Endo – Pharmacology

Endocrinology

Endo – Pharmacology

Compiled Questions from Modular + Annual Exams on Endo – Pharmacology

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Which class of drugs has the strongest evidence for reducing LDL cholesterol and cardiovascular events, especially in patients with diabetes?

1 / 81

Tags: 2019

A 50-year-old male with Diabetes Mellitus comes to the clinic for a regular medical checkup. On examination, the patient has a BMI of 29, bilateral and yellow plaques on the eyelids. The physician orders a lipid panel to check for blood levels of LDL-C and triglycerides. If reports show an increase in LDL-C, which of the following drugs should the patient be started on?

Alirocumab

Bezafibrate

Fenofibrate

Ezetimibe

Atorvastatin

Think carefully about which condition results from the absence of a natural hormone and would therefore benefit from its replacement. Which one among the options reflects a problem of water imbalance rather than sugar, airways, or heart rate?

2 / 81

Tags: 2016

In which of the following conditions is vasopressin indicated?

Hypertension

Bronchospasm

Tachycardia

Central diabetes insipidus

Diabetes mellitus

Vasopressin, also known as antidiuretic hormone (ADH), is a hormone synthesized in the hypothalamus and secreted by the posterior pituitary gland. It plays a crucial role in water reabsorption in the kidneys and vascular tone regulation.

There are two major types of vasopressin receptors:

V1 receptors: found in vascular smooth muscle — cause vasoconstriction.
V2 receptors: found in the kidneys — stimulate insertion of aquaporin-2 channels in the collecting ducts, leading to increased water reabsorption and concentrated urine.

✅ Why the Correct Option is Right:

Central diabetes insipidus is caused by a deficiency of vasopressin (either due to damage to the hypothalamus or the posterior pituitary). The hallmark symptom is polyuria (excessive urination) with dilute urine, leading to polydipsia (excessive thirst) and a risk of dehydration and hypernatremia.

Because central DI results from low or absent ADH, vasopressin replacement (or its synthetic analog desmopressin) is the treatment of choice. Administering vasopressin compensates for the hormone deficiency, reducing urine output and restoring fluid balance.

❌ Why the Other Options Are Wrong:

Bronchospasm
Bronchospasm is typically treated with bronchodilators like β2-agonists (e.g., salbutamol). Vasopressin has no role in bronchodilation and may worsen conditions by causing vasoconstriction that could reduce perfusion.
Diabetes mellitus
This is a glucose metabolism disorder, not related to ADH. The confusion may stem from the similar names (“diabetes insipidus” vs. “diabetes mellitus”), but their causes and treatments are entirely different. Vasopressin has no role in managing blood glucose.
Tachycardia
Although vasopressin can increase blood pressure by vasoconstriction (via V1 receptors), it does not directly treat tachycardia. In fact, by increasing afterload and blood pressure, it could potentially worsen certain types of tachycardia. Management of tachycardia depends on its cause and may involve beta-blockers, vagal maneuvers, or antiarrhythmics, not vasopressin.
Hypertension
Vasopressin causes vasoconstriction, which can raise blood pressure, so it is contraindicated in hypertension. Administering vasopressin here could worsen the condition, not improve it.

Which drug on this list is known to contain a high level of iodine and directly interferes with thyroid hormone synthesis and metabolism — often used in cardiac care?

3 / 81

Tags: 2019

Which of the following drugs can cause drug-induced hypothyroidism?

Aspirin

Nivolumab

Alemtuzumab

Amiodarone

Pembrolizumab

Hypothyroidism can occur as a side effect of several medications, but Amiodarone is a particularly important drug to recognize for its thyroid-related toxicity.

📌 Why Amiodarone Causes Hypothyroidism:

Amiodarone is a class III antiarrhythmic drug used to treat ventricular and supraventricular arrhythmias.

It affects the thyroid through multiple mechanisms:

High Iodine Content:
- Amiodarone contains about 37% iodine by weight, and each 200 mg tablet delivers ~75 mg of iodine, which is hundreds of times the daily recommended intake.
- This iodine load can cause Wolff-Chaikoff effect — an acute inhibition of thyroid hormone synthesis due to excess iodine.
Inhibition of Peripheral Conversion:
- Amiodarone inhibits 5′-deiodinase, reducing conversion of T4 to active T3, further contributing to hypothyroidism.
Direct Cytotoxicity:
- It can directly damage thyroid follicular cells.

💡Note: Interestingly, Amiodarone can also cause hyperthyroidism, particularly in iodine-deficient areas (called Amiodarone-induced thyrotoxicosis), but hypothyroidism is more common in iodine-sufficient regions.

❌ Explanation of Incorrect Options:

Nivolumab
🔴 A checkpoint inhibitor (PD-1 antagonist) used in cancer immunotherapy. It can cause thyroid dysfunction, usually transient thyroiditis leading to hyperthyroidism, then hypothyroidism — but this is less common and immune-mediated, not a direct pharmacologic effect like Amiodarone.
Alemtuzumab
🔴 A monoclonal antibody used in MS and certain leukemias. It may cause autoimmune thyroid disease, but hypothyroidism is not its most consistent effect, and not through direct thyroid toxicity.
Aspirin
🔴 Does not cause hypothyroidism. In fact, high doses can displace thyroid hormone from binding proteins, temporarily increasing free T4.
Pembrolizumab
🔴 Like Nivolumab, it’s a PD-1 inhibitor. It may cause immune-related thyroiditis, but again, this is autoimmune and less predictable.

To treat a condition caused by excess of a hormone that’s normally kept in check by dopamine, what class of drug would you use — one that blocks dopamine, or one that mimics it?

4 / 81

Tags: 2018

First-line therapy for prolactinoma is:

Octreotide
Metoclopramide
Acetazolamide
Dorzolamide
Bromocriptine

Dorzolamide

Bromocriptine

Octreotide

Metoclopramide

Acetazolamide

Consider which anti-thyroid drug can lead to a serious side effect involving the bone marrow, resulting in low white blood cell count. This condition can present suddenly with sore throat and fever, making it a medical emergency.

5 / 81

Tags: 2017

Which of the following anti-thyroid drug is responsible for causing sore throat with fever? Total leukocyte count is also low.

Levothyroxine

Radio iodine

Methimazole

Liothyronine

Propylthiouracil

Option	Why It’s Incorrect
Propylthiouracil	❌ Can also cause agranulocytosis, but methimazole is the more common culprit. Propylthiouracil is also associated with liver toxicity.
Levothyroxine	❌ Thyroid hormone replacement, not an anti-thyroid drug. It does not cause agranulocytosis.
Radioiodine	❌ Can lead to hypothyroidism or thyroiditis, but does not cause agranulocytosis.
Liothyronine	❌ A synthetic T3 preparation used for hypothyroidism or myxedema coma—not related to WBC suppression.

If the body can’t hold onto water because of a missing hormone, what kind of replacement would restore that function?

6 / 81

Tags: 2020

In which of the following conditions is vasopressin indicated?

Hypertension

Central diabetes insipidus

Tachycardia

Diabetes mellitus

Bronchospasm

This patient’s bone density is not yet in the osteoporosis range, but her medication history puts her at high risk for fractures — which treatment would directly prevent bone resorption?

7 / 81

Tags: 2023

A 65-year-old woman came to the clinic. She has been on oral steroids for chronic obstructive pulmonary disease (COPD) and had a DEXA scan showing a T score of -1.8. Which of the following would be the best management?

All of these

Calcium and vitamin D supplements

Abaloparatide

Raloxifene

Alendronate

Think about how thyroid hormones are synthesized—what steps occur before T3 and T4 are formed? Where would a drug intervene to reduce the production of active thyroid hormones without blocking their release?

8 / 81

Tags: 2019

Which of the following is the effect of propylthiouracil on thyroid hormone?

