The parathyroid glands are the master regulators of calcium and phosphate homeostasis in the body. Their dysfunction, leading to hyperparathyroidism or hypoparathyroidism, can cause significant and complex electrolyte and bone disorders. As detailed in the Patient Care 5 endocrinology module, the management of these conditions has significant overlap with the management of Chronic Kidney Disease and requires a deep understanding of this intricate hormonal system. This quiz will test your knowledge on the physiology of parathyroid hormone (PTH) and the pharmacologic strategies used to manage disorders of the parathyroid gland.
1. The parathyroid glands secrete parathyroid hormone (PTH) in response to what primary stimulus?
- a. High serum calcium
- b. Low serum calcium
- c. High serum phosphate
- d. Low serum TSH
Answer: b. Low serum calcium
2. Which of the following is a primary action of parathyroid hormone (PTH)?
- a. It increases calcium excretion by the kidneys.
- b. It decreases the activation of Vitamin D.
- c. It increases calcium release from bones and reabsorption from the kidneys.
- d. It lowers serum calcium levels.
Answer: c. It increases calcium release from bones and reabsorption from the kidneys.
3. A patient with primary hyperparathyroidism would be expected to have which set of lab values?
- a. High calcium, high phosphate, low PTH
- b. Low calcium, high phosphate, high PTH
- c. High calcium, low phosphate, high PTH
- d. Low calcium, low phosphate, low PTH
Answer: c. High calcium, low phosphate, high PTH
4. What is the most common cause of primary hyperparathyroidism?
- a. Chronic kidney disease
- b. A single parathyroid adenoma
- c. Vitamin D deficiency
- d. A high-calcium diet
Answer: b. A single parathyroid adenoma
5. A patient with hypoparathyroidism would be expected to have which set of lab values?
- a. High calcium, high phosphate, low PTH
- b. Low calcium, high phosphate, low PTH
- c. High calcium, low phosphate, high PTH
- d. Low calcium, low phosphate, high PTH
Answer: b. Low calcium, high phosphate, low PTH
6. The “Parathyroid Gland and its Disorders” is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. Chvostek’s sign (facial muscle twitching) and Trousseau’s sign (carpopedal spasm) are indicative of:
- a. Hypercalcemia
- b. Hyperkalemia
- c. Hypocalcemia
- d. Hyponatremia
Answer: c. Hypocalcemia
8. The definitive treatment for most cases of primary hyperparathyroidism is:
- a. Lifelong cinacalcet therapy.
- b. A low-calcium diet.
- c. Surgical removal of the overactive gland(s).
- d. A bisphosphonate infusion.
Answer: c. Surgical removal of the overactive gland(s).
9. A patient with Chronic Kidney Disease (CKD) develops secondary hyperparathyroidism. What is the initial cause of this condition?
- a. The kidneys overproduce active Vitamin D.
- b. The parathyroid glands become cancerous.
- c. The failing kidneys cannot excrete phosphate, leading to hyperphosphatemia and subsequent hypocalcemia.
- d. The patient consumes too much calcium.
Answer: c. The failing kidneys cannot excrete phosphate, leading to hyperphosphatemia and subsequent hypocalcemia.
10. What is the first-line treatment for managing hyperphosphatemia in a patient with CKD and secondary hyperparathyroidism?
- a. Dietary phosphate restriction and phosphate binders.
- b. A high-dose calcium supplement.
- c. Cinacalcet.
- d. IV fluids.
Answer: a. Dietary phosphate restriction and phosphate binders.
11. The management of adrenal gland disorders is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. Cinacalcet (Sensipar) is a calcimimetic used to treat secondary hyperparathyroidism. What is its mechanism of action?
- a. It binds phosphate in the gut.
- b. It is an active form of Vitamin D.
- c. It increases the sensitivity of the calcium-sensing receptor on the parathyroid gland to calcium.
- d. It directly inhibits PTH release.
Answer: c. It increases the sensitivity of the calcium-sensing receptor on the parathyroid gland to calcium.
13. The most common cause of hypoparathyroidism is:
- a. An autoimmune disease.
- b. A congenital disorder.
- c. Damage to or removal of the parathyroid glands during neck surgery.
- d. Chronic kidney disease.
Answer: c. Damage to or removal of the parathyroid glands during neck surgery.
14. What is the role of the kidneys in Vitamin D metabolism?
- a. The kidneys produce Vitamin D from cholesterol.
