Pharm 37 Flashcards

A tumor compresses the master control center for metabolism, growth, and reproduction. Which paired structures mediate this control?
A. Thalamus and pineal gland
B. Hypothalamus and pituitary gland
C. Medulla and adrenal medulla
D. Hippocampus and amygdala

TRH must reach the anterior pituitary efficiently. What carries small hypothalamic hormones there?
A. Systemic arterial blood
B. Neurosecretory axons
C. Lymphatic channels
D. Portal venous system

A patient lacks posterior pituitary hormones after hypothalamic injury. Where are posterior-lobe hormones synthesized?
A. Hypothalamus
B. Posterior pituitary
C. Anterior pituitary
D. Median eminence

After synthesis, posterior-lobe hormones reach the posterior pituitary via which pathway?
A. Portal capillaries
B. CSF bulk flow
C. Neurosecretory fibers
D. Hepatic sinusoids

A child with hormone deficiency receives exogenous pituitary hormones. This drug use best fits:
A. Replacement therapy
B. Immunosuppression
C. Antimicrobial prophylaxis
D. Antiarrhythmic suppression

A patient with acromegaly is treated with a pituitary-hormone–blocking drug. This primary use is:
A. Diagnostic screening
B. Antagonism of hormone excess
C. Replacement for deficiency
D. Enhancing hormone secretion

A resident orders a stimulation test using hypothalamic hormones. This primary use is:
A. Replacement therapy
B. Symptomatic palliation
C. Toxicity mitigation
D. Diagnostic tool

Two pituitary hormones share significant homology and are single-chain proteins. Which pair fits?
A. TSH and LH
B. ACTH and TSH
C. GH and prolactin
D. FSH and LH

A signaling inhibitor blocks the pathway used by both GH and prolactin receptors. Which pathway is it?
A. cGMP–PKG signaling
B. JAK/STAT signaling
C. IP3–DAG signaling
D. Nuclear receptor signaling

A lab panel focuses on pituitary dimeric hormones with shared structure. Which set is dimeric?
A. TSH FSH LH
B. GH PRL ACTH
C. TRH CRH GnRH
D. IGF-1 cortisol T3

Which receptor type do TSH, FSH, and LH activate?
A. Ion channel receptor
B. JAK/STAT receptor
C. Nuclear receptor
D. GPCR

A mutation affects a subunit shared by TSH, FSH, and LH. Which subunit is shared?
A. Beta subunit
B. Alpha subunit
C. Gamma subunit
D. Delta subunit

A patient’s ACTH is abnormal; the hormone is derived from a larger precursor. ACTH is:
A. Steroid from cholesterol
B. Dimeric glycoprotein
C. Peptide from POMC
D. Catecholamine derivative

Excess POMC processing increases other peptides besides ACTH. Which pair can result?
A. Alpha-MSH and beta-endorphin
B. T3 and thyroxine
C. Estrogen and progesterone
D. GHRH and somatostatin

An ACTH analog is given; its receptor signals through which class?
A. Nuclear receptor
B. JAK/STAT receptor
C. Ligand-gated channel
D. GPCR

A patient has ACTH resistance due to receptor defects. The ACTH receptor is also called:
A. Melanocortin 1 receptor
B. Melanocortin 2 receptor
C. Melanocortin 3 receptor
D. Melanocortin 4 receptor

Despite normal ACTH receptor sequence, signaling fails due to defective trafficking. What is required for normal ACTH signaling?
A. MRAP accessory protein
B. Thyroid-binding globulin
C. Albumin carrier protein
D. SHBG cofactor

A patient’s low TSH is traced to impaired hypothalamic stimulation. TSH release is regulated by:
A. GnRH
B. CRH
C. TRH
D. Dopamine

Pulsatile hypothalamic output is needed for normal gonadotropin secretion. Which hormone must be pulsatile?
A. TRH
B. Somatostatin
C. Dopamine
D. GnRH

A patient with adrenal insufficiency has low ACTH due to low hypothalamic drive. ACTH release is stimulated by:
A. CRH
B. Thyroxine
C. Estrogen
D. IGF-1

A hyperthyroid patient has suppressed TRH and TSH. Which feedback signal inhibits both?
A. Cortisol
B. T3 and T4
C. Testosterone
D. Dopamine