Inhibit T3 release from thyroglobulin

Hyper activates Na-I symporter

Inhibits oxidation of iodide and coupling of iodine

Inactivates thyroglobulin

Hypertrophy of thyroid follicles

Think about what “basal glucose control” implies:

Constant: It needs to work steadily, without big ups and downs.
24-hour: It needs to last a full day or close to it.
No pronounced peak: This is key, as a peak would mean a higher risk of hypoglycemia at that point, which is undesirable for background control.

9 / 81

Tags: 2024

A patient with diabetes mellitus is prescribed an insulin preparation designed to provide consistent 24-hour basal glucose control with no pronounced peak. Which of the following insulin types has this pharmacokinetic profile?

Glargine

NPH insulin

Lispro

Glulisine

Aspart

Insulin Type	Onset	Peak	Duration	Category
Lispro	~15 min	0.5–1.5 hrs	3–4 hrs	Rapid-acting ❌
Aspart	~15 min	1–3 hrs	3–5 hrs	Rapid-acting ❌
Glulisine	~15–30 min	1–2 hrs	3–5 hrs	Rapid-acting ❌
NPH	~1–2 hrs	4–10 hrs	12–18 hrs	Intermediate ❌
Glargine	~1–2 hrs	No real peak	~24 hrs	Long-acting ✅

Think about why certain drugs are preferred for long-term management: Would a medication that needs conversion and has a long duration be more useful for stability — or a fast-acting one with a short duration?

10 / 81

Tags: 2016

Which of the following is inappropriate about levothyroxine?

Lower initial doses are administered in older patients with longstanding myxedema

It is slower acting than liothyronine

It has a short half-life

It has longer half life than liothyronine

It is usually the first form of choice in patients with hypothyroidism

When asked about enzyme inhibition by glucocorticoids, think:
What’s the earliest enzyme in the inflammation pathway?
Block that, and you block everything downstream.

11 / 81

Tags: 2016

Which of the following enzymes is inhibited by glucocorticoids?

Xanthine oxidase

Phospholipase A2

Cyclooxygenase

5-lipooxygenase

Histidine decarboxylase

Consider where in the body carbohydrates are broken down before they can be absorbed. Think about enzymes involved in the final steps of carbohydrate digestion. How might blocking these enzymes help control post-meal blood sugar spikes?

12 / 81

Tags: 2017

Which drug inhibits glucose absorption in the small intestine?

Insulin aspart

Exogenous glucose

Glucosidase inhibitor

Metformin

Rosiglitazone

Glucosidase inhibitors are a class of oral antidiabetic drugs that specifically target the small intestine to inhibit carbohydrate absorption.

How do they work?

Alpha-glucosidase enzymes, located in the brush border of the small intestine, are responsible for breaking down complex carbohydrates (starches, disaccharides) into simple sugars (glucose) for absorption.
Glucosidase inhibitors (e.g., Acarbose, Miglitol) block these enzymes, delaying carbohydrate digestion.
As a result, glucose absorption is slowed down, leading to a blunted postprandial (after-meal) rise in blood sugar levels.

This mechanism is especially helpful in managing postprandial hyperglycemia in type 2 diabetes mellitus.

Clinical effect:

Decreases post-meal blood glucose peaks
Minimal risk of hypoglycemia when used alone
Common side effects: flatulence, bloating, and diarrhea (due to undigested carbs fermenting in the colon)

Why the Other Options Are Incorrect:

Metformin

Metformin is a biguanide that works by:
- Inhibiting hepatic gluconeogenesis (decreasing liver glucose production)
- Increasing insulin sensitivity in peripheral tissues
It does not inhibit intestinal glucose absorption directly, although it may mildly reduce glucose uptake from the gut in some cases—but this is not its primary mechanism.

Insulin aspart

Insulin aspart is a rapid-acting insulin analog that helps lower blood sugar by:
- Promoting glucose uptake into cells
- Suppressing hepatic glucose output
It does not affect intestinal glucose absorption.

Rosiglitazone

Rosiglitazone is a thiazolidinedione (TZD).
It works by activating PPAR-γ receptors, which increase insulin sensitivity in adipose tissue and muscle.
It has no effect on glucose absorption in the intestine.

Exogenous glucose

Exogenous glucose refers to glucose given orally or intravenously.
It raises blood glucose levels; it is not a drug that inhibits glucose absorption.

Think about which medication not only reduces thyroid hormone production but also carries a known risk of serious bone marrow suppression.

13 / 81

Tags: 2023

A patient who is taking antithyroid drugs for hyperthyroidism develops sore throat and fever. Her total leukocyte count is low. Which of the following drugs is she most likely taking?

Propranolol

Radioactive iodine

Nadolol

Methimazole

Digoxin

Consider how the body naturally regulates blood glucose after meals. There are incretin hormones (like GLP-1) that help stimulate insulin release and suppress glucagon, but they are rapidly broken down by a specific enzyme. Sitagliptin works by targeting this enzyme. What is that enzyme?

14 / 81

Tags: 2017

What is the mechanism of action of sitagliptin?

SGLT2 inhibitor

GLP-1 receptor agonist

DPP-4 inhibitor

PPARγ agonists

Alpha-glucosidase inhibitor

Option	Why It’s Incorrect
PPARγ agonists	❌ These are thiazolidinediones (e.g., pioglitazone), which increase insulin sensitivity, not inhibit DPP-4.
SGLT2 inhibitor	❌ These drugs (e.g., empagliflozin) block renal glucose reabsorption, causing glucose loss in urine, not affecting incretins.
Alpha-glucosidase inhibitor	❌ These drugs (e.g., acarbose) delay carbohydrate absorption in the intestine, unrelated to incretin pathways.
GLP-1 receptor agonist	❌ Drugs like exenatide and liraglutide mimic GLP-1, but sitagliptin prolongs natural GLP-1 action by inhibiting DPP-4.

Consider which drug group is known for causing widespread metabolic changes, including increased appetite, altered fat distribution, and fluid retention — often prescribed for inflammation or autoimmune conditions.

15 / 81

Tags: 2019

While prescribing which one of the following drugs should physicians be aware that it might cause weight gain?

Topiramate

Steroids

Fluoxetine

Antibiotics

Aspirin

If you give too much of a hormone that increases metabolism, which system in the body is likely to show early signs of being over-revved?

16 / 81

Tags: 2018

What are the side effects of levothyroxine?

Tachycardia

Nephropathy

Neuropathy

Myocardial infarction

Vision loss

System	Effect
Cardiovascular	Tachycardia, palpitations, arrhythmia, angina, AFib, even MI in elderly with heart disease
CNS	Anxiety, irritability, insomnia
GI	Diarrhea, increased appetite
Musculoskeletal	Tremors, heat intolerance
Metabolic	Weight loss, sweating

Which class of drugs helps reduce blood glucose by acting on the kidneys, not the pancreas or liver?

17 / 81

Tags: 2023

Empagliflozin belongs to which class of drugs?

Biguanides

Sodium-glucose co-transporter 2 inhibitor

DPP 4 inhibitor

GLP 1 agonist

Sodium-glucose co-transporter 1 inhibitor

What would your brain and adrenal glands do if you were constantly taking high doses of hormones that they normally try to produce?

18 / 81

Tags: 2022

Which of the following results will the reports show in a 35-year-old patient taking pharmacological doses of steroidal antiinflammatory drugs for asthma?

High CRH, high cortisol

Low CRH, low cortisol

Low CRH, high cortisol

High CRH, low cortisol

High ACTH, low cortisol

Among the options, which one would be useful if you needed a moderately quick effect without the extreme speed of a meal-time insulin — something you might use before a meal but not immediately before?

19 / 81

Tags: 2018

Which of the following insulin preparations is short-acting insulin?

