05/12/2025
🩺 FastTrack Pharmacy's Weekly Health Quiz: Steroids Challenge!
The stakes are high! Answer these 15 questions correctly this Friday at 21:00 hours (9:00 PM) to be in the running for a cool K200 CASH PRIZE!
Quiz Questions
1 Which of the following is the primary mechanism of action for glucocorticoids like prednisone?
A. Direct inhibition of Cyclooxygenase-1 (COX-1) enzyme activity, reducing prostaglandin synthesis.
B. Binding to intracellular receptors, altering gene transcription to suppress and induce anti-inflammatory proteins.
C. Stabilizing mast cell membranes to prevent the degranulation and release of histamine and leukotrienes.
D. Non-selective competitive antagonism of 1 and 2 receptors, blocking inflammatory responses.
2 A patient is started on a high-dose, long-term course of oral prednisone. Which adverse effect is primarily related to the mineralocorticoid activity of the drug?
A. Hyperglycemia and new-onset steroid-induced diabetes mellitus.
B. {Hypokalemia} and fluid retention leading to edema and hypertension.
C. Posterior subcapsular cataracts requiring ophthalmologic follow-up.
D. Increased risk of peptic ulcer disease due to reduced mucosal protection.
3 The sudden withdrawal of long-term, high-dose systemic corticosteroids can precipitate an adrenal crisis. This is primarily due to:
A. Peripheral vascular resistance dropping sharply due to the sudden removal of catecholamine potentiation.
B. Rebound inflammation overwhelming the body's natural defense mechanisms.
C. Suppression of the Hypothalamic-Pituitary-Adrenal (HPA) axis, causing {adrenal atrophy} and inadequate endogenous {cortisol} production.
D. Acute {adrenocortical hyperplasia} resulting in a temporary paradoxical overproduction of {androgens} and {aldosterone}.
4 Fluticasone propionate, a common inhaled corticosteroid, is preferred over oral formulations for asthma because it achieves a high therapeutic ratio by:
A. Being a non-halogenated compound that preferentially binds to bronchial smooth muscle receptors.
B. Having a very high topical potency and rapid systemic clearance/first-pass metabolism, minimizing systemic bioavailability.
C. Acting as an inverse agonist at the {glucocorticoid receptor} (GR)}, activating the anti-inflammatory pathway but not the metabolic pathway.
D. Exclusively targeting the {T-lymphocytes} in the pulmonary endothelium without affecting {B-cell} proliferation.
5 Which statement accurately differentiates betamethasone from hydrocortisone in terms of potency and duration of action?
A. Betamethasone is an {intermediate-acting, low-potency} steroid, whereas hydrocortisone is {short-acting, very high-potency}.
B. Betamethasone is {long-acting} and has high anti-inflammatory potency; hydrocortisone is {short-acting} and has low anti-inflammatory potency.
C. Betamethasone has high mineralocorticoid activity, while hydrocortisone is almost exclusively a glucocorticoid.
D. Betamethasone is {short-acting} and {low-potency}, requiring more frequent dosing than hydrocortisone.
6 Corticosteroids are used in severe {COVID-19} pneumonia, primarily due to their ability to:
A. Directly inhibit the viral {RNA} polymerase, preventing replication.
B. Act as potent {bronchodilators}, relieving the smooth muscle constriction caused by the infection.
C. Dampen the excessive, life-threatening systemic inflammation (the "cytokine storm") that causes acute respiratory distress syndrome {(ARDS)}.
D. Significantly increase the {hemoglobin} oxygen-carrying capacity in the severely hypoxic patient.
7 In a patient with {rheumatoid arthritis}, the anti-inflammatory effect of glucocorticoids results mainly from the induction of lipocortin-1 (annexin A1), which inhibits which key enzyme?
