The adrenal gland is a small but mighty endocrine organ responsible for producing critical hormones like cortisol and aldosterone that regulate stress, metabolism, and fluid balance. Disorders of the adrenal gland, a key topic in the Patient Care 5 endocrinology module, lead to significant and complex conditions like Cushing’s syndrome and Addison’s disease. This quiz will test your knowledge on the pathophysiology of these disorders and the pharmacologic principles behind their management, including the nuanced use of corticosteroid therapy.
1. Which part of the adrenal gland is responsible for producing glucocorticoids like cortisol?
- a. Adrenal medulla
- b. Zona glomerulosa
- c. Zona fasciculata
- d. Zona reticularis
Answer: c. Zona fasciculata
2. Cushing’s syndrome is a condition characterized by an excess of which hormone?
- a. Aldosterone
- b. Cortisol
- c. Epinephrine
- d. Androgens
Answer: b. Cortisol
3. A patient presents with central obesity, a “moon face,” a “buffalo hump,” and purple striae. These are classic physical signs of:
- a. Addison’s disease
- b. Cushing’s syndrome
- c. Hyperaldosteronism
- d. Pheochromocytoma
Answer: b. Cushing’s syndrome
4. What is the primary difference between Cushing’s syndrome and Cushing’s disease?
- a. There is no difference; the terms are interchangeable.
- b. Cushing’s syndrome is any condition with excess cortisol, while Cushing’s disease is specifically caused by a pituitary adenoma secreting excess ACTH.
- c. Cushing’s disease involves a cortisol deficiency.
- d. Cushing’s syndrome is caused by an adrenal tumor, while Cushing’s disease is caused by exogenous steroids.
Answer: b. Cushing’s syndrome is any condition with excess cortisol, while Cushing’s disease is specifically caused by a pituitary adenoma secreting excess ACTH.
5. Addison’s disease, or primary adrenal insufficiency, is characterized by a deficiency of:
- a. Cortisol only
- b. Aldosterone only
- c. Both cortisol and aldosterone
- d. ACTH only
Answer: c. Both cortisol and aldosterone
6. The “Adrenal 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. A patient with Addison’s disease presents with hypotension, hyperkalemia, and hyponatremia. These signs are primarily due to the lack of:
- a. Cortisol
- b. Androgens
- c. Epinephrine
- d. Aldosterone
Answer: d. Aldosterone
8. What is the standard pharmacologic treatment for Addison’s disease?
- a. Glucocorticoid replacement (e.g., hydrocortisone) only.
- b. Mineralocorticoid replacement (e.g., fludrocortisone) only.
- c. Both glucocorticoid and mineralocorticoid replacement.
- d. A high-dose corticosteroid to suppress the immune system.
Answer: c. Both glucocorticoid and mineralocorticoid replacement.
9. A patient on chronic high-dose prednisone therapy abruptly stops taking their medication. They are at high risk for developing:
- a. Cushing’s syndrome
- b. Secondary adrenal insufficiency
- c. Conn’s syndrome
- d. Pheochromocytoma
Answer: b. Secondary adrenal insufficiency
10. A patient with known adrenal insufficiency is undergoing a major surgery. What adjustment should be made to their corticosteroid regimen?
- a. The dose should be tapered off before surgery.
- b. The dose should be significantly increased (“stress dosing”) to mimic the body’s natural stress response.
- c. The dose should be switched to a mineralocorticoid only.
- d. No change in dose is needed.
Answer: b. The dose should be significantly increased (“stress dosing”) to mimic the body’s natural stress response.
11. The pharmacology and medicinal chemistry of corticosteroids is a topic within the Patient Care 3 curriculum.
- a. True
- b. False
Answer: a. True
12. Hyperpigmentation of the skin is a classic sign of which adrenal disorder?
- a. Cushing’s syndrome
- b. Primary adrenal insufficiency (Addison’s disease)
- c. Secondary adrenal insufficiency
- d. Hyperaldosteronism
Answer: b. Primary adrenal insufficiency (Addison’s disease)
13. A patient with primary hyperaldosteronism (Conn’s syndrome) would be expected to have which lab abnormalities?
- a. Hyperkalemia and hyponatremia
- b. Hypokalemia and hypertension
- c. Normal electrolytes and blood pressure
- d. Hyperglycemia and hyperlipidemia
Answer: b. Hypokalemia and hypertension
14. What is the drug of choice for treating primary hyperaldosteronism?
- a. Hydrocortisone
- b. A non-selective beta-blocker
- c. An aldosterone antagonist like spironolactone or eplerenone.