A woman using high-dose hormones has suppressed GnRH and gonadotropins. Which hormones mediate this inhibition?
A. Thyroxine and T3
B. Cortisol and CRH
C. Estrogen and progesterone
D. GH and IGF-1

A male on anabolic steroids develops low LH/FSH and low GnRH. Which signal best explains this?
A. Estrogen and progesterone
B. Thyroxine and T3
C. Dopamine and TRH
D. Testosterone and androgens

A patient on chronic glucocorticoids has low ACTH and low CRH. Which mediator inhibits both?
A. IGF-1
B. Cortisol
C. Thyroxine
D. Estrogen

Which pairing correctly describes GH regulators?
A. GHRH stimulates; somatostatin inhibits
B. TRH stimulates; cortisol inhibits
C. GnRH stimulates; dopamine inhibits
D. CRH stimulates; IGF-1 inhibits

GH release is limited by peripheral feedback from its main mediator. Which mediator provides that feedback?
A. Thyroxine
B. Cortisol
C. Estrogen
D. IGF-1

A patient with hyperprolactinemia improves on a D2 agonist. Prolactin production is inhibited by:
A. TRH
B. CRH
C. Dopamine
D. Thyroxine

A patient with primary hypothyroidism develops galactorrhea. Which hypothalamic hormone can raise prolactin when levels are high?
A. GnRH
B. CRH
C. TRH
D. Somatostatin

IGF-I is also known as:
A. Somatomedin C
B. Somatomedin A
C. Somatomedin B
D. Somatomedin D

Growth hormone is best described as:
A. Steroid, cholesterol-derived
B. Dimeric glycoprotein
C. Catecholamine derivative
D. 191-aa peptide hormone

A structural feature of GH includes:
A. Three disulfide bridges
B. Two sulfhydryl bridges
C. One transmembrane helix
D. Four alpha subunits

Somatropin is:
A. Recombinant GH, native sequence
B. Pituitary extract GH mix
C. IGF-I analog therapy
D. GHRH antagonist drug

Endogenous GH is predominantly cleared by the:
A. Kidney
B. Liver
C. Lung
D. Spleen

Recombinant human GH is typically administered:
A. Orally daily
B. Intravenous infusion
C. Subcutaneously
D. Intranasally

A standard rhGH schedule is:
A. Once monthly
B. Twice yearly
C. Weekly injections
D. 6–7 times weekly

After subcutaneous rhGH, peak levels occur:
A. 2–4 hours
B. 10–20 minutes
C. 12–24 hours
D. 36–48 hours

After rhGH dosing, active blood levels persist about:
A. 4 hours
B. 36 hours
C. 20 minutes
D. 7 days

Most circulating IGF-I is produced by the:
A. Bone
B. Kidney
C. Liver
D. Muscle

GH stimulates IGF-I production in tissues mainly for:
A. Autocrine/paracrine actions
B. Portal venous transport
C. Neurosecretory release
D. Renal tubular secretion

In adults, GH shifts body composition by:
A. Catabolic muscle, anabolic fat
B. Anabolic fat, catabolic muscle
C. Anabolic both muscle and fat
D. Anabolic muscle, catabolic fat

GH and IGF-I have opposite effects on:
A. Thyroid hormone synthesis
B. Insulin sensitivity
C. ACTH release
D. Renal blood flow

GH reduces insulin sensitivity, causing mild:
A. Hypoglycemia
B. Ketoacidosis
C. Hyperinsulinemia
D. Insulinopenia

IGF-I’s insulin-like action most directly:
A. Increases glucose transport
B. Decreases GH secretion
C. Inhibits TRH release
D. Blocks dopamine receptors

Neonates with isolated GH deficiency are normal size because:
A. Postnatal growth is GH-free
B. Thyroid hormone replaces GH
C. Lactation supplies GH
D. Prenatal growth is GH-independent

An early sign of GH deficiency in young children is:
A. Hyperglycemia
B. Hypoglycemia
C. Bradycardia
D. Hyperkalemia

A diagnostic criterion for GH deficiency includes reduced:
A. Appetite for age
B. Bone density for age
C. Serum TSH response
D. Height velocity for age

Which agent increases GHRH levels via dopaminergic action?
A. Somatostatin
B. TRH
C. Levodopa
D. Estrogen

Which physiologic factor increases GHRH levels?
A. High-fat meals
B. Sleep deprivation
C. Exercise
D. Hyperkalemia