Glulisine

Detemir

Aspart

Regular insulin

Lispro

Type	Onset	Peak	Duration	Examples
Rapid-acting	~15 mins	30–90 mins	3–5 hours	Lispro, Aspart, Glulisine
Short-acting	30–60 mins	2–4 hours	5–8 hours	Regular insulin
Intermediate-acting	1–2 hrs	4–12 hours	12–18 hours	NPH (Isophane insulin)
Long-acting	1–2 hrs	Minimal peak	Up to 24 hours	Detemir, Glargine, Degludec

If a patient presents with overstimulation of every parasympathetic system—salivating, sweating, urinating, and slowing their heart—what class of chemicals might be the culprit, and how can we regenerate the enzyme they’ve blocked?

20 / 81

Tags: 2020

A 12-year-old boy is found in a closed room with increased salivation from the mouth and sweating profusely. His pulse is 50 beats/minute and blood pressure is 100/60 mm Hg. Which of the following is the most appropriate antidote?

Warfarin

Propranolol

Vitamin K

Pralidoxime

Flumezanil

Symptom	Mechanism
D – Diarrhea	Muscarinic
U – Urination	Muscarinic
M – Miosis	Muscarinic
B – Bradycardia	Muscarinic
B – Bronchorrhea	Muscarinic
E – Emesis	Muscarinic
L – Lacrimation	Muscarinic
S – Salivation	Muscarinic
S – Sweating	Muscarinic

Option	Why Incorrect
Vitamin K	Antidote for warfarin toxicity, not relevant here
Flumazenil	Antidote for benzodiazepine overdose (e.g., drowsiness, coma), not cholinergic toxidrome
Warfarin	An anticoagulant, not an antidote
Propranolol	A beta-blocker — would worsen bradycardia

Imagine a hidden hormonal condition that depends on life-saving daily medication. What if a new drug secretly speeds up the breakdown of that medication — and no one notices until it’s too late?

21 / 81

Tags: 2018

A 45-year-old patient has been prescribed the 4-drug anti-tuberculous regimen for the next 3 months following a diagnosis of pulmonary tuberculosis. However, a few days later it is reported that the patient expired. What underlying undiagnosed condition most likely resulted in the demise of this patient?

Hyperparathyroidism

Congenital adrenal hyperplasia

Hypoaldosteronism

Addison's disease

Hyperaldosteronism

When a diabetic patient is overweight and on a high-dose secretagogue with poor glucose control, which agent targets insulin resistance and also benefits weight and cardiovascular risk?

22 / 81

Tags: 2020

A 42-year-old woman comes to the clinic for evaluation of uncontrolled blood sugar. She has a history of type 2 diabetes mellitus and takes glimepiride 20 mg every day before breakfast. Her BMI is 32 kg/m2 and HbA1c is 8.4%. Which of the following is the best treatment option for this patient?

Add on thiazolidinone and strictly follow lifestyle modification

Increase the dose of glimepiride

Stop glimepiride and start insulin

Add an DPP-4 inhibitor and follow life-style modification

Add on metformin and strictly follow life-style modification

Think of the most effective class of drugs that directly targets LDL cholesterol, especially in patients with existing cardiovascular disease.

23 / 81

Tags: 2018

A person with cardiovascular disease wants to decrease his low-density lipoprotein (LDL) cholesterol level. What would be the preferred suggestion?

Fibrates

Exercise

Weight loss

Statins

Niacin

If a medication contains a high concentration of iodine and is prescribed to cardiac patients, think about how excess iodine might disrupt thyroid hormone synthesis.

24 / 81

Tags: 2018

A 62-year-old male presents to the clinic with complaints of weight gain and lethargy. He suffers from hypertension and ischemic heart disease, for which he is taking drugs. His TSH and FT4 levels are 21 mIU/L and 0.02 ng/dL, respectively. Considering drug-induced hypothyroidism, which of the following drug might be the most common cause?

Amiodarone

Interferon

Sulphasalazine

Phenylbutazone

Interleukin blockers

Among the hormones that influence digestion, which one specifically targets the pancreas to stimulate enzyme secretion in response to fats and proteins? Think about who tells the pancreas to “get to work.”

25 / 81

Tags: 2018

Somatostatin inhibits which of the following hormones to decrease the pancreatic exocrine secretions?

Cholecystokinin

Vasointestinal active peptide

Pancreatic polypeptide

Secretin

Gastrin

Somatostatin is a potent inhibitory hormone secreted by D-cells in the stomach, intestine, and delta cells of the pancreas. It broadly suppresses endocrine and exocrine secretions throughout the gastrointestinal tract.

🔬 What does somatostatin do?

Inhibits the release of many GI hormones including:
- Cholecystokinin (CCK)
- Gastrin
- Secretin
- Vasoactive intestinal peptide (VIP)
Decreases:
- Gastric acid secretion
- Gallbladder contraction
- Pancreatic exocrine and endocrine secretions

💡 Why CCK is the correct answer:

CCK is released by I-cells of the duodenum and jejunum in response to fats and amino acids.
It stimulates pancreatic acinar cells to secrete digestive enzymes and causes gallbladder contraction.
Somatostatin inhibits CCK release, thus reducing pancreatic enzyme secretion, which is the main component of exocrine pancreatic function.

✅ Therefore, somatostatin decreases pancreatic exocrine secretions primarily by inhibiting CCK.

❌ Why the Other Options Are Incorrect:

A. Pancreatic polypeptide – ❌ Incorrect

It modulates pancreatic secretions and inhibits gallbladder contraction and bile secretion.
Not a primary stimulator of exocrine enzyme release.
While somatostatin may influence it, this is not the main pathway for decreasing exocrine pancreatic secretion.

B. Secretin – ❌ Incorrect

Secreted by S-cells of the duodenum in response to acid.
Stimulates pancreatic bicarbonate secretion, not enzyme secretion.
While somatostatin may inhibit it to some extent, it’s not the main target for reducing exocrine enzyme secretion.

D. Gastrin – ❌ Incorrect

Secreted by G-cells of the stomach.
Stimulates gastric acid secretion, not pancreatic enzymes.
Inhibited by somatostatin, but not linked to pancreatic exocrine secretion.

E. Vasoactive intestinal peptide (VIP) – ❌ Incorrect

A neuropeptide that causes intestinal smooth muscle relaxation and water/electrolyte secretion.
Plays a role in intestinal secretion, not pancreatic enzyme production.
Not the primary hormone related to pancreatic exocrine enzyme secretion.

Which neurotransmitter naturally suppresses prolactin — and what drug mimics it to shrink prolactin-secreting tumors?

26 / 81

Tags: 2023

A young female presents to her gynecologist complaining of irregular menstrual periods, galactorrhea, and decreased libido. She also reports experiencing headaches and vision changes (visual field defects). Physical examination reveals no abnormalities. A blood test is performed and prolactin levels are 800 ng/mL. What is the best management for this patient?

Observation alone

Somatostatin

Bromocriptine

Transsphenoidal pituitary resection

Glucagon

Which system is most sensitive to metabolic stimulation, such that sudden hormone replacement could overload its oxygen demand?

27 / 81

Tags: 2023

In which of the following diseases the dose of levothyroxine is reduced?

Ischemic heart diseases

All of these

Neurological disorders

Respiratory disorders

Hematological disorders

When blood pressure spikes due to a surge in stress hormones, it takes more than typical meds — you need something that stops the squeeze at the receptor level.

28 / 81

Tags: 2018

Phentolamine is used to reduce hypertension in which of these?

Pheochromocytoma

Hypocholesterolemia

Hypercholesterolemia

Metabolic syndrome

Diabetes mellitus

Think about what determines how much hormone you need to replace — the body’s natural production, the size of the patient, and whether any systems (especially the heart) could be stressed by increasing metabolism too quickly.

