NU 578 PHARM EXAM QUESTIONS AND ANSWERS
/. What test is used to diagnose hyperthyroidism? - Answer-TSH. Small drops in T3 &
T4 cause big increases in TSH
/.What happens when T3 & T4 fall? - Answer-TSH increases
/.How do you diagnose primary hypothyroidism? - Answer-High TSH levels
/.What is the difference between primary and secondary hypothyroidism? - Answer-
Normal or low-normal TSH levels + low T3 & T4 levels. Primary has high TSH levels.
/.Benefits of levothyroxine + liothyronine (T3) vs levothyroxine alone? - Answer-None.
Both work equally well.
/.When should pregnant women initially be screened for hypothyroidism ? - Answer-As
soon as pregnancy is confirmed. Begin levothyroxine immediately
/.When can you expect to have to increase the levothyroxine dose during pregnancy? -
Answer-Between weeks 4-8. Level off by week 16 and stays steady.
/.What is a strategy for managing T4 dose during pregnancy? - Answer-Empirically
increase by 30% as soon as pregnancy is confirmed.
/.What causes creatinism in newborns? - Answer-Failure of thyroid to develop =
congenital hypothyroidism.
/.5 week old comes in with large, tongue, potbelly, dwarfish looking. What is long term
prognosis? - Answer-Hypothyroidism. Cretinism. Permanent mental retardation but no
physical impairment.
/.How do you differentiate between transient & permanent hypothryoidism in infants? -
Answer-Treat for 3 years then stop for 4 weeks. If TSH increases = permanent
hypothyroidism = continue treatment.
/.#1 cause of hyperthyroidism - Answer-Graves' disease
/.Preferred treatment for adults with hyperthyroidism? - Answer-Radioactive iodine
/.What is the treatment of choice in young patients with hyperthyroidism? - Answer-
Methimazole or PTU
/.How do you treat tachycardia associated with hyperthyroidism? - Answer-Propanolol
(beta blockers)
, /.What good is non-radioactive iodine? - Answer-Block production & release of thyroid
hormones in hyperthyroidism
/.How do you treat exophthalmos? - Answer-Eye surgery or high dose PO
glucocorticoids
/.Thyrotoxic crisis treatment? - Answer-High dose of potassium iodide, PTU to block
thyroid hormone synthesis & conversion of T4 to T3. Beta blockers, sedation, cooling,
glucocorticoids & IV fluid
/.Free T4 - Answer-Normal: 4.5-12.5
/.Serum TSH - Answer-Most sensitive method of diagnosing hypothyroid and monitoring
replacement therap. Normal 0.3-6
/.Serum T3 - Answer-T3 rises faster than T4. Normal: 230-620
/.Methimazole - Answer-Safer than PTU. 30-40 mg once per day PO to start then switch
maintenance to 5-15 mg once per day PO
/.Methimazole side effects - Answer-Agranulocytosis, hypothyroidism, creatinism in
neonates.
/.Signs of agranulocytosis - Answer-Fever and sore throat. Stop methimazole or PTU &
give neupogen to speed up recovery
/.PTU first line for what? - Answer-First trimester pregnancy
Breast feeding women
During thyroid storm
/.PTU dose? - Answer-100-300 mg 3 times/day to start. Then switch to maintenance of
50 mg 3 times per day.
/.Radioactive Iodine - Answer-Hyperthyroidism: destroy thyroid tissue without causing
complete gland destruction
/.Who can't use radioactive iodine? - Answer-Patients younger than 30 - cancer,
pregnant, breastfeeding
/.Lugol's Solution - Answer-Decreases iodine uptake by the thyroid, blocks thyroid
hormone production, blocks release of thyroid hormone into blood
/.What is iodism? - Answer-brassy taste, burning in mouth, sore teeth & gums, frontal
HA, coryza. Fades when you stop iodine.
/. What test is used to diagnose hyperthyroidism? - Answer-TSH. Small drops in T3 &
T4 cause big increases in TSH
/.What happens when T3 & T4 fall? - Answer-TSH increases
/.How do you diagnose primary hypothyroidism? - Answer-High TSH levels
/.What is the difference between primary and secondary hypothyroidism? - Answer-
Normal or low-normal TSH levels + low T3 & T4 levels. Primary has high TSH levels.
/.Benefits of levothyroxine + liothyronine (T3) vs levothyroxine alone? - Answer-None.
Both work equally well.
/.When should pregnant women initially be screened for hypothyroidism ? - Answer-As
soon as pregnancy is confirmed. Begin levothyroxine immediately
/.When can you expect to have to increase the levothyroxine dose during pregnancy? -
Answer-Between weeks 4-8. Level off by week 16 and stays steady.
/.What is a strategy for managing T4 dose during pregnancy? - Answer-Empirically
increase by 30% as soon as pregnancy is confirmed.
/.What causes creatinism in newborns? - Answer-Failure of thyroid to develop =
congenital hypothyroidism.
/.5 week old comes in with large, tongue, potbelly, dwarfish looking. What is long term
prognosis? - Answer-Hypothyroidism. Cretinism. Permanent mental retardation but no
physical impairment.
/.How do you differentiate between transient & permanent hypothryoidism in infants? -
Answer-Treat for 3 years then stop for 4 weeks. If TSH increases = permanent
hypothyroidism = continue treatment.
/.#1 cause of hyperthyroidism - Answer-Graves' disease
/.Preferred treatment for adults with hyperthyroidism? - Answer-Radioactive iodine
/.What is the treatment of choice in young patients with hyperthyroidism? - Answer-
Methimazole or PTU
/.How do you treat tachycardia associated with hyperthyroidism? - Answer-Propanolol
(beta blockers)
, /.What good is non-radioactive iodine? - Answer-Block production & release of thyroid
hormones in hyperthyroidism
/.How do you treat exophthalmos? - Answer-Eye surgery or high dose PO
glucocorticoids
/.Thyrotoxic crisis treatment? - Answer-High dose of potassium iodide, PTU to block
thyroid hormone synthesis & conversion of T4 to T3. Beta blockers, sedation, cooling,
glucocorticoids & IV fluid
/.Free T4 - Answer-Normal: 4.5-12.5
/.Serum TSH - Answer-Most sensitive method of diagnosing hypothyroid and monitoring
replacement therap. Normal 0.3-6
/.Serum T3 - Answer-T3 rises faster than T4. Normal: 230-620
/.Methimazole - Answer-Safer than PTU. 30-40 mg once per day PO to start then switch
maintenance to 5-15 mg once per day PO
/.Methimazole side effects - Answer-Agranulocytosis, hypothyroidism, creatinism in
neonates.
/.Signs of agranulocytosis - Answer-Fever and sore throat. Stop methimazole or PTU &
give neupogen to speed up recovery
/.PTU first line for what? - Answer-First trimester pregnancy
Breast feeding women
During thyroid storm
/.PTU dose? - Answer-100-300 mg 3 times/day to start. Then switch to maintenance of
50 mg 3 times per day.
/.Radioactive Iodine - Answer-Hyperthyroidism: destroy thyroid tissue without causing
complete gland destruction
/.Who can't use radioactive iodine? - Answer-Patients younger than 30 - cancer,
pregnant, breastfeeding
/.Lugol's Solution - Answer-Decreases iodine uptake by the thyroid, blocks thyroid
hormone production, blocks release of thyroid hormone into blood
/.What is iodism? - Answer-brassy taste, burning in mouth, sore teeth & gums, frontal
HA, coryza. Fades when you stop iodine.
