[MCQ] Disorders of the Thyroid Gland- Part 4

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Disorders of the Thyroid Gland- Part 4

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Question 1

TSH responses should be measured after what time upon levothyroxine treatment ?

A	7 days
B	15 days
C	1 month
D	2 months

Question 1 Explanation:

TSH responses to levothyroxine therapy are gradual & should be measured ~ 2 months after instituting treatment.

Question 2

If TSH is high, levothyroxine dosage should be increased by ?

A	6.25 - 12.5 μg increments
B	12.5 - 25 μg increments
C	25 - 75 μg increments
D	75 - 100 μg increments

Question 2 Explanation:

Adjustment of levothyroxine dosage is made in 12.5 or 25 μg increments if the TSH is high

Question 3

Upon normalization of TSH levels, patients experience full relief from symptoms after ?

A	15 days to 2 months
B	2 to 3 months
C	3 to 6 months
D	6 months to 1 year

Question 3 Explanation:

Patients experience full relief from symptoms 3 - 6 months after normal TSH levels are restored

Question 4

Which of the following treatments is least recommended in hypothyroidism ?

A	T4 alone
B	T3 alone
C	T3 & T4 combined
D	T3 & T4 alternately

Question 4 Explanation:

There is no place for liothyronine alone as long-term replacement due to its short half-life which necessitates multiple dosage per day and is associated with fluctuating T3 levels.

Question 5

In patients taking Levothyroxine (> 200 μg/day) with elevated TSH level suggests the possibility of ?

A	Poor compliance
B	Inappropriate TSH secretion
C	Malabsorption
D	Any of the above

Question 6

Drugs that interfere with T4 absorption / clearance are all except ?

A	Cholestyramine
B	Ferrous sulfate
C	Calcium supplements
D	Isoniazid

Question 7

Drugs that interfere with T4 absorption / clearance are all except ?

A	Lovastatin
B	Aluminum hydroxide
C	Cimetidine
D	Rifampicin

Question 8

Drugs that interfere with T4 absorption / clearance are all except ?

A	Lidocaine
B	Amiodarone
C	Carbamazepine
D	Phenytoin

Question 8 Explanation:

Causes of increased levothyroxine requirements are malabsorption (celiac disease, small-bowel surgery), estrogen therapy & drugs that interfere with T4 absorption or clearance like cholestyramine, ferrous sulfate, calcium supplements, lovastatin, aluminum hydroxide, rifampicin, amiodarone, carbamazepine & phenytoin.

Question 9

During pregnancy, dose of levothyroxine may need to be ?

A	Increased
B	Decreased
C	Stopped
D	All of the above

Question 9 Explanation:

The dose of levothyroxine may need to be increased by >=50% during pregnancy and returned to previous levels after delivery.

Question 10

Thyroxine doses in elderly patients should be less than younger patients by ?

A	10 %
B	20 %
C	30 %
D	50 %

Question 11

In elderly patients with CAD, the starting dose of levothyroxine is ?

A	12.5 to 25 μg/day
B	25 to 37.5 μg/day
C	37.5 to 50 μg/day
D	50 to 62.5 μg/day

Question 11 Explanation:

Elderly patients may require up to 20% less thyroxine than younger patients. In elderly with coronary artery disease, starting dose of levothyroxine is 12.5 - 25 μg/day with similar increments every 2 - 3 months until

Question 12

Myxedema coma almost always occurs in ?

A	Neonates
B	Adolescents
C	Adults
D	Elderly

Question 13

Myxedema coma is precipitated by ?

A	Sedatives
B	Anesthetics
C	Antidepressants
D	All of the above

Question 13 Explanation:

Myxedema coma almost always occurs in the elderly & is usually precipitated by factors that impair respiration, such as drugs (sedatives, anesthetics, antidepressants), pneumonia, CHF, MI, GI bleeding, Sepsis or CVAs. Exposure to cold, hypoventilation, hypoglycemia & dilutional hyponatremia also contribute to the development of myxedema coma.

