patient is true?
A. Taking an oral estrogen alone increases the risk of uterine cancer
B. Adding a progestin to oral estrogen decreases the risk of uterine cancer
C. Adding a progestin to oral estrogen may increase the risk of invasive breast cancer
D. All of the above
D. All of the above
45
```
Hyperkalemia is a possible side effect of:
A. Levonorgestrel
B. Medroxyprogestrone acetate
C. Desogestrel
D. Drospirenone
```
D. Drospirenone
46
Implants and intrauterine devices both:
A. Require no patient compliance
B. Provide long-term protection against pregnancy
C. Permit rapid return of fertility after removal
D. All of the above
D. All of the above
47
Which of the following women should NOT take a combination oral contraceptive?
A. 44y/o with a history of breast cancer
B. 37y/o who smokes
C. 30y/o with a history of VTE
D. All of the above
D. All of the above
48
```
A 26y/o female is using medroxyprogesterone acetate as a method of contraception. An adverse effect of concern with long-term use of this therapy is:
A. Hyperkalemia
B. Male pattern baldness
C. Osteoporosis
D. Weight loss
```
C. Osteoporosis
49
Medroxyprogesterone acetate:
A. Is injected once monthly
B. Commonly causes amenorrhea/irregular bleeding
C. Permits rapid return of fertility after the last injection
D. Causes irreversible bone loss in most women
B. Commonly causes amenorrhea/irregular bleeding
50
Lower dose oral contraceptives (<20mcg of ethinyl estradiol):
A. Have a lower incidence of adverse effects
B. Have a higher risk of failure
C. Have a higher risk of bleeding problems
D. All of the above
D. All of the above
51
```
Which of the following would be the most appropriate oral contraceptive for a patient with moderate acne? (multiple correct)
A. Ethinyl estradiol - levonorgestrel
B. Ethinyl estradiol - norethindrone
C. Ethinyl estradiol - desogestrel
D. Medroxyprogesterone
E. Ulipristal
```
A. Ethinyl estradiol - levonorgestrel
B. Ethinyl estradiol - norethindrone
C. Ethinyl estradiol - desogestrel (FDA approved for acne, so most commonly used)
52
Injectable contraceptives containing medroxyprogesterone:
A. Permit rapid return of fertility after stopping the injections
B. Are not recommended for women who want to become pregnant soon after stopping the injections
C. Are injected weekly
D. Increase bone mineral density
B. Are not recommended for women who want to become pregnant soon after stopping the injections
53
The most effective method of emergency contraception is:
A. Progestin-only emergency contraception pill
B. Ullipristal acetate (Ella)
C. Copper intrauterine device
D. Two doses 12 hours apart of a combination oral contraceptive
C. Copper intrauterine device
54
A drug or drug class that will uterine contractions and deliver the products of conception following interruption of an established pregnancy (<10 weeks gestation) with mifepristone is (are):
A. Oxytocin
B. CCB (nifedipine)
C. Prostaglandin analogs (misoprostol)
D. Cyclooxygenase inhibitors (indomethacin)
C. Prostaglandin analogs (misoprostol)
55
A pregnant woman presents at term for induction of labor. The best pharmacological approach would be:
A. Administration of PGE2 vaginal gel until the woman is in active labor
B. Administration of PGE2 vaginal gel with concurrent administration of IV oxytocin through an infusion pump
C. Administration of oxytocin IM
D. Administration of PGE2 vaginal gel until the cervix ripened followed in 6h by IV infusion of oxytocin if no labor occurs
D. Administration of PGE2 vaginal gel until the cervix ripened followed in 6h by IV infusion of oxytocin if no labor occurs
56
Select the clinical scenario the represents the SAFEST use of an analgesic or anti-inflammatory agent in the patient population described.
A. Treatment of osteoarthritis with acetaminophen in an alcoholic patient
B. Treatment of fever with aspirin in a 6y/o with chicken pox
C. Treatment of headache with acetaminophen in a woman in the 39th week of pregnancy
D. Treatment of RA with naproxen in a 50y/o male with peptic ulcers
C. Treatment of headache with acetaminophen in a woman in the 39th week of pregnancy
57
Which of the following is characteristic of the use of beta-2 agonists for promoting uterine relaxation?
