The intricate hormonal cascade of male reproduction, governed by the Hypothalamic-Pituitary-Gonadal (HPG) axis, is a cornerstone of men’s health. Pharmacists play a crucial role in managing disorders of this system, particularly testosterone deficiency (hypogonadism). This quiz, based on the Men’s Health module in the Patient Care 5 curriculum,will test your knowledge on the physiology of androgens and the pharmacotherapy used in testosterone replacement.
1. The Hypothalamic-Pituitary-Gonadal (HPG) axis begins with the release of which hormone from the hypothalamus?
- a. Testosterone
- b. Luteinizing Hormone (LH)
- c. Gonadotropin-releasing Hormone (GnRH)
- d. Follicle-stimulating Hormone (FSH)
Answer: c. Gonadotropin-releasing Hormone (GnRH)
2. Luteinizing Hormone (LH) stimulates which cells in the testes to produce testosterone?
- a. Sertoli cells
- b. Germ cells
- c. Leydig cells
- d. Epithelial cells
Answer: c. Leydig cells
3. What is the primary role of Follicle-stimulating Hormone (FSH) in males?
- a. To directly stimulate testosterone production.
- b. To act on Sertoli cells to support spermatogenesis.
- c. To provide negative feedback to the pituitary.
- d. To increase libido.
Answer: b. To act on Sertoli cells to support spermatogenesis.
4. Dihydrotestosterone (DHT) is a potent androgen responsible for:
- a. Development of internal male structures like the epididymis.
- b. Growth of the prostate and male pattern baldness.
- c. Regulation of bone mass.
- d. Stimulation of erythropoiesis.
Answer: b. Growth of the prostate and male pattern baldness.
5. Which enzyme converts testosterone to dihydrotestosterone (DHT)?
- a. Aromatase
- b. 5-alpha reductase
- c. CYP2D6
- d. Xanthine oxidase
Answer: b. 5-alpha reductase
6. The “Management of Testosterone Deficiency” is a specific lecture 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 testicular failure (e.g., from chemotherapy) has low testosterone but high LH and FSH levels. This is known as:
- a. Secondary hypogonadism
- b. Tertiary hypogonadism
- c. Primary hypogonadism
- d. Euthyroid sick syndrome
Answer: c. Primary hypogonadism
8. A patient with a pituitary tumor that prevents LH and FSH secretion has low testosterone and low LH/FSH levels. This is known as:
- a. Primary hypogonadism
- b. Secondary hypogonadism
- c. Hypergonadism
- d. Testicular resistance
Answer: b. Secondary hypogonadism
9. The diagnosis of hypogonadism requires:
- a. Only the presence of symptoms like low libido.
- b. Only a single low morning testosterone level.
- c. Both the presence of symptoms AND at least two confirmed low morning testosterone levels.
- d. A high hematocrit.
Answer: c. Both the presence of symptoms AND at least two confirmed low morning testosterone levels.
10. Which formulation of testosterone carries the highest risk of transference to others?
- a. Intramuscular injection
- b. Transdermal patch
- c. Topical gel
- d. Subcutaneous pellet
Answer: c. Topical gel
11. The management of men’s health disorders is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. A major contraindication for initiating testosterone replacement therapy (TRT) is:
- a. Benign prostatic hyperplasia
- b. Type 2 diabetes
- c. A history of active prostate cancer
- d. Osteoporosis
Answer: c. A history of active prostate cancer
13. A patient on TRT should have their hematocrit monitored due to the risk of:
- a. Anemia
- b. Polycythemia
- c. Neutropenia
- d. Thrombocytosis
Answer: b. Polycythemia
14. What is the goal of testosterone replacement therapy?
- a. To achieve supraphysiologic testosterone levels for muscle growth.
- b. To restore testosterone levels to the normal physiologic range for the patient’s age.
- c. To shrink the prostate gland.
- d. To increase fertility.