Question 14

Initial dose of levothyroxine in myxedema coma given by nasogastric tube is ?

A	200 μg
B	300 μg
C	400 μg
D	500 μg

Question 14 Explanation:

In myxedema coma, 500 μg of Levothyroxine can be given either as intravenous bolus or by nasogastric tube.

Question 15

Which of the following is not indicated while treating myxedema coma ?

A	External warming
B	Parenteral hydrocortisone
C	Broad-spectrum antibiotics
D	Hypotonic intravenous fluids

Question 15 Explanation:

In myxedema coma, hypotonic intravenous fluids should be avoided as they may exacerbate water retention secondary to reduced renal perfusion & inappropriate vasopressin secretion. Metabolism of most medications is impaired so reduced doses are recommended

Question 16

TSI are synthesized in all except ?

A	Thyroid gland
B	Spleen
C	Bone marrow
D	Lymph nodesk

Question 16 Explanation:

Hyperthyroidism of Graves’ disease is caused by thyroid-stimulating immunoglobulins (TSI) that are synthesized in the thyroid gland as well as in bone marrow & lymph nodes.

Question 17

Which of the following is the most common symptom of hyperthyroidism ?

A	Palpitation
B	Heat intolerance and sweating
C	Weight loss and increased appetite
D	Diarrhoea

Question 18

Which of the following is the most common sign of hyperthyroidism ?

A	Tremor
B	Warm, moist skin
C	Tachycardia
D	Lid retraction or lag

Question 19

In hyperthyroidism, von Graefe’s sign refers to ?

A	Lagging of upper eye lid on looking downward
B	Retracted lids causing wide palpebral opening
C	Diminished frequency of blinking
D	Inability to maintain convergence for close vision

Question 20

In hyperthyroidism, Stellwag’s sign refers to ?

A	Lagging of upper eye lid on looking downward
B	Retracted lids causing wide palpebral opening
C	Diminished frequency of blinking
D	Inability to maintain convergence for close vision

Question 21

In hyperthyroidism, Dalrymple’s sign refers to ?

A	Lagging of upper eye lid on looking downward
B	Retracted lids causing wide palpebral opening
C	Diminished frequency of blinking
D	Inability to maintain convergence for close vision

Question 22

In hyperthyroidism, Moebius’ sign refers to ?

A	Lagging of upper eye lid on looking downward
B	Retracted lids causing wide palpebral opening
C	Diminished frequency of blinking
D	Inability to maintain convergence for close vision

Question 23

In hyperthyroidism, Abadie’s sign refers to ?

A	Involuntary twitching or spasm of LPS muscle
B	Retracted lids causing wide palpebral opening
C	Diminished frequency of blinking
D	Inability to maintain convergence for close vision

Question 24

Which of the following is not a cause of “thyrotoxicosis without hyperthyroidism” ?

A	Subacute thyroiditis
B	Silent thyroiditis
C	Toxic adenoma
D	Thyrotoxicosis factitia

Question 25

Which of the following is not a cause of primary hyperthyroidism ?

A	Toxic multinodular goiter
B	Toxic adenoma
C	Subacute thyroiditis
D	Functioning thyroid carcinoma metastases

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See all quizzes of Disorders of the Thyroid Gland at here:

Disorders of the Thyroid Gland- Part 1| Disorders of the Thyroid Gland- Part2| Disorders of the Thyroid Gland- Part 3| Disorders of the Thyroid Gland- Part 4| Disorders of the Thyroid Gland- Part 5

1 TSH responses should be measured after what time upon
levothyroxine treatment ?

A. 7 days
B. 15 days
C. 1 month
D. 2 months

2 If TSH is high, levothyroxine dosage should be increased by ?
A. 6.25 – 12.5 μg increments
B. 12.5 – 25 μg increments
C. 25 – 75 μg increments
D. 75 – 100 μg increments