A. No risk of cardiovascular side effects
B. No loss of effectiveness caused by tachyphylaxis
C. Risk of maternal hypoglycemia
D. Risk of fetal hypoglycemia
D. Risk of fetal hypoglycemia
58
A 33y/o pregnant woman presents to her physician with tendinitis of the left shoulder. The patient had been taking NSAIDs, but developed several gastric ulcers with her long-term use. A medication can be used that acts in the prostaglandin pathway and will reduce the incidence of NSAID-induced ulcers. However, this medication is pregnancy category X for causing which of the following adverse events?
A. Premature closing of ductus arterioles
B. Neural tube defects
C. Risk of fetal hypotension
D. Induction of labor
D. Induction of labor
The drug is misoprostol
59
```
The double-blind, placebo-controlled clinical trials that evaluated the efficacy of testosterone replacement therapy in men >65y/o found that the hormone produced the greatest improvement in:
A. Sexual function
B. Physical function
C. Vitality
D. Mood
```
A. Sexual function
60
```
Symptoms related specifically to androgen deficiency in aging males include: (multiple correct)
A. Fatigue
B. Increased fat
C. Low libido
D. Depression
E. Low bone mineral density
```
C. Low libido
| E. Low bone mineral density
61
```
Which of the following natural or synthetic steroids has both anabolic activity and androgenic activity in humans?
A. Testosterone
B. Methyltestosterone
C. Oxandrolone
D. Nandrolone
E. Stanozolol
F. All of the above
```
F. All of the above
62
```
Adverse effects associated with androgen use can include all of the following EXCEPT: (multiple correct)
A. Anemia
B. Decreased spermatogenesis
C. Testicular enlargement
D. Prostate enlargement
E. Gynecomastia
F. Hepatotoxicity
```
A. Anemia
| C. Testicular enlargement
63
```
Which of the following therapeutic approaches would NOT be useful in the treatment of prostate cancer?
A. Continuous GnRH agonist
B. Androgen receptor antagonist
C. GnRH antagonist
D. Pulsatile GnRH agonist
E. All of the above
```
D. Pulsatile GnRH agonist
64
Which of the following best describes how a1-adrenergic antagonists (tamsulosin) improves urinary flow?
A. Decreases urine production
B. Decreases the resistance of the urethral sphincter
C. Promotes relaxation of the detrusor muscle
D. Reduces formation of dihydrotestosterone
B. Decreases the resistance of the urethral sphincter
65
```
A common problem with alpha-blockers is:
A. Injection site reactions
B. Rash including Stevens-Johsnon
C. Dizziness, orthostatic hypotension
D. Edema
```
C. Dizziness, orthostatic hypotension
66
Finasteride has efficacy in the prevention of male-pattern baldness by virtue of its ability to:
A. Competitively antagonize androgen receptors
B. Decrease the release of gonadotropins
C. Increase the serum concentration of sex hormone-binding globulin (SHBG)
D. Reduce the production of dihydrotestosterone
D. Reduce the production of dihydrotestosterone
67
A 60y/o man is found to have a prostate lump and an elevated PSA. MRI suggests several enlarged lymph nodes in the lower abdomen, and an x-ray reveals 2 radiolucent lesions in the bony pelvis. This patient is likely to be treated with which of the following drug classes? (multiple correct)
A. Aromatase inhibitors (letrozole)
B. Progestin (desogestrel)
C. Androgen receptor antagonist (bicalutamide)
D. Testosterone analog (oxandrolone)
E. GnRH analog (depo leuprolide)
C. Androgen receptor antagonist (bicalutamide)
| E. GnRH analog (depo leuprolide)
68
```
When women with hypothyroidism become pregnant, they generally should take how many additional doses per week?
A. 2
B. 3
C. 4
D. 6
```
A. 2
69
```
Starting dose of T3 depends on:
A. TSH levels
B. Free T4 levels
C. Age and cardiac risk factors
D. All of the above
```
D. All of the above
70
```
When initiating T4 therapy for an elderly patient with long-standing hypothyroidism, it is important to begin with small doses to avoid which of the following?