Answer: b. To restore testosterone levels to the normal physiologic range for the patient’s age.
15. Counseling patients on the appropriate use of medications and devices is a key objective for student pharmacists.
- a. True
- b. False
Answer: a. True
16. Testosterone cypionate is a long-acting injectable formulation because the ester group:
- a. Increases the potency of testosterone.
- b. Slows the absorption of testosterone from the oily vehicle.
- c. Makes the testosterone water-soluble.
- d. Decreases protein binding.
Answer: b. Slows the absorption of testosterone from the oily vehicle.
17. The “Introduction to Urological Disorders” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
18. Exogenous testosterone use leads to negative feedback on the HPG axis, which causes:
- a. Increased natural sperm production.
- b. Suppression of LH and FSH, leading to testicular atrophy and infertility.
- c. An increase in testicular size.
- d. No change in fertility.
Answer: b. Suppression of LH and FSH, leading to testicular atrophy and infertility.
19. Which of the following is NOT a potential side effect or risk of TRT?
- a. Worsening of BPH symptoms
- b. Gynecomastia (due to aromatization to estrogen)
- c. Improved glycemic control
- d. Acne and oily skin
Answer: c. Improved glycemic control
20. An active learning session on urological disorders is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. A patient using a testosterone patch should be counseled to:
- a. Apply it to the scrotum.
- b. Apply it to a new, clean, dry site each day and not use the same site for 7 days.
- c. Cut the patch in half if the dose is too high.
- d. Wear the same patch for a full week.
Answer: b. Apply it to a new, clean, dry site each day and not use the same site for 7 days.
22. Which of the following is a symptom of hypogonadism?
- a. Increased muscle mass
- b. Loss of body hair
- c. Increased libido
- d. Priapism
Answer: b. Loss of body hair
23. The principles of hormonal agents are covered in the Patient Care 2 oncology module.
- a. True
- b. False
Answer: a. True
24. An active learning session on men’s health 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 pharmacist’s role in TRT involves all of the following EXCEPT:
- a. Counseling on proper administration technique.
- b. Educating on the risks and expected benefits.
- c. Administering the intramuscular injections.
- d. Recommending appropriate lab monitoring.
Answer: c. Administering the intramuscular injections.
26. The primary mechanism of finasteride in treating male pattern baldness is:
- a. Increasing testosterone levels.
- b. Blocking the androgen receptor.
- c. Inhibiting the 5-alpha reductase enzyme, which decreases scalp DHT levels.
- d. Acting as a vasodilator.
Answer: c. Inhibiting the 5-alpha reductase enzyme, which decreases scalp DHT levels.
27. Testosterone levels naturally begin to decline in men after age:
- a. 20
- b. 30
- c. 50
- d. 65
Answer: b. 30
28. An active learning session on urological disorders is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 3: Women’s Health
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
29. The most significant portion of circulating testosterone is bound to:
- a. Red blood cells
- b. Sex hormone-binding globulin (SHBG)
- c. The androgen receptor
- d. Creatine kinase
Answer: b. Sex hormone-binding globulin (SHBG)
30. The “Management of Testosterone Deficiency” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. Which of the following is an oral androgen formulation that is absorbed via the lymphatic system, reducing hepatotoxicity?
- a. Methyltestosterone
- b. Fluoxymesterone
- c. Testosterone undecanoate
- d. Danazol
Answer: c. Testosterone undecanoate
32. A patient on TRT who develops an elevated hematocrit (>54%) may need to:
- a. Increase their testosterone dose.
- b. Have their dose held or reduced and/or undergo therapeutic phlebotomy.
- c. Start an iron supplement.
- d. Do nothing, as this is a desired effect.
Answer: b. Have their dose held or reduced and/or undergo therapeutic phlebotomy.
33. What is the primary reason for checking a PSA at baseline and during TRT?
- a. To monitor for the development or worsening of prostate cancer.