A. {HMG-CoA reductase} (3-hydroxy-3-methylglutaryl \text{coenzyme A} reductase).
B. {Phospholipase A}_2 {(PLA}_2}, preventing the release of {arachidonic acid}.
C. {Glucose-6-phosphatase}, thereby stabilizing blood glucose levels.
D. {DNA gyrase}, stopping the proliferation of inflammatory cells.
8 Dexamethasone is often chosen over other glucocorticoids for treating cerebral edema associated with brain tumours because:
A. It has a significantly lower risk of {HPA} axis suppression compared to {prednisolone}.
B. It is one of the few steroids that can be administered {intrathecally}.
C. It has high potency, a long duration of action, and minimal mineralocorticoid activity, which reduces the risk of sodium and water retention.
D. Its lipophilicity allows for rapid, selective binding to the {astrocyte} receptors at the {blood-brain barrier}.
9 Anabolic steroids (androgens) like {testosterone} derivatives are often abused. Which serious, irreversible long-term side effect is primarily associated with their hepatotoxicity?
A. Increased risk of developing {hepatic cavernous hemangiomas}.
B. {Cholecystitis} and cholesterol gallstone formation due to altered bile composition.
C. Peliosis hepatis and an increased risk of {hepatocellular carcinoma}.
D. {Non-alcoholic fatty liver disease} {(NAFLD)} progressing rapidly to {cirrhosis}.
10 What is the mechanism by which glucocorticoids can lead to osteoporosis?
A. Direct stimulation of {osteoclast} differentiation, increasing bone resorption.
B. Indirectly promoting the {Parathyroid hormone (PTH)} receptor sensitivity, driving calcium mobilization.
C. Decreasing intestinal {calcium} absorption, inhibiting {osteoblast} function, and promoting {osteoclast} survival, leading to a negative bone balance.
D. Shifting the {calcium} concentration gradient across the {osteocyte} membrane, causing bone demineralization.
11 The mechanism of action for the {mineralocorticoid} fludrocortisone is most closely related to its ability to:
A. Inhibit the {Angiotensin-Converting Enzyme (ACE)} in the kidney tubules.
B. Directly bind to and {antagonize} the {Vasopressin 2} receptors in the collecting ducts.
C. Activate the {mineralocorticoid} receptors (MR)} in the distal renal tubules, promoting {sodium} and water {reabsorption} and {potassium} {excretion}.
D. Block the {sodium-potassium-2 chloride} (NKCC2) co-transporter in the loop of {Henle}.
12 A patient on long-term systemic corticosteroids develops {Cushingoid} features. The classic symptom that is specifically due to the {catabolic} effect of the steroid on \text{protein} is:
A. Central obesity and a {buffalo hump}.
B. {Hirsutism} (excess hair growth) in women.
C. Muscle wasting and thin skin/easy bruising (ecchymoses).
D. {Psychosis} and severe mood swings.
13 Which laboratory finding is most consistent with a patient on high-dose glucocorticoid therapy?
A. {Hypoglycemia} and {Hypochloremic alkalosis}.
B. {Hypocalcemia} and {Hypophosphatemia}.
C. Hyperglycemia and {Leukocytosis} with {Lymphopenia}.
D. {Hypernatremia} and {Eosinophilia}.
14 In the treatment of acute {gout}, corticosteroids (e.g., intra-articular injection) are effective because their primary role is:
A. Directly {neutralizing} the {uric acid crystals} within the joint space.
B. {Inhibiting} the renal reabsorption of {urate}, increasing its excretion.
C. Potently {suppressing} the local inflammatory response to the monosodium urate crystals.
D. Activating microphages to engulf the crystals more rapidly.
15 The principal reason for prescribing a corticosteroid in combination with a long-acting beta-agonist LABA in COPD is:
A. The {LABA} potentiates the steroid’s {systemic} {anti-inflammatory} effects via a synergistic metabolic pathway.
B. The steroid reverses the down-regulation of {beta}_2 receptors caused by the {LABA}.
C. The steroid treats the underlying airway inflammation, while the {LABA} provides \text{bronchodilation}, resulting in better disease control than either agent alone.
D. The combination prevents the adrenal suppression typically associated with high-dose {LABA} therapy.
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