Arginine increases GH release primarily by reducing:
A. Somatostatin tone
B. Dopamine tone
C. TRH release
D. CRH release

Insulin-induced hypoglycemia increases GH by reducing:
A. GHRH secretion
B. IGF-I secretion
C. Somatostatin tone
D. TRH secretion

GH therapy improves final height in girls with:
A. Turner syndrome
B. Klinefelter syndrome
C. Cushing syndrome
D. Addison disease

In Turner syndrome, GH should be combined with:
A. Thyroid hormones
B. Cortisol analogs
C. Dopamine agonists
D. Gonadal steroids

A controversial but approved GH indication is:
A. Congenital adrenal hyperplasia
B. Idiopathic short stature
C. Primary hypothyroidism
D. Central diabetes insipidus

GH therapy can reduce levels of some drugs by:
A. Decreasing renal filtration
B. Inhibiting CYP isoforms
C. Increasing CYP isoforms
D. Blocking gut absorption

A child with short stature has a newly diagnosed leukemia. Which statement about GH therapy is correct?
A. Safe if monitored closely
B. Contraindicated with active malignancy
C. Contraindicated only in adults
D. Increases malignancy incidence

A patient has severe IGF-I deficiency unresponsive to GH. Which therapy is FDA-approved for this scenario?
A. Octreotide
B. Pegvisomant
C. Recombinant human IGF-I
D. Dopamine agonist

Which pair are FDA-approved forms of rhIGF-I?
A. Pegvisomant, lanreotide
B. Mecasermin, mecasermin rinfabate
C. Somatostatin, octreotide
D. Levodopa, clonidine

Mecasermin rinfabate contains rhIGF-I plus:
A. Recombinant IGFBP-3
B. Recombinant GH
C. Dopamine agonist
D. Somatostatin analog

A child starts mecasermin and becomes diaphoretic and confused. Most important adverse effect?
A. Bradycardia
B. Steatorrhea
C. Hypoglycemia
D. Hyperglycemia

To reduce mecasermin hypoglycemia risk, the patient should:
A. Fast before injection
B. Avoid carbohydrates that day
C. Take dose at bedtime
D. Eat carbs near dosing

The meal/snack timing recommended with mecasermin is:
A. 2 hours before dose
B. 20 minutes before or after
C. Only after symptoms occur
D. Exactly 6 hours after

Hormone-secreting pituitary adenomas occur most commonly in:
A. Neonates
B. Children
C. Adults
D. Adolescents

An adult with GH-secreting adenoma develops coarse facial features and organ enlargement. Diagnosis?
A. Gigantism
B. Acromegaly
C. Cushing disease
D. Hypopituitarism

Acromegaly reflects abnormal growth of:
A. Cartilage, bone, many organs
B. Only long bones
C. Only skeletal muscle
D. Only adipose tissue

A GH-secreting tumor arises before epiphyseal closure. Most likely outcome?
A. Acromegaly
B. Dwarfism
C. Gigantism
D. Hyperprolactinemia

Initial therapy of choice for GH-secreting adenoma is:
A. Endoscopic transsphenoidal surgery
B. High-dose octreotide first
C. Pegvisomant monotherapy first
D. Dopamine agonist monotherapy

GH hypersecretion persists after surgery. Next step typically adds:
A. Levothyroxine
B. GH antagonist medical therapy
C. Insulin infusion
D. Glucocorticoid taper

Which agents reduce GH production post-op?
A. Pegvisomant only
B. Somatostatin analogs, D2 agonists
C. IGF-I analogs only
D. TRH analogs, CRH analogs

Which drug prevents GH receptor signaling?
A. Octreotide
B. Lanreotide
C. Pegvisomant
D. Mecasermin

Somatostatin is best described as:
A. 14–amino-acid peptide
B. 191–amino-acid peptide
C. Steroid hormone
D. Dimeric glycoprotein

Somatostatin is found in hypothalamus and also:
A. Thyroid follicles
B. Pancreas and GI tract
C. Adrenal cortex
D. Gonadal stroma

Somatostatin functions primarily as:
A. Excitatory neurotransmitter
B. Stimulatory endocrine hormone
C. Inhibitory paracrine factor
D. Growth factor mediator

Somatostatin inhibits release of which set?
A. GH, TSH, insulin, gastrin
B. GH, ACTH, estrogen, cortisol
C. FSH, LH, prolactin, ADH
D. T3, T4, cortisol, aldosterone