29 / 81

Tags: 2018

What is the recommended initial dose of levothyroxine for patients without ischemic heart disease who require thyroid hormone replacement?

15 micrograms

25 micrograms

50 micrograms

75 micrograms

100 micrograms

If the parasympathetic nervous system is shut down completely, what happens to secretion, digestion, urination, and heart rate — and which of these will make the skin dry?

30 / 81

Tags: 2020

Which of the following is a feature of atropine overdose?

Excessive urination

Sinus bradycardia

Diarrhea

Miosis

Dry skin and mucus membrane

Mnemonic	Symptom
Dry as a bone	Dry skin and mucous membranes due to reduced glandular secretions
Hot as a hare	Hyperthermia (decreased sweating)
Red as a beet	Flushed skin
Blind as a bat	Mydriasis (pupil dilation) → blurred vision
Mad as a hatter	Delirium, agitation, hallucinations
Others	Urinary retention, tachycardia, constipation

Option	Why Incorrect
Excessive urination	❌ Atropine causes urinary retention, not excessive urination
Sinus bradycardia	❌ Atropine increases heart rate by blocking vagal tone → tachycardia, not bradycardia
Miosis (pupil constriction)	❌ Atropine causes mydriasis (dilated pupils)
Diarrhea	❌ Anticholinergic agents like atropine decrease gut motility → constipation, not diarrhea

Think about how long a long-acting hormone takes to reach a new steady state in the bloodstream. What timing would capture the first meaningful change in lab values after initiating treatment?

31 / 81

Tags: 2019

A hypothyroid patient is treated with thyroxine. How frequently should a thyroid function test be repeated?

6 month interval

3 month interval

1 year interval

2 week interval

1 month interval

If cortisol is a matchstick, then well this glucocorticoid is a flamethrower — tiny dose, huge power. POCKET ROCKET!

32 / 81

Tags: 2024

Among the following glucocorticoids, which is considered the most potent in terms of anti-inflammatory and glucocorticoid activity?

Cortisol

Prednisolone

Corticosterone

Dexamethasone

Medifolone

Glucocorticoid	Anti-inflammatory Potency	Sodium Retention	Duration	Notes
Cortisol	1 (baseline)	Yes	Short	Natural hormone
Corticosterone	0.3	Moderate	Short	Weak glucocorticoid
Prednisolone	~4	Minimal	Intermediate	Commonly used
Dexamethasone	~25–30 ✅	Negligible	Long	Most potent clinically

Think about what the digestive system does to proteins. Would a hormone made of amino acids survive this journey intact to carry out its function?

33 / 81

Tags: 2018

Instead of taking insulin intravenously, a patient started taking insulin orally. Which of the following is most likely to happen?

Nausea

Persistent hypoglycemia

Transient ischemic attack

Hypoglycemia shock

Persistent hyperglycemia

If you want to control blood sugar by acting before glucose even enters the bloodstream, which class of drug would you choose — one that works at the gut wall, or one that acts after glucose is already absorbed?

34 / 81

Tags: 2018

Which of the following drugs acts to inhibit glucose absorption in the small intestine?

Glucosidase inhibitors

Glipazide

Exogenous glucose

Insulin aspart

Metformin

Drug	Why Incorrect
Insulin aspart	A rapid-acting insulin analog that promotes glucose uptake, not absorption inhibition
Glipizide	A sulfonylurea that stimulates insulin secretion from pancreatic β-cells
Metformin	Decreases hepatic gluconeogenesis, improves insulin sensitivity, and slightly reduces glucose absorption, but its primary action is not in the intestine like glucosidase inhibitors
Exogenous glucose	Provides more glucose — does not inhibit absorption at all

no hormone — MIT and DIT never get married, T₃ and T₄ never born.

35 / 81

Tags: 2024

Anti-thyroid agents such as methimazole and propylthiouracil (PTU) reduce circulating levels of free T₃ and T₄ by interfering with which of the following steps in thyroid hormone synthesis?

Oxidation of iodide

Reduced binding to thyroid-binding globulin (TBG)

Reduced uptake of iodide into the cell

Reduced release of thyroid hormones

Coupling of MIT and DIT

Think about whether this hormone tells the kidneys to hold on to water or let it go.

36 / 81

Tags: 2018

Which of the following statements is incorrect regarding vasopressin?

Help to increase blood pressure

Prevent side effects during abdominal X-ray

Used in the treatment of diabetes insipidus

Promote diuresis

Used to control variceal bleeding

When a side effect arises due to hormonal interference from a medication, think about whether a structurally or mechanistically different drug could achieve the same goal—without the unwanted hormonal effect.

37 / 81

Tags: 2018

If a patient taking spironolactone develops gynecomastia as an adverse effect, what is the recommended management?

Reduce the dose of spironolactone

Perform surgery to remove excess breast tissue

Discontinue spironolactone and monitor for resolution

Start androgen replacement

Switch to amiloride

Let’s explore this from a clinical pharmacology and patient management perspective.

🩺 Background: Spironolactone and Gynecomastia

Spironolactone is a potassium-sparing diuretic and a mineralocorticoid receptor antagonist. It is commonly used in:

Heart failure
Hypertension
Primary hyperaldosteronism
Cirrhosis-related ascites
PCOS (off-label)

It also has anti-androgenic effects because it:

Blocks androgen receptors
Inhibits testosterone synthesis
Increases peripheral conversion of testosterone to estradiol

As a result, gynecomastia (benign male breast enlargement) can occur — particularly in men on higher doses or long-term therapy.

✅ Why “Switch to Amiloride” is Correct:

Amiloride is another potassium-sparing diuretic that:

Works via blocking epithelial sodium channels (ENaCs) in the distal nephron.
Does not have anti-androgenic effects.
Maintains similar natriuretic and potassium-sparing effects as spironolactone.

➡️ So, switching to amiloride allows for continued therapeutic effect without the risk of gynecomastia.

❌ Why the Other Options Are Incorrect:

❌ Reduce the dose of spironolactone

May lessen symptoms but does not reliably reverse gynecomastia.
If the anti-androgenic effect persists even at lower doses, the problem may continue.

❌ Discontinue spironolactone and monitor for resolution

Stopping the drug may lead to loss of therapeutic benefit in managing heart failure or hyperaldosteronism.
While it might reverse gynecomastia, it’s not the most balanced approach if alternatives like amiloride are available.

❌ Perform surgery to remove excess breast tissue

This is only considered in persistent or severe cases where symptoms are distressing and do not resolve after stopping the drug.
It’s invasive and not first-line management.

❌ Start androgen replacement

Androgen therapy is not indicated in this scenario.
It may lead to worsening of underlying cardiovascular or endocrine issues and is not a treatment for drug-induced gynecomastia.

When your body is growing too much due to a hormone, the best drugs are either mimics of its natural inhibitor or blockers of its receptor. Which choice offers both?

38 / 81

Tags: 2018

Which of the following drug is used to treat acromegaly?

Octreotide and pegvisomant

Metformin

Desmopressin

Regular insulin

None of them

What hormone is typically missing in anovulatory cycles that can be given in a timed manner to safely trigger menstrual bleeding?

39 / 81

Tags: 2023

What is the treatment for oligomenorrhea?

Cyproterone acetate

None of these

COCPs

Cyclical progesterone

Metformin

Focus on timing and duration:
If it starts working quickly and doesn’t last all day, it’s short-acting.
If it’s steady and flat with minimal peak, it’s long-acting.

40 / 81

Tags: 2016

Which of the following is short-acting insulin?

