Hydrocortisone MCQs With Answer

Hydrocortisone MCQs With Answer

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Hydrocortisone MCQs With Answer

Hydrocortisone is a fundamental glucocorticoid used in replacement therapy, anti-inflammatory and immunosuppressive treatments. This collection of Hydrocortisone MCQs is designed for B. Pharm students to deepen understanding of pharmacology, mechanism of action, pharmacokinetics, formulations (topical, oral, IV), dosing, adverse effects, HPA axis suppression, drug interactions, and clinical monitoring. Questions emphasize practical knowledge such as indications (adrenal insufficiency, allergic and dermatologic uses), potency comparisons, and emergency management. Clear explanations and targeted practice will strengthen exam readiness and clinical decision-making. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Hydrocortisone is best described as which of the following?

  • The natural human glucocorticoid identical to cortisol
  • A synthetic long-acting glucocorticoid only used topically
  • A mineralocorticoid-only hormone
  • An anti-histamine derivative

Correct Answer: The natural human glucocorticoid identical to cortisol

Q2. The primary mechanism of action of hydrocortisone involves:

  • Blocking H1 histamine receptors on mast cells
  • Activation of intracellular glucocorticoid receptors and modulation of gene transcription
  • Inhibition of cyclooxygenase-1 enzyme directly
  • Binding to opioid receptors in the CNS

Correct Answer: Activation of intracellular glucocorticoid receptors and modulation of gene transcription

Q3. Compared with synthetic glucocorticoids like dexamethasone, hydrocortisone has:

  • Greater glucocorticoid potency and no mineralocorticoid effect
  • Approximately equal potency and no mineralocorticoid activity
  • Lower glucocorticoid potency but significant mineralocorticoid activity
  • No clinical use in adrenal insufficiency

Correct Answer: Lower glucocorticoid potency but significant mineralocorticoid activity

Q4. The preferred initial treatment for an adrenal crisis is:

  • Oral hydrocortisone tablets at home
  • Topical hydrocortisone application
  • Intravenous hydrocortisone injection
  • Subcutaneous insulin injection

Correct Answer: Intravenous hydrocortisone injection

Q5. For topical dermatologic use, hydrocortisone is classified as:

  • High-potency topical steroid
  • Medium-potency topical steroid
  • Low-potency topical steroid
  • Non-steroidal anti-inflammatory cream

Correct Answer: Low-potency topical steroid

Q6. Long-term systemic use of hydrocortisone is most likely to cause which adverse effect?

  • Osteoporosis and increased fracture risk
  • Improved bone density
  • Permanent increase in adrenal hormone production
  • Reduced blood glucose levels chronically

Correct Answer: Osteoporosis and increased fracture risk

Q7. Suppression of the hypothalamic-pituitary-adrenal (HPA) axis is most likely with which regimen?

  • A single low-dose topical application
  • Short course (<3 days) of oral hydrocortisone
  • Prolonged high-dose systemic therapy
  • Topical hydrocortisone cream applied once to a small area

Correct Answer: Prolonged high-dose systemic therapy

Q8. The primary organ responsible for metabolism of hydrocortisone is:

  • The kidneys by filtration only
  • The liver by reduction and conjugation
  • The pancreas through enzymatic hydrolysis
  • The lungs through oxidative metabolism

Correct Answer: The liver by reduction and conjugation

Q9. Which drug interaction is clinically significant for hydrocortisone levels?

  • Rifampicin decreasing hydrocortisone effectiveness by enzyme induction
  • Amoxicillin increasing hydrocortisone bioavailability
  • Metformin causing hydrocortisone accumulation
  • Vitamin C preventing hydrocortisone metabolism

Correct Answer: Rifampicin decreasing hydrocortisone effectiveness by enzyme induction

Q10. In pregnancy, hydrocortisone exposure to the fetus is limited because:

  • Hydrocortisone is completely excluded from maternal circulation
  • Placental 11β-HSD2 inactivates a significant portion to cortisone
  • It is rapidly excreted unchanged in urine before reaching placenta
  • Hydrocortisone cannot cross cell membranes

Correct Answer: Placental 11β-HSD2 inactivates a significant portion to cortisone

Q11. For an acute exacerbation of severe eczema in hospital, which formulation is appropriate?

  • High-potency oral hydrocortisone tablets only
  • Topical hydrocortisone cream and systemic therapy as needed
  • Long-term intramuscular depot steroid as first-line
  • Avoid any corticosteroid use

Correct Answer: Topical hydrocortisone cream and systemic therapy as needed

Q12. Hydrocortisone’s effect on carbohydrate metabolism typically causes:

  • Hypoglycemia due to increased insulin secretion
  • Hyperglycemia due to increased gluconeogenesis and insulin resistance
  • No change in glucose homeostasis
  • Permanent cure of diabetes mellitus

Correct Answer: Hyperglycemia due to increased gluconeogenesis and insulin resistance

Q13. Which laboratory change is characteristic after systemic hydrocortisone administration?

  • Decreased neutrophil count and increased lymphocytes
  • Neutrophilia and lymphopenia
  • Marked thrombocytopenia
  • Rapid rise in serum creatinine

Correct Answer: Neutrophilia and lymphopenia

Q14. Which scenario is contraindicated for systemic hydrocortisone therapy?

  • Acute adrenal insufficiency
  • Systemic fungal infection without antifungal cover
  • Severe allergic reaction as adjunctive care
  • Palliative management of certain cancers

Correct Answer: Systemic fungal infection without antifungal cover

Q15. To minimize HPA suppression when stopping long-term high-dose hydrocortisone, you should:

  • Stop immediately once symptoms resolve
  • Taper the dose gradually over weeks to months
  • Switch abruptly to a topical steroid
  • Double the dose for two weeks before stopping

Correct Answer: Taper the dose gradually over weeks to months

Q16. Which hydrocortisone formulation is commonly used for emergency parenteral therapy?