Key organ for somatostatin metabolism/excretion:
A. Liver
B. Lung
C. Kidney
D. Skin

Native somatostatin has limited usefulness because:
A. Slow onset, narrow window
B. Short action, multiple effects
C. Poor oral absorption only
D. High malignancy risk

Octreotide potency compared with somatostatin for GH inhibition:
A. 2 times more potent
B. 10 times more potent
C. 45 times more potent
D. 100 times more potent

Octreotide potency for insulin suppression is about:
A. Same as somatostatin
B. Twice as potent
C. 45 times as potent
D. Not clinically relevant

Typical octreotide regimen for tumors is:
A. Oral daily tablets
B. SC every 8 hours
C. IM monthly injections
D. IV continuous infusion

Octreotide reduces symptoms from many tumors, including:
A. Insulinoma, VIPoma, carcinoid
B. AML, ALL, CLL
C. Medullary thyroid carcinoma
D. Renal cell carcinoma

Octreotide is also useful for acute control of:
A. GI reflux
B. Variceal bleeding
C. Asthma exacerbation
D. Migraine aura

A patient on octreotide reports bulky oily stools. This adverse effect is:
A. Constipation
B. Diarrhea from lactose
C. Steatorrhea
D. GI bleeding

A patient on octreotide develops HR 48. This cardiac adverse effect is:
A. Atrial flutter
B. Sinus bradycardia
C. Ventricular tachycardia
D. Complete AV block

Long-term octreotide therapy may cause deficiency of:
A. Folate
B. Vitamin B6
C. Vitamin A
D. Vitamin B12

Another approved somatostatin analog for acromegaly is:
A. Lanreotide
B. Mecasermin
C. Pegvisomant
D. Clonidine

Pegvisomant is used to treat:
A. Primary hypothyroidism
B. Gigantism only
C. Acromegaly
D. Prolactinoma

A patient with hypothalamic infertility needs GnRH to stimulate pituitary gonadotrophs. What pattern is required?
A. Continuous GnRH infusion
B. Pulsatile GnRH secretion
C. Single monthly GnRH bolus
D. Rectal GnRH delivery

A man receives sustained leuprolide (nonpulsatile). What pituitary outcome results in both sexes?
A. Hypergonadotropic hypogonadism
B. Hyperthyroid flare
C. Hypogonadotropic hypogonadism
D. Acromegaly

Gonadorelin is best described as:
A. Recombinant LH preparation
B. Pituitary extract hMG
C. Somatostatin analog peptide
D. Synthetic GnRH acetate salt

Compared with native GnRH, GnRH agonist analogs are generally:
A. Shorter-acting, less potent
B. Same potency, same duration
C. Less potent, longer-acting
D. More potent, longer-lasting

Gonadorelin can be administered by:
A. Oral tablet
B. Intranasal spray
C. IV or subcutaneous
D. Transdermal patch

A patient is prescribed nafarelin (GnRH agonist). Which route matches this agonist?
A. Intravenous infusion
B. Intramuscular depot
C. Nasal spray
D. Oral capsule

Histrelin (a GnRH agonist) may be delivered as a:
A. Rectal suppository
B. Subcutaneous implant
C. Sublingual tablet
D. Inhaled aerosol

Between which ages does GnRH secretion fall off with very low pituitary sensitivity?
A. Birth until age two
B. Puberty through adulthood
C. Late follicular phase
D. Age two until puberty

Just before puberty, GnRH release typically shows:
A. Lower frequency, lower amplitude
B. Higher frequency and amplitude
C. Higher amplitude only
D. Higher frequency only

In early puberty, pituitary sensitivity rises partly due to increasing:
A. Thyroid hormones
B. Cortisol levels
C. Gonadal steroids
D. IGF-1 levels

Highest GnRH pulse amplitudes occur during the:
A. Early follicular phase
B. Late follicular phase
C. Luteal phase
D. Ovulatory phase

Highest GnRH pulse frequency occurs late in the:
A. Early follicular phase
B. Late follicular phase
C. Luteal phase
D. Early pregnancy

Lower GnRH pulse frequencies preferentially favor secretion of:
A. FSH
B. LH
C. ACTH
D. Prolactin

Higher GnRH pulse frequencies preferentially favor secretion of:
A. FSH
B. TSH
C. LH
D. ACTH

