Corticosteroids: mechanism, uses and adverse effects MCQs With Answer

Corticosteroids: mechanism, uses and adverse effects MCQs With Answer

This quiz set is designed for M.Pharm students preparing for Advanced Pharmacology-II and focuses on corticosteroids—their molecular mechanisms, clinical applications and adverse effect profiles. Questions emphasize both genomic and non‑genomic actions, receptor selectivity, metabolic activation, therapeutic choices in different clinical settings (asthma, adrenal insufficiency, cerebral edema, transplant, dermatology) and common pharmacokinetic interactions. Adverse effect scenarios cover HPA axis suppression, metabolic consequences, bone health, growth effects and psychiatric manifestations. Use these MCQs to test mechanistic understanding, rational drug selection and safe clinical use, and review explanations where a deeper comprehension of pathway interactions and drug properties is required.

Q1. Which mechanism principally explains corticosteroid-mediated suppression of pro-inflammatory cytokine gene expression?

• Activation of glucocorticoid response elements (GRE) to induce anti‑inflammatory proteins
• Transrepression of transcription factors NF‑κB and AP‑1, reducing pro‑inflammatory gene transcription
• Direct enzymatic inhibition of cyclooxygenase‑1 activity
• Antagonism of TNF‑alpha receptors on inflammatory cells

Correct Answer: Transrepression of transcription factors NF‑κB and AP‑1, reducing pro‑inflammatory gene transcription

Q2. Rapid non‑genomic effects of high‑dose glucocorticoids are most likely mediated by which mechanism?

• Classic cytosolic glucocorticoid receptor altering gene transcription via GREs
• Membrane‑associated glucocorticoid receptors and direct effects on cell signaling
• Covalent modification of DNA by steroid molecules
• Irreversible inhibition of prostaglandin synthase

Correct Answer: Membrane‑associated glucocorticoid receptors and direct effects on cell signaling

Q3. Induction of annexin‑1 (lipocortin‑1) by glucocorticoids results primarily in inhibition of which enzyme?

• Cyclooxygenase‑2 (COX‑2)
• Phospholipase A2
• 5‑lipoxygenase
• Phosphodiesterase‑4

Correct Answer: Phospholipase A2

Q4. Prednisone is a prodrug that requires hepatic conversion to which active metabolite?

• Methylprednisolone
• Prednisolone
• Dexamethasone
• Hydrocortisone

Correct Answer: Prednisolone

Q5. Which systemic corticosteroid has minimal mineralocorticoid activity and is therefore preferred when sodium‑retaining effects are undesirable?

• Fludrocortisone
• Hydrocortisone
• Dexamethasone
• Prednisone

Correct Answer: Dexamethasone

Q6. Long‑term systemic corticosteroid therapy is most strongly associated with which skeletal adverse effect?

• Osteoporosis with increased fracture risk
• Transient hypercalcemia that resolves on withdrawal
• Enhanced bone formation leading to sclerosis
• Vitamin D intoxication

Correct Answer: Osteoporosis with increased fracture risk

Q7. A common peripheral blood change seen shortly after systemic glucocorticoid administration is:

• Lymphocytosis
• Eosinophilia
• Neutrophilia
• Thrombocytopenia

Correct Answer: Neutrophilia

Q8. For physiologic glucocorticoid replacement in primary adrenal insufficiency, which agent is most appropriate as the glucocorticoid component?

• Dexamethasone
• Hydrocortisone
• Methylprednisolone
• Budesonide

Correct Answer: Hydrocortisone

Q9. Which inhaled corticosteroid is noted for high first‑pass hepatic metabolism, reducing systemic exposure after oropharyngeal absorption?

• Beclomethasone dipropionate
• Fluticasone propionate
• Budesonide
• Prednisone (oral)

Correct Answer: Budesonide

Q10. Co‑administration of strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) most increases systemic exposure and risk of iatrogenic Cushing’s with which corticosteroid?

• Dexamethasone
• Fludrocortisone
• Fluticasone (especially inhaled or nasal formulations)
• Hydrocortisone

Correct Answer: Fluticasone (especially inhaled or nasal formulations)

Q11. Abrupt discontinuation of high‑dose, long‑term systemic corticosteroids most commonly risks which serious condition?

• Thyroid storm
• Addisonian (adrenal) crisis due to HPA axis suppression
• Immediate rebound hypertension
• Serotonin syndrome

Correct Answer: Addisonian (adrenal) crisis due to HPA axis suppression

Q12. Activation of mineralocorticoid receptors by certain corticosteroids is primarily associated with which electrolyte disturbance?

• Hyperkalemia and hyponatremia
• Hypernatremia and hypokalemia
• Hypocalcemia and hyperphosphatemia
• Metabolic acidosis with low chloride

Correct Answer: Hypernatremia and hypokalemia

Q13. For reduction of vasogenic cerebral edema associated with brain tumors, which corticosteroid is typically preferred?

• Hydrocortisone
• Fludrocortisone
• Dexamethasone
• Prednisone

Correct Answer: Dexamethasone

Q14. Steroid‑induced hyperglycemia is principally due to which metabolic action?

• Increased peripheral insulin sensitivity
• Increased hepatic gluconeogenesis and decreased peripheral glucose uptake
• Enhanced pancreatic beta‑cell insulin secretion
• Selective inhibition of intestinal glucose absorption

Correct Answer: Increased hepatic gluconeogenesis and decreased peripheral glucose uptake

Q15. Which adverse effect is of particular concern in children receiving chronic systemic corticosteroids?

• Peripheral neuropathy
• Growth suppression and reduced linear growth velocity
• Irreversible infertility
• Renal failure

Correct Answer: Growth suppression and reduced linear growth velocity

Q16. The term “transrepression” in glucocorticoid pharmacology refers to interference with which cellular components?

• Peroxisome proliferator‑activated receptors (PPARs)
• NF‑κB and AP‑1 transcription factors
• Tyrosine kinase growth factor receptors
• Mitochondrial electron transport complexes

Correct Answer: NF‑κB and AP‑1 transcription factors

Q17. Which corticosteroid is most potent on a milligram‑per‑milligram basis for glucocorticoid effects?

• Hydrocortisone
• Prednisolone
• Dexamethasone
• Fludrocortisone

Correct Answer: Dexamethasone

Q18. Progressive proximal muscle weakness in a patient on long‑term glucocorticoids is most consistent with which diagnosis?

• Myasthenia gravis
• Steroid myopathy
• Guillain‑Barré syndrome
• Polymyalgia rheumatica

Correct Answer: Steroid myopathy

Q19. Which corticosteroid is primarily used when mineralocorticoid replacement is required in primary adrenal (Addisonian) insufficiency?

• Fludrocortisone
• Dexamethasone
• Budesonide
• Hydrocortisone

Correct Answer: Fludrocortisone

Q20. High‑dose systemic corticosteroids can precipitate which prominent psychiatric adverse effect?

• Progressive dementia
• Acute psychosis with mood lability and mania‑like features
• Improved cognitive focus and reduced anxiety
• Primary obsessive‑compulsive disorder onset

Correct Answer: Acute psychosis with mood lability and mania‑like features

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