3 Upon normalization of TSH levels, patients experience full relief
from symptoms after ?
A. 15 days to 2 months
B. 2 to 3 months
C. 3 to 6 months
D. 6 months to 1 year

4 Which of the following treatments is least recommended in
hypothyroidism ?
A. T4 alone
B. T3 alone
C. T3 & T4 combined
D. T3 & T4 alternately

5 In patients taking Levothyroxine (> 200 μg/day) with elevated
TSH level suggests the possibility of ?
A. Poor compliance
B. Inappropriate TSH secretion
C. Malabsorption
D. Any of the above
6 Drugs that interfere with T4 absorption / clearance are all except ?
A. Cholestyramine
B. Ferrous sulfate
C. Calcium supplements
D. Isoniazid
7 Drugs that interfere with T4 absorption / clearance are all except ?
A. Lovastatin
B. Aluminum hydroxide
C. Cimetidine
D. Rifampicin

8 Drugs that interfere with T4 absorption / clearance are all
except ?
A. Lidocaine
B. Amiodarone
C. Carbamazepine
D. Phenytoin

9 During pregnancy, dose of levothyroxine may need to be ?
A. Increased
B. Decreased
C. Stopped
D. All of the above

10 Thyroxine doses in elderly patients should be less than younger
patients by ?
A. 10 %
B. 20 %
C. 30 %
D. 50 %
11 In elderly patients with CAD, the starting dose of levothyroxine
is ?
A. 12.5 to 25 μg/day
B. 25 to 37.5 μg/day
C. 37.5 to 50 μg/day
D. 50 to 62.5 μg/day

12 Myxedema coma almost always occurs in ?
A. Neonates
B. Adolescents
C. Adults
D. Elderly
13 Myxedema coma is precipitated by ?
A. Sedatives
B. Anesthetics
C. Antidepressants
D. All of the above

14 Initial dose of levothyroxine in myxedema coma given by
nasogastric tube is ?
A. 200 μg
B. 300 μg
C. 400 μg
D. 500 μg

15 Which of the following is not indicated while treating myxedema
coma ?
A. External warming
B. Parenteral hydrocortisone
C. Broad-spectrum antibiotics
D. Hypotonic intravenous fluids

16 TSI are synthesized in all except ?
A. Thyroid gland
B. Spleen
C. Bone marrow
D. Lymph nodes

17 Which of the following is the most common symptom of
hyperthyroidism ?
A. Palpitation
B. Heat intolerance and sweating
C. Weight loss and increased appetite
D. Diarrhoea
18 Which of the following is the most common sign of hyperthyroidism ?
A. Tremor
B. Warm, moist skin
C. Tachycardia
D. Lid retraction or lag
19 In hyperthyroidism, von Graefe’s sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
20 In hyperthyroidism, Stellwag’s sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision

21 In hyperthyroidism, Dalrymple’s sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
22 In hyperthyroidism, Moebius’ sign refers to ?
A. Lagging of upper eye lid on looking downward
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
23 In hyperthyroidism, Abadie’s sign refers to ?
A. Involuntary twitching or spasm of LPS muscle
B. Retracted lids causing wide palpebral opening
C. Diminished frequency of blinking
D. Inability to maintain convergence for close vision
24 Which of the following is not a cause of “thyrotoxicosis without
hyperthyroidism” ?
A. Subacute thyroiditis
B. Silent thyroiditis
C. Toxic adenoma
D. Thyrotoxicosis factitia
25 Which of the following is not a cause of primary hyperthyroidism ?
A. Toxic multinodular goiter
B. Toxic adenoma
C. Subacute thyroiditis
D. Functioning thyroid carcinoma metastases

Disorders of the Thyroid Gland

[MCQ] Disorders of the Thyroid Gland- Part 4

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Disorders of the Thyroid Gland- Part 4

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