Continuous gonadorelin (or analog) produces a:
A. Monophasic stimulatory response
B. Triphasic stimulatory response
C. Nonresponsive state
D. Biphasic response

The first 7–10 days of continuous GnRH agonist therapy is the:
A. Flare phase
B. Downregulation phase
C. Withdrawal phase
D. Escape phase

During the flare phase, gonadal hormone concentrations:
A. Fall immediately
B. Increase transiently
C. Remain unchanged
D. Oscillate randomly

After the flare, continued agonist presence causes:
A. Increased gonadotropins persist
B. Decreased gonadotropins and steroids
C. Increased progesterone surge
D. Increased GnRH secretion

A major barrier to pulsatile GnRH therapy is:
A. IV pump use, cost, access
B. Requires daily oral tablets
C. Always causes OHSS
D. Only works after menopause

In women undergoing gonadotropin ovulation induction, gonadorelin (or an agonist analog) can be used to:
A. Suppress estradiol production
B. Treat endometriosis pain
C. Induce androgen deprivation
D. Trigger LH surge, ovulation

GnRH testing can help evaluate delayed puberty by assessing:
A. Thyroid hormone reserve
B. Adrenal cortisol reserve
C. Pituitary LH response
D. Placental hCG response

An impaired LH response to GnRH most strongly suggests:
A. Rules out constitutional delay
B. Confirms constitutional delay
C. Proves pituitary tumor
D. Hypogonadotropic hypogonadism likely

In controlled ovarian stimulation for IVF, a critical goal is to:
A. Trigger early ovulation
B. Raise endogenous LH surge
C. Increase prolactin secretion
D. Suppress endogenous LH surge

The most common LH suppression approach uses:
A. Daily oral clomiphene
B. IM hCG weekly
C. SC leuprolide or nasal nafarelin
D. IV gonadorelin bolus

Continuous GnRH agonist therapy reduces endometriosis pain primarily because it:
A. Increases ovarian estrogen cycling
B. Suppresses estrogen and progesterone
C. Stimulates LH surge daily
D. Blocks androgen receptors

Preferred GnRH agonist treatment duration for endometriosis is limited to ~6 months because of:
A. Bone mineral density loss
B. Severe hypoglycemia risk
C. Acute renal failure
D. Higher malignancy incidence

Uterine leiomyomata are:
A. Malignant smooth muscle tumors
B. Benign uterine smooth muscle tumors
C. Pituitary lactotroph tumors
D. Estrogen-resistant endometrial cysts

A patient with leiomyomata most classically presents with:
A. Menorrhagia anemia pelvic pain
B. Amenorrhea galactorrhea headache
C. Hirsutism acne virilization
D. Hot flashes sleep disturbance

Treating leiomyomata for 3–6 months with a GnRH agonist plus iron most directly:
A. Shrinks fibroids, improves anemia
B. Raises fibroid size rapidly
C. Worsens anemia without iron
D. Has no effect on size

Primary medical therapy for prostate cancer is:
A. Surgery is primary therapy
B. Chemotherapy is primary therapy
C. Androgen deprivation therapy
D. Radiation is primary therapy

Negative feedback inhibition of GH is mediated by which pair?
A. GH and IGF-1
B. TRH and TSH
C. LH and hCG
D. Dopamine and prolactin

Prolactin release is primarily inhibited by:
A. Dopamine via D2
B. TRH via TRH-R
C. Somatostatin via SSTR
D. GnRH via GnRH-R

TRH stimulates release of which set?
A. ACTH and cortisol
B. FSH and LH
C. TSH and prolactin
D. GH and IGF-1

Growth-promoting effects of GH are mediated mainly through:
A. Cortisol
B. Somatomedin C
C. Dopamine
D. Progesterone

Most circulating IGF-1 is synthesized in the:
A. Kidney
B. Liver
C. Bone
D. Pancreas

Reduced GH levels would most likely lead to:
A. Hyperglycemia
B. Hypoglycemia
C. Ketoacidosis
D. No glucose change

Clonidine, levodopa, and exercise have what effect on GHRH?
A. Decrease GHRH levels
B. No effect on GHRH
C. Increase GHRH levels
D. Block GHRH receptors

In provocative testing, clonidine acts primarily as:
A. Alpha2-adrenergic agonist
B. Beta1-adrenergic agonist
C. Dopaminergic antagonist
D. Muscarinic agonist