Regular insulin

None of them

Glyburide

Insulin glargine

Insulin detemir

Type	Example	Onset	Peak	Duration
Rapid-acting	Lispro, Aspart	~15 min	1–2 hrs	3–5 hrs
Short-acting	Regular insulin	~30–60 min	2–4 hrs	5–8 hrs
Intermediate-acting	NPH	1–2 hrs	6–12 hrs	18–24 hrs
Long-acting	Glargine, Detemir	~1 hr	None (flat)	~24 hrs

When evaluating drug indications, ask: Does this condition benefit from vasoconstriction or antidiuretic action? If neither applies — especially in clot-related disorders — the drug is likely not indicated.

41 / 81

Tags: 2016

Which of the following is not an indication for vasopressin therapy?

Diverticular bleeding

Esophageal varices

Von Willebrand disease

Diabetes Insipidus

Venous thromboembolism

When calcium climbs high, a certain substance calmly says — “Go back into bone, bhai.”

42 / 81

Tags: 2024

A patient is found to have elevated serum calcium levels. Which of the following agents is the most appropriate pharmacological treatment to lower calcium levels?

Antidiuretic hormone

Hydrochlorothiazide

Calcitonin

Teriparatide

Vitamin D

Think of a condition where promoting clotting and vasoconstriction would actually be dangerous, not helpful. That’s your odd one out.

43 / 81

Tags: 2018

Which of the following is not an indication for vasopressin therapy?

Von Willebrand disease

Esophageal varices

Diabetes Insipidus

Diverticular bleeding

Venous thromboembolism

In chronic conditions like hypothyroidism, would you prefer a drug that wears off quickly or one that provides stable hormone levels with less frequent dosing?

44 / 81

Tags: 2018

Which of the following is inappropriate about levothyroxine?

It has a short half-life

It is usually the first form of choice in patients with hypothyroidism

It has longer half life than liothyronine

It is slower acting than liothyronine

Lower initial doses are administered in older patients with longstanding myxedema

Which steroid would you choose if you needed the maximum anti-inflammatory effect with minimal fluid retention?

45 / 81

Tags: 2022

Which of the following is the most potent corticosteroid?

Cortisone

Corticosterone

Prednisone

Cortisol

Dexamethasone

Steroid	Relative Glucocorticoid Potency	Mineralocorticoid Activity
Cortisol (Hydrocortisone)	1	1
Cortisone	0.8	0.8
Prednisone	4	0.8
Dexamethasone	25–30	~0
Corticosterone	0.1	0.4

Think of the antihypertensive that improves insulin sensitivity and protects the kidneys.

46 / 81

Tags: 2018

Which of the following drugs are used to treat hypertension in metabolic syndrome?

None of these

ACE-inhibitors

Corticosteroids

Aminoglycosides

Quinolones

Consider which insulin formulation has delayed absorption due to protamine, allowing it to act longer than regular insulin but shorter than long-acting types.

47 / 81

Tags: 2020

Which of the following is an intermediate-acting insulin?

Insulin aspartate

Protamine zinc

Neutral protamine hagedorn (NPH)

Insulin lispro

Regular insulin

Think about which drug would be chosen when a physician needs a powerful anti-inflammatory effect that lasts for more than a day, without needing frequent re-dosing or affecting salt balance much.

48 / 81

Tags: 2018

Which of the following is the long-acting glucocorticoid?

Hydrocortisone

Prednisone

Dexamethasone

Methyl prednisone

None of them

Type	Examples	Half-life & Duration
Short-acting	Hydrocortisone	~8–12 hrs
Intermediate	Prednisone, Methylprednisolone	~12–36 hrs
Long-acting	Dexamethasone	>36 hrs

Which condition involves excessive urination due to failure of the kidneys to retain water—not because of blood sugar, but due to a missing hormone that acts on the collecting ducts?

49 / 81

Tags: 2020

Which of the following is an indication for vasopressin?

Diabetes insipidus

Diabetes mellitus

Adrenal carcinoma

Hypertension

Cushing syndrome

Sometimes the same tool that helps you see what’s wrong is also the tool that fixes the problem — especially when your target organ is hungry for what you’re offering.

50 / 81

Tags: 2018

Radioactive iodine uptake is used for which of the following?

Checking presence of drug

None of them

Diagnosis of thyroid disorders only

Treatment of thyroid disorders only

Diagnosis and treatment for thyroid disorders

Consider which hormone deficiency would lead to hypotension, electrolyte imbalances, hypoglycemia, and shock-like symptoms. What hormone must be urgently replaced to stabilize the patient, especially if the problem is related to the adrenal glands?

51 / 81

Tags: 2017

A 16-year-old girl came to the clinic with the complaints of lethargy and weight loss since six months. She also has hypotension and altered mentation. She also has mild flank tendernes. What is the treatment of choice?

Intravenous hydrocostisone

Fluids

Antibiotics

Insulin

Sedatives

Option	Why It’s Incorrect
Insulin	❌ The patient is hypoglycemic, not hyperglycemic, so insulin would worsen her condition.
Antibiotics	❌ Use only if there’s a confirmed infection. The primary issue is adrenal failure, so steroids are priority.
Sedatives	❌ May worsen altered mentation and hypotension. Sedation is dangerous in adrenal crisis.
Fluids alone	❌ Fluids help but are not sufficient by themselves. Without steroid replacement, shock will persist.

PTU breaks the wedding of MIT and DIT — no couple, no T3–T4 party.

52 / 81

Tags: 2024

Propylthiouracil (PTU) reduces thyroid hormone levels through which of the following mechanisms?

Increase valence of iodine

Reducing thyroxine-binding globulin (TBG)

Reducing thyroglobulin

Inhibits MIT and DIT coupling

Reuptake of iodine by thyroid

What insulin regimen most closely mimics the body’s natural insulin release pattern — offering both background and meal-related coverage?

53 / 81

Tags: 2020

A 16-year-old boy has type 1 diabetes mellitus and is on mixed insulin twice daily. His HbA1c is 9.5%. Which of the following is the best next step in management?

Put him on sliding scale of insulin

Put him on split dosage of insulin twice thrice daily

Add on metformin

Increase the current dosage of insulin

Put him on basal bolus regimen

When the kidneys begin to fail, ask yourself: which medications depend on renal clearance and could become toxic even if they’ve been tolerated before?

54 / 81

Tags: 2020

A 64-year-old male who is a known case of diabetes presents to the outpatient department for a regular follow-up. His glomerular filtration rate (GFR) is 28 ml/min and he is currently on mixed insulin and metformin. In the past six months he has had no hypoglycemic event. Which of the following is the most appropriate next step in his treatment?

Stop metformin and start DPP-4 inhibitor

Decrease the dose of metformin and insulin

Continue with the same treatment

Stop insulin and metformin both and put him on short-acting sulphonylurea

Stop metformin and continue insulin

This case involves a 64-year-old diabetic patient with chronic kidney disease (CKD) — GFR = 28 ml/min, which is Stage 4 CKD.

The key issue here is the use of metformin in a patient with significantly reduced renal function.

🔬 Metformin and Renal Function:

Metformin is contraindicated or not recommended when:
- eGFR < 30 ml/min → Must STOP metformin
- eGFR 30–45 ml/min → Use with caution; generally avoid initiation or dose reduction required

Why?

Risk of lactic acidosis increases significantly in patients with impaired renal clearance of metformin
Though rare, metformin-associated lactic acidosis (MALA) is potentially fatal

➡️ Therefore, GFR of 28 mandates stopping metformin.

