Corticosteroids MCQs With Answer is a focused review designed for B. Pharm students to deepen understanding of corticosteroid pharmacology, clinical uses, adverse effects and therapeutic monitoring. This collection emphasizes key concepts such as glucocorticoid versus mineralocorticoid actions, mechanism of action via glucocorticoid receptors, steroid potency and equivalent dosing, pharmacokinetics, HPA axis suppression and tapering, drug interactions, and common toxicities like hyperglycemia and osteoporosis. Questions include practical clinical and formulation aspects—systemic, inhaled and topical steroids—plus interpretation of diagnostic tests and management of complications. The set is ideal for exam preparation and reinforcing applied knowledge in therapeutics and pharmacy practice. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. What is the primary mechanism by which glucocorticoids exert their anti‑inflammatory effects?
- Activation of membrane cyclooxygenase enzymes
- Inhibition of phospholipase A2 via induction of lipocortin (annexin-1)
- Direct neutralization of circulating cytokines
- Blocking T-cell receptor signaling at the cell membrane
Correct Answer: Inhibition of phospholipase A2 via induction of lipocortin (annexin-1)
Q2. Which of the following best describes the cellular location of the inactive glucocorticoid receptor before ligand binding?
- Nucleus bound to DNA
- Cytoplasm bound to heat shock proteins (HSP90)
- Mitochondrial membrane
- Embedded in the plasma membrane
Correct Answer: Cytoplasm bound to heat shock proteins (HSP90)
Q3. Which enzyme converts inactive cortisone to active cortisol in peripheral tissues?
- 11β-hydroxylase
- 17α-hydroxylase
- 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1)
- 21-hydroxylase
Correct Answer: 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1)
Q4. Which corticosteroid has the highest systemic glucocorticoid potency with minimal mineralocorticoid activity?
- Hydrocortisone
- Prednisone
- Methylprednisolone
- Dexamethasone
Correct Answer: Dexamethasone
Q5. According to standard equivalence, 5 mg of prednisone is approximately equivalent to which daily dose of hydrocortisone?
- 5 mg hydrocortisone
- 20 mg hydrocortisone
- 40 mg hydrocortisone
- 0.75 mg hydrocortisone
Correct Answer: 20 mg hydrocortisone
Q6. Which laboratory pattern is most consistent with primary (Addison’s) adrenal insufficiency when using the ACTH stimulation test?
- Normal baseline cortisol and exaggerated response to ACTH
- Low baseline cortisol with marked increase after ACTH
- Low cortisol that fails to rise after ACTH, with high plasma ACTH
- High baseline cortisol with suppressed ACTH
Correct Answer: Low cortisol that fails to rise after ACTH, with high plasma ACTH
Q7. Which adverse effect is most commonly observed with long‑term systemic corticosteroid therapy?
- Hypoglycemia
- Osteoporosis and increased fracture risk
- Decreased susceptibility to infections
- Marked weight loss
Correct Answer: Osteoporosis and increased fracture risk
Q8. What hematologic change is typically produced by systemic corticosteroids?
- Lymphocytosis and eosinophilia
- Neutrophilia due to demargination, with lymphopenia
- Pancytopenia
- Selective basophil increase only
Correct Answer: Neutrophilia due to demargination, with lymphopenia
Q9. Which topical steroid is classified as super‑potent and commonly used for short-term severe dermatoses?
- Hydrocortisone 1% cream
- Betamethasone valerate 0.1% cream
- Clobetasol propionate 0.05% ointment
- Triamcinolone acetonide 0.1% cream
Correct Answer: Clobetasol propionate 0.05% ointment
Q10. Which statement about inhaled corticosteroids is true?
- They have no systemic absorption and no systemic adverse effects
- Oropharyngeal candidiasis is a common local side effect
- They are ineffective for maintenance therapy in asthma
- They cause immediate adrenal suppression after a single dose
Correct Answer: Oropharyngeal candidiasis is a common local side effect
Q11. Which corticosteroid is commonly used as mineralocorticoid replacement in primary adrenal insufficiency?
- Fludrocortisone
- Dexamethasone
- Hydrocortisone exclusively (no mineralocorticoid needed)
- Betamethasone
Correct Answer: Fludrocortisone
Q12. What is a principal rationale for using morning dosing of systemic corticosteroids?
- Maximizes immunosuppression during sleep
- Avoids interaction with food
- Reduces HPA axis suppression by aligning with circadian cortisol peak
- Enhances topical absorption
Correct Answer: Reduces HPA axis suppression by aligning with circadian cortisol peak
Q13. Which drug interaction increases systemic corticosteroid levels and risk of Cushingoid effects?
- Rifampicin coadministration
- Carbamazepine coadministration
- Ketoconazole coadministration
- Phenobarbital coadministration
Correct Answer: Ketoconazole coadministration
Q14. Prednisone is a prodrug that must be converted in the liver to which active compound?
- Hydrocortisone
- Prednisolone
- Cortisone acetate
- Dexamethasone
Correct Answer: Prednisolone
Q15. Which of the following is an important prophylactic measure to prevent corticosteroid‑induced osteoporosis in chronic users?