A. Flare-up of exophthalmos
B. Acute renal failure
C. Hemolysis
D. Overstimulation of the heart
E. Seizures
```
D. Overstimulation of the heart
71
Relative to levothyroxine (T4), triiodothyronine (T3):
A. Has lower oral bioavailability
B. Has a longer duration of action
C. Has a greater affinity for thyroid hormone receptors
D. Is required for most patients to adequately reduce symptoms of hypothyroidism
E. Is less expensive
C. Has a greater affinity for thyroid hormone receptors
72
```
Thyroid USP:
A. Is prepared from human thyroid tissue
B. Contains more T3 than T4
C. Can produce supra physiologic levels of T3
D. All of the above
```
C. Can produce supra physiologic levels of T3
73
```
Resolution of symptoms of hypothyroidism usually begins how long after start LT4?
A. 2-3 days
B. 2-3 weeks
C. 2-3 months
D. 4-6 months
```
B. 2-3 weeks
74
```
Clinical resolution of thyrotoxicosis usually begins how long after starting a thionamide?
A. 2 days
B. 2 weeks
C. 1 month
D. 4-8 weeks
E. 2 months
```
B. 2 weeks
75
Clinical considerations in medical management of Graves disease include:
A. More rapid achievement of euthyroid state with PTU vs methimazole
B. Possibility of life-threatening hepatotoxicity with PTU
C. Thionamides are more effective in patients with low uptake (RAIU)
D. Methimazole has greater binding to plasma proteins than PTU and is safer for use in pregnant patient
B. Possibility of life-threatening hepatotoxicity with PTU
76
A 24y/o woman was found to have mild hyperthyroidism due to Graves disease, and it is decided to begin treatment with methimazole. Methimazole reduces serum concentrations of T3 primarily by:
A. Accelerating the peripheral metabolism of T3
B. Inhibiting the proteolysis of thyroglobulin
C. Inhibiting the secretion of TSH
D. Inhibiting the uptake of iodide by cells in the thyroid
E. Preventing the addition of iodine to tyrosine residues on thyroglobulin
E. Preventing the addition of iodine to tyrosine residues on thyroglobulin
77
```
The most widely used treatment for hyperthyroidism in the US is:
A. Antithyroid drugs
B. Radioactive iodine
C. Thyroidectomy
D. None of the above
```
B. Radioactive iodine
78
```
A 56y/o woman presented to the ED with tachycardia, SOB, and chest pain. She had SOB and diarrhea for the last 2 days and was sweating and anxious. A relative reported that the patient had run out of methimazole 2 weeks earlier. A TSH measurement revealed a value of <0.01 (nl: 0.4-4.0) and a diagnosis of thyroid storm was made. Which of the following is a drug that is a useful adjuvant in the treatment of thyroid storm? (multiple correct)
A. Amiodarone
B. Epinephrine
C. Propranolol
D. Radioactive iodine
E. Hydrocortisone
```
C. Propranolol
| E. Hydrocortisone
79
```
Multiple medication are utilized in the management of thyroid storm. Which agent is most effective in blocking the release of preformed thyroid hormone from the gland?
A. Metoprolol
B. Potassium iodide
C. Propranolol
D. Propylthiouracil
```
B. Potassium iodide
80
```
The usual daily full replacement dose of levothyroxine is:
A. 25-50mcg
B. 50-100mcg
C. 100-125mcg
D. 250mcg
```
B. 50-100mcg
81
```
Levothyroxine should be taken:
A. With the evening meal
B. With breakfast
C. One hour before breakfast
D. With or without food
```
C. One hour before breakfast
82
```
Drugs that interfere with the absorption of levothyroxine include:
A. Bile acid sequestrants
B. Calcium
C. Iron
D. All of the above
```
D. All of the above
83
Compared to levothyroxine, liothyronine:
A. Is less completely absorbed
B. Has a longer half-life
C. Shows marked fluctuations in plasma levels
D. All of the above
C. Shows marked fluctuations in plasma levels
84
```
Adverse effects of LT4 are usually caused by:
A. Undertreatment
B. Overtreatment
C. Allergy
D. Renal disease
```
B. Overtreatment
85
```
T4-T3 combination therapy may be beneficial for patients with:
A. Diminished renal function
B. Severe hypothyroidism
C. No health insurance
D. A genetic polymorphism
```
D. A genetic polymorphism
86
```
Which of the following is true of methimazole?
A. It has a long duration of action
B. It inhibits conversion of T4 to T3
C. It can only be taken orally
D. All of the above
```
A. It has a long duration of action
87
```
Which of the following is true of PTU?