- d. A loop diuretic.
Answer: c. An aldosterone antagonist like spironolactone or eplerenone.
15. A patient with Cushing’s syndrome is being treated pharmacologically with ketoconazole. The goal of this therapy is to:
- a. Replace cortisol.
- b. Inhibit steroidogenesis (cortisol synthesis).
- c. Block aldosterone receptors.
- d. Stimulate ACTH release.
Answer: b. Inhibit steroidogenesis (cortisol synthesis).
16. An adrenal crisis is a life-threatening emergency characterized by:
- a. Severe hypertension and hyperglycemia.
- b. Severe hypotension, shock, and dehydration.
- c. A severe skin rash.
- d. An extremely high fever only.
Answer: b. Severe hypotension, shock, and dehydration.
17. The immediate treatment for an adrenal crisis is:
- a. Oral hydrocortisone
- b. IV fludrocortisone
- c. IV hydrocortisone and aggressive IV fluid resuscitation.
- d. An epinephrine injection.
Answer: c. IV hydrocortisone and aggressive IV fluid resuscitation.
18. The hypothalamic-pituitary-adrenal (HPA) axis operates on what type of feedback mechanism?
- a. Positive feedback
- b. Negative feedback
- c. Feed-forward
- d. No feedback
Answer: b. Negative feedback
19. Which corticosteroid has the most potent anti-inflammatory (glucocorticoid) activity?
- a. Hydrocortisone
- b. Prednisone
- c. Dexamethasone
- d. Cortisone
Answer: c. Dexamethasone
20. An active learning session on adrenal gland disorders is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. Which corticosteroid has significant mineralocorticoid activity and is used for mineralocorticoid replacement?
- a. Dexamethasone
- b. Methylprednisolone
- c. Prednisone
- d. Fludrocortisone
Answer: d. Fludrocortisone
22. A key counseling point for a patient on long-term steroid therapy is:
- a. The medication can be stopped abruptly at any time.
- b. The importance of not stopping the medication abruptly and the need for a slow taper.
- c. To take the medication on an empty stomach.
- d. That there are no long-term side effects.
Answer: b. The importance of not stopping the medication abruptly and the need for a slow taper.
23. The adrenal medulla is responsible for synthesizing:
- a. Cortisol
- b. Aldosterone
- c. Catecholamines (epinephrine, norepinephrine)
- d. Androgens
Answer: c. Catecholamines (epinephrine, norepinephrine)
24. An active learning session on adrenal 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
25. A patient with adrenal insufficiency should be counseled to wear a medical alert bracelet.
- a. True
- b. False
Answer: a. True
26. Which of the following is a long-term complication of Cushing’s syndrome or chronic steroid use?
- a. Osteoporosis
- b. Diabetes
- c. Increased risk of infections
- d. All of the above
Answer: d. All of the above.
27. Spironolactone can cause which anti-androgenic side effect?
- a. Alopecia
- b. Gynecomastia
- c. Hirsutism
- d. Acne
Answer: b. Gynecomastia
28. An active learning session on adrenal disorders is part of which course module?
- a. Module 2: Endocrinology
- b. Module 3: Women’s Health
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 2: Endocrinology
29. The release of cortisol follows a diurnal rhythm, with levels being highest:
- a. In the late evening.
- b. In the middle of the night.
- c. In the early morning upon waking.
- d. In the afternoon.
Answer: c. In the early morning upon waking.
30. The “Management of Adrenal Gland Disorders” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. In secondary adrenal insufficiency, aldosterone levels are typically normal. Why?
- a. Because aldosterone release is primarily regulated by the renin-angiotensin-aldosterone system (RAAS), not ACTH.
- b. Because the adrenal gland can still make aldosterone without ACTH.
- c. Because aldosterone is not an important hormone.
- d. Aldosterone levels are actually low in secondary adrenal insufficiency.
Answer: a. Because aldosterone release is primarily regulated by the renin-angiotensin-aldosterone system (RAAS), not ACTH.
32. The “moon facies” seen in Cushing’s syndrome is due to:
- a. Fluid retention.
- b. A buildup of muscle.
- c. The redistribution of fat.
- d. An allergic reaction.
Answer: c. The redistribution of fat.
33. A patient on replacement hydrocortisone for Addison’s disease gets the stomach flu and is vomiting. They should:
- a. Stop taking their hydrocortisone.
- b. Take their normal oral dose.
- c. Contact their doctor immediately as they may need IV hydrocortisone.
- d. Double their next oral dose.
Answer: c. Contact their doctor immediately as they may need IV hydrocortisone.