In provocative testing, levodopa acts primarily as:
A. D2 antagonist
B. Dopaminergic agonist
C. Alpha2 antagonist
D. Serotonin agonist

Arginine and insulin-induced hypoglycemia increase GH mainly by:
A. Increasing TRH tone
B. Increasing cortisol feedback
C. Increasing IGF-1 production
D. Reducing somatostatin tone

A patient on GH develops swelling and muscle pains. Which adverse effect fits GH therapy?
A. Peripheral edema
B. Steatorrhea
C. Bradycardia
D. Hypoglycemia

Another adverse effect of GH therapy is:
A. Carpal tunnel syndrome
B. Nephrolithiasis
C. Variceal bleeding
D. Retinal detachment

Mecasermin is:
A. Recombinant human IGF-1
B. Recombinant human GH
C. GH receptor antagonist
D. Somatostatin analog

Mecasermin rinfabate is best described as:
A. IGF-1 plus IGFBP-3
B. GH plus IGF-1 complex
C. IGF-1 plus albumin complex
D. IGF-1 plus insulin complex

Most important adverse effect of mecasermin is:
A. Bradycardia
B. Hyperglycemia
C. Hypoglycemia
D. Steatorrhea

Somatostatin inhibits release of which set?
A. GH TSH glucagon insulin gastrin
B. GH LH estrogen progesterone
C. TSH ACTH cortisol aldosterone
D. Prolactin dopamine GH GHRH

Somatostatin half-life is closest to:
A. 36 hours
B. 20 minutes
C. 80 minutes
D. 1–3 minutes

Octreotide is best described as:
A. GH receptor antagonist
B. Widely used SST analog
C. Recombinant IGF-1 agent
D. GnRH agonist analog

Octreotide half-life is closest to:
A. 1–3 minutes
B. 20 minutes
C. 80 minutes
D. 36 hours

Lanreotide is:
A. Long-acting SST analog
B. Recombinant LH analog
C. Recombinant IGF-1 analog
D. TRH antagonist

Pegvisomant is:
A. Dopamine receptor agonist
B. Somatostatin analog
C. GH receptor antagonist
D. GnRH receptor antagonist

Pegvisomant can lead to increased GH levels because it:
A. Inhibits GH secretion
B. Blocks GH clearance
C. Does not inhibit secretion
D. Stimulates GHRH release

In the ovary, LH stimulates androgen production by:
A. Granulosa cells
B. Theca cells
C. Leydig cells
D. Sertoli cells

In the ovary, FSH stimulates androgen→estrogen conversion in:
A. Theca cells
B. Granulosa cells
C. Leydig cells
D. Corpus luteum

In the luteal phase, estrogen/progesterone are controlled first by LH and then by:
A. FSH
B. IGF-1
C. hCG
D. TRH

FSH maintains local androgen by stimulating Sertoli production of:
A. Thyroxine-binding globulin
B. Androgen-binding protein
C. Sex hormone-binding globulin
D. Cortisol-binding globulin

FSH also stimulates Sertoli conversion of testosterone to:
A. DHT
B. Estradiol
C. Progesterone
D. Cortisol

LH and hCG are used interchangeably because their:
A. Alpha subunits differ
B. Clearance rates identical
C. Receptors are unrelated
D. Beta subunits nearly identical

In the first 8 weeks of pregnancy, the progesterone/estrogen that maintain pregnancy are produced primarily by the:
A. Placenta
B. Corpus luteum
C. Maternal adrenal cortex
D. Fetal liver

For the corpus luteum to persist beyond early luteal support, maternal LH must be taken over by:
A. FSH
B. Progesterone
C. Prolactin
D. hCG

Human chorionic gonadotropin (hCG) is produced by:
A. Placental syncytiotrophoblasts
B. Placental cytotrophoblasts
C. Ovarian granulosa cells
D. Testicular Leydig cells

A patient undergoing ovulation induction asks about the two most common serious complications. Best answer:
A. Ectopic pregnancy and torsion
B. Infection and hemorrhage
C. Multiple pregnancies and OHSS
D. Prematurity and gestational diabetes

A patient with hypothalamic infertility is placed on a GnRH pump. Which pattern is required to stimulate LH/FSH release?
A. Pulsatile GnRH secretion
B. Continuous GnRH infusion
C. Monthly depot GnRH
D. Single high-dose bolus