A. It can be given once orally
B. It is more toxic than methimazole
C. It does not cause hepatotoxicity
D. None of the above
```
B. It is more toxic than methimazole
88
```
Which of the following drugs is routinely added to calcium supplements and mil for the purpose of preventing rickets in children and osteomalacia in adults?
A. Cholecalciferol - D3
B. Calcitriol
C. Calcitonin
D. Dihydrotachysterol
E. Fluroide
```
A. Cholecalciferol - D3
89
```
The recommended serum level of >30 ng/mL of 25(OH)D can generally be achieved by taking daily vitamin D dosage of:
A. 600-800 IU
B. 1000-2000 IU
C. 10,000-20,000 IU
D. 25,000-50,000 IU
```
B. 1000-2000 IU
90
Which of the following statements about calcium supplementation in postmenopausal women with osteoporosis is true?
A. Eating 8 ounces of yogurt provides almost half of the recommended amount of daily calcium
B. There is no convincing evidence that taking a calcium and vitamin D supplement reduces the risk of fracture
C. Calcium supplements can cause constipation, intestinal bloating, and gas
D. All of the above
D. All of the above
91
The active metabolites of vitamin D act through a nuclear receptor to produce which of the following effects?
A. Decrease the absorption of calcium from bone
B. Increase PTH formation
C. Increase renal production of erythropoietin
D. Increase the absorption of calcium from the GI tract
E. Lower the serum phosphate concentration
D. Increase the absorption of calcium from the GI tract
92
```
Side effects associated with the use of calcitriol (activated D3) in the treatment of hyperparathyroidism include:
A. Erosive esophagitis
B. Thromboembolic disorders
C. Hypocalcemia
D. Endometrial cancer
E. Kidney stones
```
E. Kidney stones
93
```
A 58-year-old postmenopausal woman was sent for dual-energy x-ray absorptiometry to evaluate bone mineral density of her lumbar spine, femoral neck, and total. Test results revealed low bone density in all sites. Chronic use of which of the following medications is most likely to have contributed to this woman’s osteoporosis?
A. Atorvastatin
B. Metformin
C. Fludrocortisone
D. Methimazole
E. Prednisone
```
E. Prednisone
94
```
OP is a 65-year-old female who has been diagnosed with postmenopausal osteoporosis. She has no history of fractures and no other pertinent medical conditions. Which of the following would be most appropriate for management of her osteoporosis?
A. Calcitonin
B. Denosumab
C. Raloxifene
D. Teriparatide
E. Alendronate
```
E. Alendronate
95
```
A patient has begun therapy with risedronate (Actonel), a bisphosphonate, and was advised to drink large quantities of water with the tablets and remain in an upright position for at least 30 minutes and until eating the first meal of the day. These instructions are given to reduce the risk of:
A. Osteonecrosis of the jaw
B.Diarrhea
C. Constipation
D. Erosive esophagitis
E. Duodenal ulcers
```
D. Erosive esophagitis
96
```
Which of the following agents used in the treatment of osteoporosis will promote bone deposition at low intermittent levels but increase bone resorption at higher sustained levels?
A. Alendronate
B. Calcitonin
C. Calcitriol
D. Estrogen
E. Teriparatide
```
E. Teriparatide
97
Parathyroid hormone analogs:
A. Are injected once monthly
B. Have not been shown to reduce the risk of vertebral fractures
C. Should not be used for more than 2 years in the patient’s lifetime
D. All of the above
C. Should not be used for more than 2 years in the patient’s lifetime
98
Denosumab differs from bisphosphonates in that it:
A. Reduces bone resorption
B. Is injected subcutaneously
C. Has been associated with atypical femoral fractures
D. Reduces the risk of vertebral, hip, and other nonvertebral fractures
B. Is injected subcutaneously
99
The selective estrogen receptor modulator (SERM) raloxifene:
A. Has not been shown to reduce the risk of vertebral fractures
B. Increases the risk of venous thromboembolic events
C. Increases the risk of breast cancer
D. All of the above
B. Increases the risk of venous thromboembolic events
100
Romosozumab:
A. Is injected subcutaneously once daily
B. Has not been associated with atypical femoral fractures
C. Should not be used in patients who had a myocardial infarction or stroke within the previous year
D. All of the above
C. Should not be used in patients who had a myocardial infarction or stroke within the previous year