✅ Why Continuing Insulin Is Appropriate:

Insulin is safe in CKD, though dose adjustments may be needed due to decreased renal insulin clearance (can increase insulin sensitivity)
This patient has had no hypoglycemic episodes, so current insulin regimen appears effective and safe

❌ Why Other Options Are Incorrect:

Decrease dose of metformin and insulin – ❌

Decreasing metformin is not sufficient when GFR is <30 ml/min
Metformin must be discontinued entirely

Stop metformin and start DPP-4 inhibitor – ❌

DPP-4 inhibitors may be added in some cases, but patient is well-controlled on insulin alone
No reason to add an oral agent unless needed
Some DPP-4 inhibitors (like sitagliptin) require renal dose adjustments at this GFR

Stop both insulin and metformin, start short-acting sulfonylurea – ❌

Sulfonylureas are high-risk for hypoglycemia in CKD
Especially short-acting types like glipizide still pose a risk
This patient is doing well on insulin; no justification to change therapy

Continue same treatment – ❌

Unsafe due to ongoing metformin use with GFR 28 ml/min
Continuing metformin is not acceptable

🧪 Management Summary:

Drug	GFR < 30 ml/min
Metformin	❌ Contraindicated
Insulin	✅ Safe with monitoring
DPP-4 inhibitors	✅ Some are OK with dose adjustment
Sulfonylureas	⚠️ Risk of hypoglycemia; caution

Think about the mechanism that targets nutrient absorption rather than metabolic or hormonal modulation. How might this approach differ from medications managing underlying diseases?

55 / 81

Tags: 2021

A 58-year-old woman presents to the outpatient department for a general health checkup. Her blood pressure is 140/100 mm Hg, and her pulse rate is 89 per minute. The rest of her vitals are normal. She is 163 cm tall (5’4″) and weighs 102 kg (225 lbs). Her BMI is 38.4 kg/m². She mentions that she frequently wakes up from her sleep and her husband constantly complains about her snoring. The physician advises her to lose weight for better health, but the patient complains that she has tried multiple times and follows the advice of her nutritionist religiously. She mentions she has heard of bariatric surgery and has been considering it for some time. The physician advises trying medical therapy before moving on to surgical intervention. Which of the following medications is usually prescribed to help weight loss only?

Growth hormone

Levothyroxine

Metformin

Sitagliptin

Orlistat

1. Understanding the clinical scenario

The patient is obese with a BMI of 38.4 kg/m².
She has symptoms suggestive of obstructive sleep apnea (waking up frequently, snoring).
She has tried diet and lifestyle modifications but struggles with weight loss.
The physician recommends medical therapy for weight loss before considering bariatric surgery.

2. Review of each medication and its role in weight management

🔹 Sitagliptin

Class: DPP-4 inhibitor (antidiabetic)
Indication: Primarily for type 2 diabetes mellitus management.
Effect on weight: Weight neutral; does not promote weight loss.
❌ Not used solely for weight loss.

🔹 Levothyroxine

Class: Thyroid hormone replacement
Indication: Hypothyroidism
Effect on weight: Can cause weight loss if hypothyroidism is corrected, but not prescribed to lose weight in euthyroid patients due to risk of hyperthyroidism.
❌ Not used solely for weight loss.

🔹 Metformin

Class: Biguanide (antidiabetic)
Indication: Type 2 diabetes mellitus
Effect on weight: May cause modest weight loss or be weight neutral.
❌ Primarily an antidiabetic, not a dedicated weight-loss drug.

🔹 Growth hormone

Class: Hormone therapy
Indication: GH deficiency, certain wasting conditions
Effect on weight: Can increase lean body mass but not primarily used for weight loss; can cause side effects.
❌ Not used for obesity treatment.

🔹 Orlistat

Class: Lipase inhibitor
Indication: Approved for obesity management
Mechanism: Blocks absorption of dietary fats (~30%) in the intestine, leading to reduced calorie absorption.
Effect on weight: Used specifically and only for weight loss.
✅ This is the medication prescribed solely for weight loss.

Summary Table:

Medication	Primary Use	Weight Loss Effect	Used for Weight Loss Only?
Sitagliptin	Diabetes	Weight neutral	No
Levothyroxine	Hypothyroidism	May reduce weight if hypothyroid	No
Metformin	Diabetes	Modest weight loss	No
Growth hormone	GH deficiency	Increase lean mass	No
Orlistat	Obesity	Directly promotes weight loss	Yes

Consider which steps in thyroid hormone synthesis involve iodine chemistry — and what a drug would need to block to prevent new hormone production.

56 / 81

Tags: 2018

Which of the following is the effect of propylthiouracil on thyroid hormone?

Hypertrophy of thyroid follicles

Inhibits oxidation of iodide and coupling of iodine

Inhibit T3 release from thyroglobulin

Inactivates thyroglobulin

Hyper activates Na-I symporter

When choosing a treatment for a patient with both metabolic and reproductive symptoms, think about a medication that can target the root cause instead of just treating the lab numbers. Consider the pathophysiology of insulin resistance and its broader effects on the endocrine system

57 / 81

Tags: 2017

A female patient came to the clinic with the complaints of amenorrhea, increased blood sugar and obesity. She is not on any medications. Which of the following drug should be advised to her?

Biguanides

Alpha-glucosidase inhibitors

Thiazolidinediones

Sulphonylureas

Insulin

Biguanides (Metformin) are the first-line drug for patients with insulin resistance, which is commonly seen in both Type 2 Diabetes Mellitus and Polycystic Ovary Syndrome (PCOS).

Mechanism of Action:

Reduces hepatic glucose production (gluconeogenesis)
Increases insulin sensitivity in peripheral tissues (muscle and fat)
Helps with weight control or mild weight loss, making it ideal for obese patients

Why is Metformin Ideal Here?

Hyperglycemia: Metformin lowers blood sugar without causing hypoglycemia.
Obesity: Metformin does not cause weight gain, unlike insulin or sulfonylureas.
Amenorrhea: In cases like PCOS, Metformin can help restore menstrual cycles by improving insulin sensitivity, which reduces hyperandrogenism and helps normalize ovulation.

Thus, Metformin addresses all three of the patient’s issues in a safe and effective manner.

Incorrect Answer Explanations:

Alpha-glucosidase Inhibitors

Mechanism: Slow carbohydrate digestion in the intestines, reducing post-meal blood sugar spikes.
Why Incorrect?
- They do not affect insulin resistance.
- No role in correcting amenorrhea or aiding in weight loss.
- Not first-line for this clinical scenario.

Insulin

Mechanism: Lowers blood glucose by promoting glucose uptake into cells.
Why Incorrect?
- May cause further weight gain, which is counterproductive in an obese, insulin-resistant patient.
- Does not address amenorrhea or improve insulin resistance directly.
- Reserved for severe hyperglycemia or treatment failure with oral agents.

Sulphonylureas

Mechanism: Increase insulin secretion from the pancreas.
Why Incorrect?
- Can cause hypoglycemia and weight gain.
- Do not improve insulin sensitivity.
- Not preferred in obese patients with insulin resistance.

Thiazolidinediones (TZDs)

Mechanism: Increase insulin sensitivity in adipose tissue and muscle.
Why Incorrect?
- Cause weight gain, including fluid retention and increased fat mass.
- Potential side effects include cardiovascular risks (e.g., heart failure exacerbation).
- Although they improve insulin resistance, they are not first-line therapy, especially in an obese patient.

Which insulin behaves like a slow, steady drip of water from a tap—no peaks, just 24-hour background coverage?

58 / 81

Tags: 2019

Which of the following insulin preparations provides 24 hour effects?

Aspart

NPH insulin

Glulisine

Glargine

Lispro

When time is critical and blood glucose needs to be lowered immediately, which type of insulin delivery would make the most sense?

59 / 81

Tags: 2020

Which of the following explains why regular insulin is used in a hyperglycemic emergency?

It does not form antibody

None of these

It can be given intravenously for rapid onset of action

It has a delayed onset of action

Human insulin is not allergic

If you wanted to stop a factory from producing a product, would you cut off the raw materials, block the assembly line, or destroy the warehouse? Consider what step this drug targets in hormone production.

60 / 81

Tags: 2022

Which of the following is the effect of propylthiouracil on thyroid hormone?