- b. To assess the efficacy of the therapy.
- c. To check for bone marrow suppression.
- d. To monitor for liver toxicity.
Answer: a. To monitor for the development or worsening of prostate cancer.
34. Which of the following is NOT a formulation of testosterone replacement therapy?
- a. Intramuscular injection
- b. Transdermal gel
- c. Intravenous infusion
- d. Subcutaneous pellet
Answer: c. Intravenous infusion
35. A key counseling point for a patient starting TRT is that improvement in symptoms:
- a. Is immediate for all symptoms.
- b. May take several weeks to months to become apparent.
- c. Is not expected.
- d. Only occurs with injectable formulations.
Answer: b. May take several weeks to months to become apparent.
36. “Anabolic” refers to the ____ properties of androgens, while “androgenic” refers to the ____ properties.
- a. masculinizing, muscle-building
- b. muscle-building, masculinizing
- c. stimulating, sedating
- d. sedating, stimulating
Answer: b. muscle-building, masculinizing
37. The abuse of anabolic-androgenic steroids can lead to what adverse psychiatric effect?
- a. Calmness
- b. Apathy
- c. Increased aggression and irritability (“roid rage”)
- d. Improved emotional control
Answer: c. Increased aggression and irritability (“roid rage”)
38. The lecture “Men’s Health 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
39. Testosterone replacement therapy can worsen which comorbid condition common in older men?
- a. Obstructive sleep apnea
- b. Gout
- c. Migraines
- d. Allergic rhinitis
Answer: a. Obstructive sleep apnea
40. An active learning session covering men’s health 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 TRT is to mimic the natural diurnal rhythm of testosterone production.
- a. True
- b. False
Answer: a. True
42. Which of the following is a potential cause of secondary hypogonadism?
- a. Klinefelter syndrome
- b. Testicular trauma
- c. Chronic opioid use
- d. Mumps orchitis
Answer: c. Chronic opioid use
43. A pharmacist’s role includes ensuring that a patient being evaluated for TRT has had:
- a. Their testosterone level checked appropriately.
- b. Their contraindications assessed.
- c. A discussion about the risks and benefits.
- d. All of the above.
Answer: d. All of the above.
44. Infertility is a potential side effect of TRT.
- a. True
- b. False
Answer: a. True
45. Which of the following is NOT a desired effect of TRT in a truly hypogonadal male?
- a. Increased bone mineral density
- b. Improved libido
- c. Increased muscle mass
- d. Increased prostate size
Answer: d. Increased prostate size
46. A patient asks about an over-the-counter “testosterone booster.” The pharmacist should counsel that:
- a. These products are FDA-approved and highly effective.
- b. These products are generally not proven to be effective and may contain unsafe ingredients.
- c. They are a good substitute for prescription TRT.
- d. They have no side effects.
Answer: b. These products are generally not proven to be effective and may contain unsafe ingredients.
47. A key part of the “Introduction to Urological Disorders” lecture would be the physiology of the male reproductive axis.
- a. True
- b. False
Answer: a. True
48. An active learning session on men’s health is part of which course module?
- a. Module 8: Urological Disorders
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 6: Geriatrics
Answer: a. Module 8: Urological Disorders
49. The overall management of a patient considering TRT requires:
- a. A “one-size-fits-all” approach.
- b. A careful diagnosis and a shared decision-making process regarding the risks and benefits.
- c. Starting with the highest possible dose.
- d. No follow-up monitoring.
Answer: b. A careful diagnosis and a shared decision-making process regarding the risks and benefits.
50. The ultimate goal of learning about male reproduction is to:
- a. Be able to safely and effectively manage pharmacotherapy for related disorders like hypogonadism.
- b. Recommend anabolic steroids for bodybuilding.
- c. Pass the final exam.
- d. Memorize all the formulations of testosterone.
Answer: a. Be able to safely and effectively manage pharmacotherapy for related disorders like hypogonadism.