- b. The kidneys convert inactive 25-hydroxyvitamin D to its active form, 1,25-dihydroxyvitamin D (calcitriol).
- c. The kidneys excrete all forms of Vitamin D.
- d. The kidneys have no role in Vitamin D metabolism.
Answer: b. The kidneys convert inactive 25-hydroxyvitamin D to its active form, 1,25-dihydroxyvitamin D (calcitriol).
15. A patient with hypoparathyroidism is treated with calcium supplements and which other essential medication?
- a. A non-selective beta-blocker
- b. A phosphate binder
- c. An active Vitamin D analog, such as calcitriol
- d. A bisphosphonate
Answer: c. An active Vitamin D analog, such as calcitriol
16. The classic mnemonic for the symptoms of hypercalcemia is “bones, stones, groans, and…”
- a. “…psychiatric overtones.”
- b. “…muscle moans.”
- c. “…low tones.”
- d. “…high thrones.”
Answer: a. “…psychiatric overtones.”
17. The management of thyroid gland disorders is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
18. Why is calcitriol used in patients with severe CKD or hypoparathyroidism instead of ergocalciferol (Vitamin D2) or cholecalciferol (Vitamin D3)?
- a. It is less expensive.
- b. It bypasses the need for renal activation, as it is already the active form of Vitamin D.
- c. It has fewer side effects.
- d. It is available over-the-counter.
Answer: b. It bypasses the need for renal activation, as it is already the active form of Vitamin D.
19. What effect does PTH have on phosphate levels?
- a. It increases renal reabsorption of phosphate.
- b. It decreases renal excretion of phosphate.
- c. It increases renal excretion of phosphate (phosphaturic effect).
- d. It has no effect on phosphate levels.
Answer: c. It increases renal excretion of phosphate (phosphaturic effect).
20. An active learning session on endocrinology is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A patient taking cinacalcet should be monitored for which potential adverse effect?
- a. Hypercalcemia
- b. Hypocalcemia
- c. Hyperkalemia
- d. Hypertension
Answer: b. Hypocalcemia
22. Which of the following is NOT an action of PTH?
- a. Increases bone resorption.
- b. Increases calcium reabsorption in the kidneys.
- c. Increases calcium absorption from the gut.
- d. Stimulates conversion of Vitamin D to its active form.
Answer: c. Increases calcium absorption from the gut.
23. The management of CKD-Mineral and Bone Disorder is a key topic in the renal system module.
- a. True
- b. False
Answer: a. True
24. An active learning session on endocrinology is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A patient with severe hypercalcemia due to malignancy might be treated emergently in the hospital with:
- a. IV hydration, calcitonin, and an IV bisphosphonate.
- b. A high-dose oral calcium supplement.
- c. IV magnesium sulfate.
- d. A thiazide diuretic.
Answer: a. IV hydration, calcitonin, and an IV bisphosphonate.
26. A pharmacist’s role in managing parathyroid disorders includes:
- a. Counseling on the proper administration of phosphate binders.
- b. Educating patients on the signs of hypocalcemia or hypercalcemia.
- c. Monitoring for drug interactions with calcium and vitamin D supplements.
- d. All of the above.
Answer: d. All of the above.
27. Parathyroid hormone release is regulated by a:
- a. Positive feedback loop with calcium.
- b. Negative feedback loop with calcium.
- c. Diurnal rhythm.
- d. Connection to the pituitary gland.
Answer: b. Negative feedback loop with calcium.
28. An active learning session on endocrinology is part of which course module?
- a. Module 2: Endocrinology
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 2: Endocrinology
29. A patient is taking calcium carbonate as a phosphate binder. They should also be taking levothyroxine. What counseling is required?
- a. Take both medications together to improve absorption.
- b. Separate the administration of the two medications by several hours.
- c. The combination is contraindicated.
- d. Take the calcium on an empty stomach.
Answer: b. Separate the administration of the two medications by several hours.
30. The “Intro to Parathyroid Gland” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. In secondary hyperparathyroidism of CKD, PTH levels are high but serum calcium is often:
- a. High
- b. Normal or low
- c. Unchanged
- d. Not measurable
Answer: b. Normal or low
32. The term “tetany” refers to:
- a. A type of skin rash.
- b. Involuntary muscle contraction or spasms, often due to hypocalcemia.
- c. High blood pressure.
- d. A symptom of hypercalcemia.
Answer: b. Involuntary muscle contraction or spasms, often due to hypocalcemia.
