Anesthesia Pharmacology: Adrenocorticoid Practice Questions

Addison's disease:
1. monotherapy with cortisol is appropriate
2. usually associate with weight gain
3. hypopigmentation
4. weakness
5. none of the above
Management of acute adrenocortical insufficiency:
1. parenteral cortisol
2. correction of fluid imbalance
3. correction of electrolytes abnormalities
4. treatment of precipitating factors
5. all the above
Most appropriate mineralocorticoids following management of acute adrenocortical insufficiency:
1. dexamethasone
2. triamcinolone
3. desoxycorticosterone acetate
4. hydrocortisone (cortisol)
5. fludrocortisone
Addison's disease:
1. effectively managed by monotherapy with methylprednisolone
2. characterized by chronic adrenocortical hyperactivity
3. infections or minor trauma may produce acute renal insufficiency
4. A & C
5. none of the above
Primary adrenocortical deficiency (Addison's disease):
1. affects both sexes equally
2. may occur any age
3. 90% of the adrenal gland must be destroyed before adrenal insufficiency appears
4. most frequent cause: idiopathic atrophy
5. all of the above
Secondary adrenal insufficiency:
1. infection -- especially in AIDS patients
2. idiopathic atrophy
3. congenital adrenal hyperplasia
4. suppression of hypothalamic-pituitary axis by endogenous steroid
5. mutation in ACTH receptor gene
Pharmacological potentiation of adrenal-insufficiency:
1. rifampin
2. phenytoin
3. ketoconazole
4. opiates
5. all the above
Cardinal symptom of Addison's disease:
1. hyperpigmentation
2. arteriole hypotension
3. asthenia
4. abnormal Gi function
5. hypoglycemia
Pharmacological mainstay of treatment of Addison's disease:
1. fludrocortisone
2. hydrocortisone (cortisol)
Complications of mineralocorticoid treatment:
1. hypokalemia
2. hypertension
3. cardiac enlargement
4. congestive heart failure
5. all of the above
At recommended dosages, most common complication of glucocorticoid therapy for Addison's disease:
1. hypokalemia
2. gastritis
3. hypertension
4. A & B
5. A, B & C
Congenital adrenal hyperplasia:
1. due to increased cortisol levels
2. may require dexamethasone administration to the mother in order to protect the fetus from genital abnormalities
3. associated with compensatory decrease in ACTH release
4. most common defect: decrease or a lack of 11 beta hydroxylase activity
5. all the above
An infant (first seen) with congenital adrenal hyperplasia, in acute adrenal crisis is likely to require:
1. cortisol
2. mineralocorticoid
3. electrolyte solutions
4. A & B
5. A, B & C
Truncal obesity and hirsuitism is most likely associated with:
1. Addison's disease
2. Cushing's syndrome
3. Conn's syndrome
4. primary aldosteronism
5. all the above
Causes of Cushing's syndrome:
1. pituitary ACTH hypersecretion
2. ACTH production by nonendocrine tumor
3. both
4. neither
In Cushing's syndrome due to adrenal neoplasm:most common drug for treating adrenocortical carcinoma:
1. cortisol
2. spironolactone
3. mitotane
4. mitoxantrone
5. aminoglutethimide
Pharmacological (chemical) adrenalectomy -- when surgical intervention for adrenal hyperplasia is not possible
1. metyrapone
2. mitotane
3. ketoconazole
4. aminoglutethimide
5. all the above
Primary aldosteronism -- aldosterone-producing adrenal adenoma
1. Addison's disease
2. Cushing's syndrome
3. Conn's syndrome
Medical management of primary aldosteronism due to adenoma:
1. dietary sodium restriction
2. spironolactone
3. both
4. neither
Causes of secondary aldosteronism:
1. in pregnancy -- normal estrogen-induced increases in renin substrate and plasma renin activity
2. primary overproduction of renin
3. renin-producing tumors (juxtaglomerular cell tumor)
4. renal artery stenosis (due to atherosclerosis)
5. all the above