34. The primary role of aldosterone is to:
- a. Increase blood glucose.
- b. Promote sodium and water reabsorption and potassium excretion in the kidneys.
- c. Suppress the immune system.
- d. Increase heart rate.
Answer: b. Promote sodium and water reabsorption and potassium excretion in the kidneys.
35. A pharmacist’s role in managing patients with adrenal disorders includes:
- a. Counseling on the signs of adrenal crisis.
- b. Educating on the need for stress dosing.
- c. Counseling on corticosteroid side effects.
- d. All of the above.
Answer: d. All of the above.
36. Eplerenone has what advantage over spironolactone as an aldosterone antagonist?
- a. It is more potent.
- b. It is less expensive.
- c. It has a lower affinity for androgen and progesterone receptors, causing fewer endocrine side effects.
- d. It is dosed once weekly.
Answer: c. It has a lower affinity for androgen and progesterone receptors, causing fewer endocrine side effects.
37. The “Intro to Adrenal Gland” is a lecture in the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
38. The most common cause of endogenous Cushing’s syndrome is:
- a. An adrenal adenoma.
- a. A pituitary adenoma secreting ACTH (Cushing’s disease).
- c. An ectopic ACTH-producing tumor.
- d. Adrenal carcinoma.
Answer: b. A pituitary adenoma secreting ACTH (Cushing’s disease).
39. A patient is taking prednisone 5 mg daily for rheumatoid arthritis. This is considered a ________ dose.
- a. high
- b. moderate
- c. low (physiologic or near-physiologic)
- d. stress
Answer: c. low (physiologic or near-physiologic)
40. An active learning session covering adrenal 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. Which of the following is a symptom of adrenal crisis?
- a. Extreme weakness
- b. Abdominal pain, vomiting
- c. Hypotension and shock
- d. All of the above
Answer: d. All of the above
42. The most common cause of primary adrenal insufficiency in developed countries is:
- a. Infection (like tuberculosis).
- b. Autoimmune adrenalitis.
- c. Cancer metastasis to the adrenal glands.
- d. Congenital adrenal hyperplasia.
Answer: b. Autoimmune adrenalitis.
43. A patient on hydrocortisone for Addison’s disease should be counseled to take their doses:
- a. All at bedtime.
- b. In divided doses, with a larger portion in the morning, to mimic the natural cortisol rhythm.
- c. Once a week.
- d. Only when they feel stressed.
Answer: b. In divided doses, with a larger portion in the morning, to mimic the natural cortisol rhythm.
44. What is the role of ACTH (corticotropin)?
- a. It is released from the hypothalamus to stimulate the pituitary.
- b. It is released from the pituitary to stimulate the adrenal cortex to produce cortisol.
- c. It is released from the adrenal gland to provide negative feedback.
- d. It is another name for cortisol.
Answer: b. It is released from the pituitary to stimulate the adrenal cortex to produce cortisol.
45. Which of the following is NOT a side effect of long-term supraphysiologic corticosteroid use?
- a. Osteoporosis
- b. Hyperglycemia
- c. Hypopigmentation
- d. Glaucoma and cataracts
Answer: c. Hypopigmentation
46. A dexamethasone suppression test is used to help diagnose:
- a. Adrenal insufficiency
- b. Cushing’s syndrome
- c. Hyperaldosteronism
- d. Pheochromocytoma
Answer: b. Cushing’s syndrome
47. A patient with secondary adrenal insufficiency does not typically need fludrocortisone because:
- a. Their body produces excess aldosterone.
- b. Their aldosterone production, regulated by the RAAS, is usually intact.
- c. Fludrocortisone is contraindicated.
- d. Their cortisol provides enough mineralocorticoid activity.
Answer: b. Their aldosterone production, regulated by the RAAS, is usually intact.
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 adrenal disorders requires:
- a. A single medication to cure the condition.
- b. Careful diagnosis of the underlying cause and tailored hormone replacement or suppression therapy.
- c. Only surgical intervention.
- d. A low-sodium diet for all conditions.
Answer: b. Careful diagnosis of the underlying cause and tailored hormone replacement or suppression therapy.
50. The ultimate goal of learning about the management of adrenal disorders is to:
- a. Safely manage complex hormone therapies to prevent life-threatening complications and improve quality of life.
- b. Be able to order and interpret all endocrine tests.
- c. Pass the endocrinology module.
- d. Memorize the structures of all corticosteroids.
Answer: a. Safely manage complex hormone therapies to prevent life-threatening complications and improve quality of life.