  • Hydrocortisone acetate oral tablet
  • Hydrocortisone sodium succinate for IV injection
  • Hydrocortisone topical ointment
  • Hydrocortisone inhaler powder

Correct Answer: Hydrocortisone sodium succinate for IV injection

Q17. Which feature helps distinguish hydrocortisone from more potent synthetic glucocorticoids?

  • Longer biological half-life and no mineralocorticoid action
  • Shorter duration of action and measurable mineralocorticoid effect
  • Exclusive topical use only
  • No anti-inflammatory properties

Correct Answer: Shorter duration of action and measurable mineralocorticoid effect

Q18. For a patient on chronic replacement hydrocortisone therapy, what advice is appropriate during acute illness or surgery?

  • Stop hydrocortisone because illness will increase endogenous cortisol
  • Continue usual dose with no changes
  • Increase the dose (stress dosing) during illness or perioperatively
  • Switch to topical hydrocortisone only

Correct Answer: Increase the dose (stress dosing) during illness or perioperatively

Q19. Which adverse dermatologic effect can occur with prolonged topical hydrocortisone use?

  • Skin atrophy and striae with chronic excessive use
  • Immediate systemic Cushing’s syndrome after one application
  • Permanent increase in hair color
  • Enhanced skin regeneration and thickness

Correct Answer: Skin atrophy and striae with chronic excessive use

Q20. Which clinical test is most useful to assess adrenal reserve when hydrocortisone therapy is suspected to suppress endogenous cortisol?

  • Random afternoon serum sodium
  • ACTH (cosyntropin) stimulation test
  • Complete blood count only
  • Fasting lipid profile

Correct Answer: ACTH (cosyntropin) stimulation test

Q21. Live vaccines in patients on systemic hydrocortisone are generally:

  • Safe without restrictions regardless of dose
  • Contraindicated during significant immunosuppression from systemic corticosteroids
  • Recommended as the only therapy for immune suppression
  • Irrelevant to hydrocortisone therapy

Correct Answer: Contraindicated during significant immunosuppression from systemic corticosteroids

Q22. Which electrolyte change is commonly associated with hydrocortisone’s mineralocorticoid action?

  • Hyperkalemia due to potassium retention
  • Hypokalemia due to potassium loss and sodium retention
  • No change in sodium or potassium balance
  • Marked hypercalcemia

Correct Answer: Hypokalemia due to potassium loss and sodium retention

Q23. Hydrocortisone’s immunosuppressive and anti-inflammatory effects are primarily due to:

  • Enhancement of leukotriene synthesis
  • Inhibition of inflammatory gene expression and cytokine production
  • Direct killing of bacteria and viruses
  • Blocking renal excretion of inflammatory mediators

Correct Answer: Inhibition of inflammatory gene expression and cytokine production

Q24. In children, prolonged systemic hydrocortisone therapy carries a significant risk of:

  • Enhanced linear growth and puberty acceleration
  • Growth suppression and potential delayed puberty
  • Permanent immunity to infections
  • Improved bone maturation

Correct Answer: Growth suppression and potential delayed puberty

Q25. Which statement about topical hydrocortisone potency and systemic absorption is correct?

  • Low-potency hydrocortisone never absorbs systemically regardless of area treated
  • Systemic absorption increases with occlusion, large surface area, and prolonged use
  • Systemic absorption is immediate and identical to IV dosing
  • Hydrocortisone cannot be absorbed through damaged skin

Correct Answer: Systemic absorption increases with occlusion, large surface area, and prolonged use

Q26. Which hydrocortisone formulation is most appropriate for rapid reduction of severe inflammation in hospital?

  • Oral hydrocortisone tablets given once weekly
  • Intravenous hydrocortisone sodium succinate
  • Topical hydrocortisone cream applied to a distant site
  • Delayed-release hydrocortisone tablets taken overnight

Correct Answer: Intravenous hydrocortisone sodium succinate

Q27. Which monitoring parameter is most important in a diabetic patient starting systemic hydrocortisone?

  • Daily body weight only
  • Frequent blood glucose monitoring and adjustment of antidiabetic therapy
  • Monthly uric acid levels only
  • No monitoring required

Correct Answer: Frequent blood glucose monitoring and adjustment of antidiabetic therapy

Q28. Hydrocortisone produces rapid non-genomic effects; however, its principal clinical effects are mediated by:

  • Membrane receptor blockade exclusively
  • Genomic mechanisms altering transcription over hours
  • Direct enzymatic degradation of inflammatory mediators within seconds
  • Permanent modification of DNA sequence

Correct Answer: Genomic mechanisms altering transcription over hours

Q29. Which practice reduces the risk of systemic side effects when using topical hydrocortisone?

  • Applying to large areas under occlusion for prolonged periods
  • Using the lowest effective potency for the shortest duration
  • Doubling frequency of application routinely
  • Mixing with systemic steroids without medical advice

Correct Answer: Using the lowest effective potency for the shortest duration

Q30. Which statement about hydrocortisone replacement dosing is correct?

  • Maintenance replacement doses mimic physiologic circadian rhythm and often require morning dosing
  • Replacement therapy should always be given as a single nighttime dose to mimic physiology
  • Hydrocortisone replacement does not require individualized dosing
  • Higher doses are never required during stress or surgery

Correct Answer: Maintenance replacement doses mimic physiologic circadian rhythm and often require morning dosing

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