33. Which of the following is NOT a symptom of hypercalcemia?
- a. Kidney stones
- b. Bone pain
- c. Constipation
- d. Paresthesias (tingling) around the mouth
Answer: d. Paresthesias (tingling) around the mouth
34. What is the relationship between serum calcium and serum phosphate?
- a. They have a direct relationship.
- b. They have an inverse relationship, regulated by PTH and other hormones.
- c. There is no relationship.
- d. They are the same molecule.
Answer: b. They have an inverse relationship, regulated by PTH and other hormones.
35. A patient with hypoparathyroidism requires lifelong therapy because:
- a. The parathyroid glands do not typically regenerate.
- b. The treatment is inexpensive.
- c. The symptoms are mild.
- d. The condition resolves on its own.
Answer: a. The parathyroid glands do not typically regenerate.
36. A patient taking cinacalcet should be advised that it:
- a. Should be taken on an empty stomach.
- b. Should be taken with food or shortly after a meal.
- c. Can be crushed or chewed.
- d. Has no gastrointestinal side effects.
Answer: b. Should be taken with food or shortly after a meal.
37. Which diuretic class can cause hypercalcemia and should be used with caution in patients with primary hyperparathyroidism?
- a. Loop diuretics
- b. Thiazide diuretics
- c. Potassium-sparing diuretics
- d. Osmotic diuretics
Answer: b. Thiazide diuretics
38. The “Management of Parathyroid Gland Disorders” is a lecture in the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
39. Calcitonin is a hormone that has what effect on serum calcium?
- a. It increases serum calcium.
- b. It decreases serum calcium, primarily by inhibiting osteoclast activity.
- c. It has no effect on serum calcium.
- d. It increases calcium absorption from the gut.
Answer: b. It decreases serum calcium, primarily by inhibiting osteoclast activity.
40. An active learning session covering parathyroid disorders is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. The goal of treating hypoparathyroidism is to:
- a. Achieve a high-normal serum calcium level.
- b. Maintain a low-normal serum calcium level to relieve symptoms while avoiding hypercalciuria.
- c. Normalize the PTH level.
- d. Cure the underlying condition.
Answer: b. Maintain a low-normal serum calcium level to relieve symptoms while avoiding hypercalciuria.
42. Which of the following is NOT a cause of hypercalcemia?
- a. Malignancy
- b. Primary hyperparathyroidism
- c. Vitamin D toxicity
- d. Chronic kidney disease (in its later stages)
Answer: d. Chronic kidney disease (in its later stages)
43. A pharmacist’s role in managing a patient on cinacalcet includes counseling on:
- a. The signs and symptoms of hypocalcemia.
- b. The need for regular lab monitoring.
- c. The importance of taking it with food.
- d. All of the above.
Answer: d. All of the above.
44. A patient with severe vitamin D deficiency will likely have:
- a. High PTH levels (secondary hyperparathyroidism).
- b. Low PTH levels.
- c. High serum calcium.
- d. High serum phosphate.
Answer: a. High PTH levels (secondary hyperparathyroidism).
45. Which of the following is the most bioavailable form of oral calcium supplement, which does not require an acidic environment for absorption?
- a. Calcium carbonate
- b. Calcium citrate
- c. Calcium phosphate
- d. All are equally bioavailable.
Answer: b. Calcium citrate
46. A patient is taking a phosphate binder containing calcium. A pharmacist should be aware of the potential for this to contribute to:
- a. Hypocalcemia
- b. Hypercalcemia and vascular calcification
- c. Hypophosphatemia
- d. Hyperkalemia
Answer: b. Hypercalcemia and vascular calcification
47. The management of electrolyte abnormalities is covered in the renal system module.
- a. True
- b. False
Answer: a. True
48. An active learning session on endocrinology is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
49. The overall management of parathyroid disorders requires:
- a. A single medication for all patients.
- b. A “one-size-fits-all” dosing strategy.
- c. Careful monitoring of calcium, phosphate, and PTH levels to guide individualized therapy.
- d. A focus on diet alone.
Answer: c. Careful monitoring of calcium, phosphate, and PTH levels to guide individualized therapy.
50. The ultimate goal of learning about the management of parathyroid disorders is to:
- a. Safely manage complex electrolyte and bone metabolism disorders to improve patient outcomes.
- b. Be able to surgically remove the parathyroid gland.
- c. Pass the endocrinology exam.
- d. Memorize the structure of parathyroid hormone.
Answer: a. Safely manage complex electrolyte and bone metabolism disorders to improve patient outcomes.