Hormonal therapies — MCQs

A 68-year-old man presents to his primary care physician with a 4-week history of back pain. He says that the pain does not appear to be associated with activity and is somewhat relieved by taking an NSAID. Furthermore, he says that he has had increasing difficulty trying to urinate. His past medical history is significant for kidney stones and a 30-pack-year smoking history. Radiographs reveal osteoblastic lesions in the spine. Which of the following drugs would most likely be effective in treating this patient's disease?

A 57-year-old presents to your clinic complaining of baldness. He is overweight, has been diagnosed with BPH, and is currently taking atorvastatin for hyperlipidemia. The patient has tried several over-the-counter products for hair-loss; however, none have been effective. After discussing several options, the patient is prescribed a medication to treat his baldness that has the additional benefit of treating symptoms of BPH as well. Synthesis of which of the following compounds would be expected to decrease in response to this therapy?

A 57-year-old woman comes to the physician for evaluation of a lump in the right breast that she first noticed a week ago. Biopsy of the mass confirms a diagnosis of a pleomorphic lobular carcinoma-in-situ that is estrogen receptor-positive. The patient undergoes lumpectomy, and treatment with tamoxifen is initiated. Which of the following conditions is most likely to occur as a result of tamoxifen therapy?

A 27-year-old woman comes to the physician for the evaluation of infertility. She has been unable to conceive for the past 2 years. Menses occur at 45 to 80-day intervals. She is 168 cm (5 ft 6 in) tall and weighs 77 kg (170 lb); BMI is 27.4 kg/m2. Physical examination shows facial acne and pigmented hair on the upper lip. Serum studies show elevated levels of testosterone and an LH:FSH ratio of 4:1. Treatment with the appropriate drug for this patient's infertility is begun. Which of the following is the primary mechanism of action of this drug?

A 65-year-old woman arrives for her annual physical. She has no specific complaints. She has seasonal allergies and takes loratadine. She had a cholecystectomy 15 years ago. Her last menstrual period was 9 years ago. Both her mother and her maternal aunt had breast cancer. A physical examination is unremarkable. The patient is given the pneumococcal conjugate vaccine and the shingles vaccine. A dual-energy x-ray absorptiometry (DEXA) scan is obtained. Her T-score is -2.6. She is prescribed a new medication. The next month the patient returns to her primary care physician complaining of hot flashes. Which of the following is the most likely medication the patient was prescribed?

A 46-year-old female with estrogen receptor positive invasive ductal carcinoma is prescribed tamoxifen. Which of the following is the MOST concerning side effect that requires patient counseling regarding potentially life-threatening complications?

A 69-year-old man comes to the physician because of a 3-month history of urinary urgency, nocturia, and progressive pain in his lower back. The pain is worse at night and does not respond to ibuprofen. Rectal examination shows an enlarged, asymmetric prostate with a nodular surface. Prostate-specific antigen concentration is 11 ng/ml (N < 4). A biopsy of the prostate shows a high-grade adenocarcinoma. A CT scan of the pelvis shows multiple osteoblastic lesions of the lumbar spine. The patient is started on a drug that competes with androgens for interaction with the testosterone receptors. Treatment with which of the following drugs was most likely initiated in this patient?

A 40-year-old man presents with a painless firm mass in the right breast. Examination shows retraction of the nipple and the skin is fixed to the underlying mass. The axillary nodes are palpable. Which of the following statements is FALSE regarding the above condition?

A 19-year-old South Asian male presents to the family physician concerned that he is beginning to go bald. He is especially troubled because his father and grandfather "went completely bald by the age of 25," and he is willing to try anything to prevent his hair loss. The family physician prescribes a medication that prevents the conversion of testosterone to dihydrotestosterone. Which of the following enzymes is inhibited by this medication?

A 64-year-old woman presents to the clinic with a history of 3 fractures in the past year with the last one being last month. Her bone-density screening from last year reported a T-score of -3.1 and she was diagnosed with osteoporosis. She was advised to quit smoking and was asked to adapt to a healthy lifestyle to which she complied. She was also given calcium and vitamin D supplements. After a detailed discussion with the patient, the physician decides to start her on weekly alendronate. Which of the following statements best describes this patient’s new therapy?