- Short naps during daytime
- High‑dose systemic vitamin C
- Calcium and vitamin D supplementation with bisphosphonate therapy when indicated
- Avoid weight‑bearing exercise
Correct Answer: Calcium and vitamin D supplementation with bisphosphonate therapy when indicated
Q16. In a patient receiving long‑term systemic corticosteroids, abrupt withdrawal can lead to which dangerous condition?
- Hyperthyroidism
- Adrenal crisis due to HPA axis suppression
- Immediate rebound asthma only
- Permanent immune enhancement
Correct Answer: Adrenal crisis due to HPA axis suppression
Q17. Which steroid is commonly administered antenatally to accelerate fetal lung maturation in threatened preterm labor?
- Hydrocortisone
- Betamethasone
- Fludrocortisone
- Prednisone (oral maternal dosing only)
Correct Answer: Betamethasone
Q18. Which adverse psychiatric effect can be caused by high‑dose corticosteroid therapy?
- Sedative hypomania only
- Depressive symptoms, mood swings, or steroid‑induced psychosis
- Selective memory improvement
- Permanent suppression of all emotions
Correct Answer: Depressive symptoms, mood swings, or steroid‑induced psychosis
Q19. Which clinical situation is a relative contraindication to systemic corticosteroid therapy?
- Severe bacterial sepsis adequately covered with antibiotics
- Uncontrolled systemic fungal infection
- Acute spinal cord compression where steroids are indicated
- Organ transplant rejection prophylaxis
Correct Answer: Uncontrolled systemic fungal infection
Q20. Which monitoring test is most useful to detect early steroid‑induced bone loss in chronic users?
- Serum potassium
- DEXA (bone mineral density) scan
- Chest X‑ray
- Fasting insulin level
Correct Answer: DEXA (bone mineral density) scan
Q21. Which corticosteroid is preferred for rapid anti‑inflammatory effect in severe asthma exacerbation given intravenously?
- Oral hydrocortisone only
- Intravenous methylprednisolone
- Topical betamethasone
- Inhaled beclomethasone immediately
Correct Answer: Intravenous methylprednisolone
Q22. How do corticosteroids typically affect blood glucose?
- Cause hypoglycemia by increasing insulin sensitivity
- No effect on glucose metabolism
- Cause hyperglycemia by increasing gluconeogenesis and insulin resistance
- Lower hepatic glucose production
Correct Answer: Cause hyperglycemia by increasing gluconeogenesis and insulin resistance
Q23. Which enzyme deficiency would lead to excessive mineralocorticoid activity from cortisol at the renal mineralocorticoid receptor?
- Deficiency of 11β-HSD2
- Excess 11β-HSD1 activity
- 21‑hydroxylase deficiency
- 17α‑hydroxylase deficiency
Correct Answer: Deficiency of 11β-HSD2
Q24. Which steroid synthesis inhibitor is commonly used diagnostically and therapeutically to block 11β‑hydroxylase?
- Ketoconazole
- Metyrapone
- Mifepristone
- Spironolactone
Correct Answer: Metyrapone
Q25. What pharmacokinetic property distinguishes prednisolone from prednisone?
- Prednisone is active without metabolic conversion
- Prednisolone is the active form and does not require hepatic activation
- Both are inactive prodrugs
- Prednisolone has no anti‑inflammatory activity
Correct Answer: Prednisolone is the active form and does not require hepatic activation
Q26. Which clinical strategy is used to minimize systemic adverse effects while maintaining efficacy in chronic inflammatory disease?
- Use highest possible systemic dose continuously
- Prefer topical, inhaled, or intra‑articular routes and use lowest effective systemic dose
- Abruptly stop therapy every week
- Combine multiple oral steroids simultaneously
Correct Answer: Prefer topical, inhaled, or intra‑articular routes and use lowest effective systemic dose
Q27. Which sign is characteristic of Cushing’s syndrome caused by long‑term corticosteroid use?
- Peripheral muscle hypertrophy and weight loss
- Central obesity, moon face and buffalo hump
- Generalized hypopigmentation
- Bradycardia and cold intolerance
Correct Answer: Central obesity, moon face and buffalo hump
Q28. Which adrenal receptor mediates sodium retention and potassium loss when activated by mineralocorticoids?
- Glucocorticoid receptor in the nucleus
- Mineralocorticoid receptor in the renal distal tubule
- Beta‑adrenergic receptor in the heart
- Insulin receptor in muscle
Correct Answer: Mineralocorticoid receptor in the renal distal tubule
Q29. Which of the following is an appropriate step when a patient on long‑term prednisone shows signs of HPA suppression?
- Stop prednisone immediately and start antibiotics
- Switch to a super‑potent topical steroid
- Taper the prednisone gradually to allow HPA recovery and consider endocrinology referral
- Double the dose for one week then stop
Correct Answer: Taper the prednisone gradually to allow HPA recovery and consider endocrinology referral
Q30. Which therapy can potentiate systemic corticosteroid effects by inhibiting hepatic metabolism and thereby increase toxicity risk?
- Co‑administration of rifampicin
- Co‑administration of phenytoin
- Co‑administration of strong CYP3A4 inhibitors like ketoconazole
- Co‑administration of antacids only
Correct Answer: Co‑administration of strong CYP3A4 inhibitors like ketoconazole
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