A man receives sustained nonpulsatile GnRH agonist therapy. What pituitary-gonadal outcome occurs in both sexes?
A. Hypergonadotropic hypogonadism
B. Hypogonadotropic hypogonadism
C. Primary gonadal failure
D. Premature ovarian insufficiency

Which drug is a GnRH agonist analog?
A. Ganirelix
B. Octreotide
C. Leuprolide
D. Pegvisomant

In this framework, lower GnRH pulse frequency favors which menstrual-cycle phase?
A. Follicular phase
B. Luteal phase
C. Ovulatory phase
D. Menstrual phase

A patient starts continuous leuprolide. What is expected during the first 7–10 days?
A. Immediate LH/FSH suppression
B. Immediate ovarian shutdown
C. No gonadal hormone change
D. Increased gonadal hormone levels

After the initial 7–10 day flare, continued GnRH agonist exposure causes:
A. Persistent estrogen elevation
B. Increased LH pulse frequency
C. Decreased LH and FSH
D. Increased ovarian androgen output

A hypogonadotropic adolescent is given GnRH to assess LH responsiveness. A robust LH rise most suggests:
A. Primary gonadal failure
B. Early pubertal status
C. Pituitary apoplexy
D. Permanent infertility

A hypogonadotropic adolescent is given GnRH to assess LH responsiveness. The test shows a low/impaired LH response. This most strongly suggests:
A. Isolated ovarian failure
B. Androgen insensitivity syndrome
C. Thyroid hormone deficiency
D. Hypogonadotropic hypogonadism

A patient with fibroids has menorrhagia and anemia. A 3–6 month regimen most consistent with your notes is:
A. GnRH antagonist plus progesterone
B. GnRH agonist plus iron
C. Dopamine agonist plus iron
D. hCG injections plus iron

For advanced prostate cancer, the primary medical strategy in your notes is:
A. Aromatase inhibitor monotherapy
B. Estrogen receptor antagonist only
C. GnRH agonist plus antiandrogen
D. Continuous pulsatile GnRH pump

A 7-year-old girl develops breast development and pubic hair. Best treatment approach:
A. Continuous GnRH agonist
B. Pulsatile GnRH infusion
C. GnRH antagonist “flare” dosing
D. Recombinant FSH injections

A patient is prescribed a GnRH agonist for endometriosis. Which is a contraindication?
A. Past anemia from menorrhagia
B. Prior ovarian cyst history
C. Pregnant or breastfeeding
D. History of acne vulgaris

One month after starting a GnRH agonist, a patient develops pelvic pain and an ovarian cyst. This is most associated with:
A. Immediate receptor blockade
B. Flare-related cyst formation
C. Placental hCG stimulation
D. Dopamine withdrawal effect

GnRH receptor antagonists in this set are best described as:
A. Partial agonist heptapeptides
B. Competitive steroid receptor blockers
C. Noncompetitive ion-channel inhibitors
D. Competitive decapeptide antagonists

Which drug is a GnRH receptor antagonist?
A. Cetrorelix
B. Nafarelin
C. Triptorelin
D. Histrelin

During ovarian stimulation procedures, which GnRH antagonists are used (per your list)?
A. Degarelix and abarelix
B. Leuprolide and nafarelin
C. Goserelin and triptorelin
D. Ganirelix and cetrorelix

For advanced prostate cancer, which GnRH receptor antagonists are used (per your list)?
A. Ganirelix and cetrorelix
B. Nafarelin and leuprolide
C. Degarelix and abarelix
D. Triptorelin and goserelin

Two advantages of GnRH antagonists over continuous GnRH agonist therapy are:
A. Immediate inhibition; less ovarian suppression
B. Stronger flare; longer depot duration
C. Higher multiple-gestation risk
D. Greater ovarian receptor downregulation

Which GnRH antagonist is associated with elevated liver enzymes (per your notes)?
A. Ganirelix
B. Cetrorelix
C. Degarelix
D. Abarelix

Which description best matches prolactin?
A. Placental glycoprotein heterodimer
B. 198-aa anterior pituitary peptide
C. Steroid from adrenal cortex
D. Hypothalamic catecholamine hormone

A nonfunctioning pituitary mass compresses the pituitary stalk. What happens to prolactin levels?
A. Increased prolactin levels
B. Decreased prolactin levels
C. No prolactin change
D. Biphasic prolactin change