Inhibits oxidation of iodide and coupling of iodine

Inactivates thyroglobulin

Hyper activates Na-I symporter

Hypertrophy of thyroid follicles

Inhibit T3 release from thyroglobulin

When the hormone is high but its natural byproduct is missing, consider whether the hormone came from outside the body.

61 / 81

Tags: 2018

A nurse was brought to the emergency with hypoglycemia. Investigations were carried out, which showed high insulin levels with decreased C-peptide. Which of the following is mostly likely responsible for hypoglycemia?

Exogenous insulin

Metformin

Endogenous physiological insulin production

Insulinoma

Sulfonylurea drug

Source of Insulin	Insulin	C-peptide
Endogenous	High	High
Exogenous (injected insulin)	High	Low (no C-peptide in synthetic insulin)

What therapy replaces the very hormone that’s missing in patients showing signs of uncontrolled catabolism and high blood sugar?

62 / 81

Tags: 2023

A 30-year-old patient presents with complaints of 5 kg weight loss, fatigue, lethargy, polyuria, and polydipsia. His blood sugar level was raised. What is the best treatment for this patient?

Metformin

Thiazolidinediones

GLP-1 receptor agonists

Glyburide

Start insulin

If a drug stores sugar in tissues more efficiently, think about what else might get stored along with it — especially when your patient starts swelling.

63 / 81

Tags: 2018

Which class of diabetes drug causes peripheral edema?

GLP-1 analogs

Biguanides

Thiazolidinediones

Meglitinides

DPP-4 inhibitors

Think about the hormone that tells your kidneys to hang onto sodium and dump potassium. Now, consider what happens if you block that hormone — which direction does potassium go?

64 / 81

Tags: 2018

Which antihypertensive drug causes hyperkalemia?

Metolazone

Hydrochlorothiazide

Fludrocortisone

Spironolactone

Furosemide

When evaluating hormonal feedback loops, think about which substances closely mimic natural hormones without confusing the measurements used to detect them. Which synthetic steroid gives clear results without being mistaken for cortisol itself?

65 / 81

Tags: 2021

The differentiation between ACTH (adrenocorticotropic hormone)-dependent and ACTH-independent Cushing syndrome is made by administering high doses of which of the following synthetic glucocorticoids?

Prednisolone

Dexamethasone

Methylprednisolone

Corticosterone

None of these

Condition	Effect of High-Dose Dexamethasone
Cushing disease (pituitary)	Partial suppression of cortisol
Ectopic ACTH	No suppression
Adrenal tumor	Already ACTH-independent; no suppression

Synthetic Steroid	Use in Suppression Tests	Reason
Dexamethasone	✅ Yes	Potent, long-acting, no assay interference
Prednisolone	❌ No	Interferes with cortisol assay
Corticosterone	❌ No	Not used clinically for this purpose
Methylprednisolone	❌ No	Also interferes with cortisol assay

Which antithyroid drug is safest to use early in pregnancy due to fewer birth defects, even though it’s not the first choice outside pregnancy?

66 / 81

Tags: 2023

A 30-year-old pregnant woman, who is a known case of Grave’s disease and has been taking medications for it came for consultation regarding her treatment during pregnancy. Which of the following will be the drug of choice for this patient?

Iodine

Beta blocker

Phenytoin

Carbimazole

Propylthiouracil

If a drug treats hyperthyroidism by blocking thyroid hormone production in the mother, what do you expect it to do to the fetus who depends on that same hormone?

67 / 81

Tags: 2018

A 36-year-old woman who was on medication for hyperthyroidism gives birth to a baby with fetal hypothyroidism. Which of the following drugs was she taking?

Penicillin

Warfarin

Propranolol

Atenolol

Carbimazole

Think about which insulin you’d want working quietly in the background all day, not spiking or crashing—just keeping the blood sugar steady like a good bodyguard you never notice.

68 / 81

Tags: 2019

Which of the following insulin preparations is used for long term, 24-hour activity?

Insulin glargine

Insulin lispro

NPH insulin

Insulin glulisine

Insulin aspart

When a powerful hormone-like drug is used for a long time, the body often downregulates its own natural production of the same substance. Think about what happens when external support is suddenly removed and the internal system hasn’t yet recovered.

69 / 81

Tags: 2019

A patient was on prednisone treatment for a long period of time. What is most likely to happen if the drug is withdrawn?

Hyperaldosteronism

Adrenal crisis

Hemolytic anemia

Increased risk of infection

Adrenal hyperplasia

Imagine turning off the engine of a factory for weeks because you’re importing all its products from outside. What happens if the imports stop suddenly—before the factory has time to power back up?

70 / 81

Tags: 2019

A patient was on prednisone treatment for a long period of time. What is most likely to happen if the drug is withdrawn?

Hemolytic anemia

Adrenal hyperplasia

Hyperaldosteronism

Increased risk of infection

Adrenal crisis

Which drug class operates not by immediately stimulating insulin, but by turning on genes that improve how the body responds to insulin — much like rewriting the rules rather than just turning up the volume?

71 / 81

Tags: 2018

Which of the following drugs activates the PPAR-gamma nuclear receptor?

Linagliptin
Metformin
Pioglitazone
Nateglinide
Glipizide

Nateglinide

Linagliptin

Pioglitazone

Metformin

Glipizide

What life-threatening condition can result if the body suddenly loses a hormone it has stopped producing on its own due to long-term external replacement? Think about the stress response and what hormone is essential for it.

72 / 81

Tags: 2019

A 37-year-old female who had a kidney transplant two months ago is currently on immunosuppressants and corticosteroids. She suddenly stops taking prednisone. This puts her at an increased risk of developing which of the following?

Nausea

Adrenal crisis

Opportunistic infections

Hemolytic anemia

Hyperaldosteronism

In conditions involving insulin resistance or glucose intolerance, ask: Does this drug help or hurt carbohydrate metabolism? That will guide you to the safest choice.

73 / 81

Tags: 2016

Which of the following drugs are used to treat hypertension in metabolic syndrome?

None of these

Quinolones

ACE-inhibitors

Aminoglycosides

Corticosteroids

Which drug used in heart disease has such a high iodine content that it can confuse the thyroid into shutting down hormone production?

74 / 81

Tags: 2020

A 62-year-old male presents to the clinic with complaints of weight gain and lethargy. He suffers from hypertension and ischemic heart disease, for which he is taking drugs. His TSH and FT4 levels are 21 mIU/L and 0.02 ng/dL, respectively. Considering drug-induced hypothyroidism, which of the following drug might be the most common cause?

Sulphasalazine

Phenylbutazone

Interferon

Interleukin blockers

Amiodarone

Consider a scenario where hypertension arises not from typical vascular resistance or fluid overload, but from sudden surges of a powerful endogenous substance that stimulates both alpha and beta receptors. In such a case, would standard antihypertensives suffice — or would you need something more targeted?

75 / 81

Tags: 2017

Phentolamine is used to reduce hypertension in which of the following conditions?

Pheochromocytoma

Diabetes mellitus

Metabolic syndrome

None of these

Hypercholesterolemia

Phentolamine is a non-selective alpha-adrenergic antagonist — it blocks both α1 and α2 receptors. This causes:

Vasodilation (via α1 blockade), reducing peripheral vascular resistance and thus lowering blood pressure.
Increased norepinephrine release (via α2 blockade), which can lead to reflex tachycardia.

Because of these effects, phentolamine is not a routine antihypertensive. Instead, it’s reserved for special hypertensive crises, particularly those involving excess catecholamines.

🧬 Enter: Pheochromocytoma

Pheochromocytoma is a catecholamine-secreting tumor of the adrenal medulla (producing epinephrine, norepinephrine, and sometimes dopamine). This causes:

Paroxysmal or sustained hypertension
Palpitations, sweating, headache

Treating these patients with regular beta-blockers or standard antihypertensives can worsen the crisis if alpha-blockade isn’t done first. Why?