A patient has hyperprolactinemia with low libido and infertility. Which mechanism-and-treatment pairing best fits?
A. Blocks LH; estrogen therapy
B. Low FSH; pulsatile GnRH
C. High GnRH; GnRH antagonist
D. Inhibits GnRH; dopamine agonist

Bromocriptine and cabergoline are best classified as:
A. GnRH receptor antagonists
B. Oxytocin receptor antagonists
C. D2 dopamine receptor agonists
D. Somatostatin analog peptides

First-line pharmacotherapy for hyperprolactinemia is:
A. GnRH agonist therapy
B. Dopamine agonist therapy
C. Vasopressin antagonist therapy
D. Oxytocin infusion therapy

Dopamine agonists inhibit prolactin by activating:
A. D2 receptors
B. V2 receptors
C. GnRH receptors
D. Oxytocin receptors

A patient with acromegaly needs an adjunct that partially inhibits GH. Which drug fits?
A. Nafarelin
B. Tolvaptan
C. Atosiban
D. Cabergoline

Oxytocin is a peptide composed of:
A. 14 amino acids
B. 9 amino acids
C. 191 amino acids
D. 198 amino acids

Oxytocin contracts smooth muscle via:
A. Gi cAMP inhibition
B. Gs cAMP activation
C. Gq PLC Ca2 signaling
D. JAK STAT signaling

For augmentation of labor, oxytocin is typically given by:
A. Intravenous infusion
B. Oral tablet
C. Nasal spray
D. Transdermal patch

Milk letdown occurs when oxytocin contracts:
A. Leydig cells
B. Myoepithelial cells
C. Theca cells
D. Sertoli cells

An oxytocin antagonist for preterm labor outside the US is:
A. Leuprolide
B. Conivaptan
C. Atosiban
D. Bromocriptine

High-dose oxytocin can cause fluid retention by activating:
A. Vasopressin receptors
B. Dopamine receptors
C. Androgen receptors
D. Estrogen receptors

Which is a contraindication to oxytocin?
A. Postterm pregnancy
B. Premature rupture membranes
C. Postpartum hemorrhage
D. Placental abruption

Another oxytocin contraindication is:
A. Postdates pregnancy
B. Fetal malpresentation
C. Prior cesarean history
D. Maternal hypothyroidism

Oxytocin should be avoided with:
A. Fetal distress
B. Mild edema only
C. Prior acne history
D. Low hemoglobin only

Vasopressin release increases most with:
A. Decreased plasma tonicity
B. Increased blood pressure
C. Increased plasma tonicity
D. Decreased plasma glucose

ADH V2 receptors are primarily located on:
A. Renal tubule cells
B. Vascular smooth muscle
C. Mammary alveolar ducts
D. Gonadotroph pituitary cells

V2 receptor signaling decreases diuresis via:
A. Gi inhibition of cyclase
B. Gs adenylyl cyclase
C. Gq PLC activation
D. Nuclear receptor binding

V1 receptors mediate vasoconstriction through:
A. Gs adenylyl cyclase
B. Gi cAMP inhibition
C. Gq PLC signaling
D. JAK STAT signaling

ADH-mediated release of factor VIII and vWF occurs via:
A. V1 receptors
B. Oxytocin receptors
C. V2 receptors
D. D2 receptors

Per these notes, diabetes insipidus is treated with:
A. Vasopressin at bedtime
B. Tolvaptan at bedtime
C. Oxytocin at bedtime
D. Cabergoline at bedtime

Which agent does NOT cause vasoconstriction?
A. Vasopressin
B. Desmopressin
C. Oxytocin
D. Leuprolide

Conivaptan and tolvaptan are:
A. Dopamine agonists
B. GnRH agonists
C. Vasopressin antagonists
D. Somatostatin analogs

Conivaptan has high affinity for:
A. V2 receptors only
B. V1 receptors only
C. D2 receptors only
D. V1a and V2 receptors

Tolvaptan’s receptor affinity is best described as:
A. V1a and V2 equal
B. V2 thirtyfold over V1
C. D2 over V2
D. Oxytocin over V1

Tolvaptan duration is limited due to:
A. Risk of hepatotoxic liver failure
B. Risk of renal stone disease
C. Risk of severe neutropenia
D. Risk of adrenal suppression

A hyponatremic heart-failure patient receives a V1a/V2 blocker. Which drug is used?
A. Tolvaptan
B. Conivaptan
C. Cabergoline
D. Bromocriptine