Because alpha receptors cause vasoconstriction. If you block only beta receptors (e.g., with propranolol), you’ll leave unopposed alpha activity — leading to severe vasoconstriction and hypertensive crisis.

Hence, phentolamine (or phenoxybenzamine) is used to:

Block alpha receptors first
Lower BP before surgery or during hypertensive crises

✅ Correct Answer: Pheochromocytoma

❌ Why the Other Options Are Incorrect:

Hypercholesterolemia:
- Primarily affects lipid profiles and atherosclerosis risk.
- Does not cause acute catecholamine surges → phentolamine not used.
Diabetes mellitus:
- May lead to hypertension through vascular and renal changes, but treatment is with ACE inhibitors, ARBs, or CCBs — not alpha-blockers like phentolamine.
Metabolic syndrome:
- Associated with insulin resistance, obesity, and low-grade chronic hypertension. Again, not catecholamine-driven → phentolamine isn’t used.
None of these:
- Incorrect because pheochromocytoma is very much a valid indication.

Think about which arthritis medications are known to cause systemic side effects like weight gain, muscle weakness, and visual changes. Could the drug mimic a hormonal syndrome if used for a long time or at high doses?

76 / 81

Tags: 2017

A 35-year-old female came to the clinic with the complaints of muscle weakness, excessive weight gain and blurry vision. She has been taking medications to relieve her arthritic pain. Which of the following medication is responsible in this case?

Azathriopine

Lefluanamide

Methotrexate

Sulfasalazine

Steroids

Option	Why It’s Incorrect
Leflunomide	❌ Can cause liver toxicity and teratogenicity, but not Cushingoid symptoms.
Methotrexate	❌ Causes liver toxicity, bone marrow suppression, and mouth ulcers, but not weight gain or vision problems.
Azathioprine	❌ Can lead to bone marrow suppression and infections, but not Cushing-like symptoms.
Sulfasalazine	❌ May cause GI upset, rash, or hemolysis, but not the features described.

When a drug for a metabolic disorder suddenly leads to a dangerous infection-like illness, what type of immune cell might be missing — and which drug is most infamous for causing it?

77 / 81

Tags: 2020

A patient who is taking antithyroid drugs for hyperthyroidism develops sore throat and fever. Her total leukocyte count is low. Which of the following drugs is she most likely taking?

Methimazole

Propranolol

Radioactive iodine

Digoxin

Nadolol

In a critical moment, timing is everything. Think about which tools work immediately versus those designed to keep things steady in the long run. Would you use a slow-release option to fix an emergency?

78 / 81

Tags: 2019

A 39-year-old man with insulin-dependent diabetes mellitus is brought to the emergency department after collapsing in a shopping mall. His blood sugar is 589 mg/dL. Which of the following preparations would have the least effect on his blood sugar level?

Insulin aspart

NPH insulin

Insulin glargine

Insulin lispro

Insulin glulisine

Type	Examples	Onset	Peak	Duration
Rapid-acting	Lispro, Aspart, Glulisine	10–30 min	30–90 min	3–5 hours
Intermediate-acting	NPH	1–2 hrs	4–12 hrs	12–18 hours
Long-acting (basal)	Glargine, Detemir	1–2 hrs	No true peak	~24 hours

When targeting an organ that naturally pulls something from the digestive tract, consider how the body normally absorbs that substance.

79 / 81

Tags: 2018

Which of the following is wrong about radioactive iodine?

It is given orally

It is given intravenously

It is a single dose

Used for diagnosis

None of them

Purpose	Radioisotope	Route	Notes
Diagnosis	Iodine-123 (I-123)	Oral	Used in RAI uptake scans and thyroid imaging
Treatment	Iodine-131 (I-131)	Oral	Used for Graves’, toxic nodules, and thyroid cancer

When the body gets what it needs from the outside, does it still bother making it inside? Think about how the system reacts to an excess of a hormone mimic.

80 / 81

Tags: 2022

If a person is given steroidal anti-inflammatory drugs, what will be the drug’s effect on this person?

High cortisol, high CRH

High CRH, high ACTH

Low ACTH, low CRH

Low cortisol, high ACTH

High cortisol, low ACTH

When considering insulin types, always ask: Is this for maintenance or emergency? If it’s an acute condition, you’ll need an IV insulin with rapid action, not long-acting or intermediate preparations.

81 / 81

Tags: 2016

Which of the following is inappropriate about neutral protamine hagedorn (NPH)?

It is an intermediate-acting form of insulin

It is used to treat diabetic ketoacidosis

None of these

All of these

It is given subcutaneously

Your score is

The average score is 0%

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Thank you for your feedback.

Endo – Pharmacology

Report a question

Clinical Context:

Drug Options Analysis:

Summary:

Final Answer:

✅ Why the Correct Option is Right:

❌ Why the Other Options Are Wrong:

📌 Why Amiodarone Causes Hypothyroidism:

❌ Explanation of Incorrect Options:

What is a Prolactinoma?

🎯 Treatment Goals:

💊 First-Line Therapy: Dopamine Agonists

Dopamine inhibits prolactin secretion.

Why it’s correct:

❌ Why the Other Options Are Incorrect:

Serious Side Effect:

Management:

Why the Other Options Are Incorrect:

Summary:

🧪 In Central Diabetes Insipidus, the problem is:

❌ Why the Other Options Are Wrong (Simple):

❌ Why the Other Options Are Less Appropriate Alone

Incorrect Answer Explanations:

Hypertrophy of thyroid follicles

Inhibit T3 release from thyroglobulin

Hyper activates Na⁺-I⁻ symporter

Inactivates thyroglobulin

❌ Why the Other Options Are Incorrect:

🔹 What is Levothyroxine?

🔬 Pharmacokinetics:

✅ Correct Statements (All True):

❌ Why “It has a short half-life” is inappropriate (False):

🔹 Mechanism of Glucocorticoids:

✅ Why “Phospholipase A2” Is Correct:

❌ Why the Other Options Are Incorrect:

How do they work?

Clinical effect:

Why the Other Options Are Incorrect:

Metformin

Insulin aspart

Rosiglitazone

Exogenous glucose

Mechanism of Action:

Why the Other Options Are Incorrect:

Summary:

❌ Incorrect Answer Breakdown:

⚠️ Common Side Effects of Levothyroxine (Signs of Overdose):

❌ Why the Other Options Are Incorrect:

❌ Why the Other Options Are Incorrect

❌ Why the Other Options Are Incorrect:

🔬 Why “Regular insulin” is Correct:

❌ Why the Other Options Are Incorrect:

🔻 Detemir

🔻 Aspart

🔻 Lispro

🔻 Glulisine

📌 Clinical Picture Suggests: Organophosphate Poisoning

🧬 Cholinergic Symptoms: DUMBBELSS Mnemonic

🧪 Treatment of Organophosphate Poisoning:

❌ Why Other Options Are Incorrect:

💣 So what’s the danger with Rifampin in Addison’s disease?

❌ Why the Other Options Are Wrong:

📌 Step-by-Step Clinical Reasoning:

1. Target HbA1c in T2DM:

2. Current Medication:

3. Next Step in Management:

❌ Why Other Options Are Incorrect:

🔬 How Statins Work:

❌ Why Other Options Are Less Preferred:

💡 Clinical Tip:

📌 Why Amiodarone?

🧪 Mechanism of Amiodarone-Induced Hypothyroidism (AIH):

❌ Why the Other Options Are Incorrect:

🔬 What does somatostatin do?

💡 Why CCK is the correct answer:

❌ Why the Other Options Are Incorrect:

A. Pancreatic polypeptide – ❌ Incorrect

B. Secretin – ❌ Incorrect

D. Gastrin – ❌ Incorrect

❌ **Why “It has a short half-life” is inappropriate (False):**