Endocrinology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Endocrinology

Sample item

A woman with Graves disease develops fever of 40 degrees Celsius, agitation, heart rate 160 and vomiting after an emergency appendicectomy. Which sequence of drugs is correct?

AIodine first, then thionamide a day laterBPropranolol and a thionamide such as propylthiouracil, then iodine at least an hour later, with hydrocortisoneCRadioactive iodine immediatelyDLevothyroxine and verapamil

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Propranolol and a thionamide such as propylthiouracil, then iodine at least an hour later, with hydrocortisone

Thyroid storm is managed by blocking synthesis, release and peripheral effects of thyroid hormone. A thionamide (propylthiouracil also blocks T4 to T3 conversion) is given first, and iodine is given at least an hour later to block release. Propranolol controls adrenergic effects, and steroids reduce conversion, with cooling and fluids as supportive care.

Option by option

A. Iodine first, then thionamide a day later
Giving iodine before a thionamide can provide substrate for new hormone synthesis.
B. Propranolol and a thionamide such as propylthiouracil, then iodine at least an hour later, with hydrocortisone (correct)
Correct. Thionamide before iodine, with beta-blocker and steroid, is the standard protocol.
C. Radioactive iodine immediately
Radioactive iodine is not used in acute storm because the effect is delayed.
D. Levothyroxine and verapamil
Levothyroxine adds thyroid hormone and is harmful.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Propranolol and a thionamide such as propylthiouracil, then iodine at least an hour later, with hydrocortisone. Thyroid storm is managed by blocking synthesis, release and peripheral effects of thyroid hormone.

Why is "Iodine first, then thionamide a day later" not the answer?

Giving iodine before a thionamide can provide substrate for new hormone synthesis.

Why is "Radioactive iodine immediately" not the answer?

Radioactive iodine is not used in acute storm because the effect is delayed.

Why is "Levothyroxine and verapamil" not the answer?

Levothyroxine adds thyroid hormone and is harmful.

What concept does this question test?

It tests Endocrinology in General Medicine. A thionamide (propylthiouracil also blocks T4 to T3 conversion) is given first, and iodine is given at least an hour later to block release. Propranolol controls adrenergic effects, and steroids reduce conversion, with cooling and fluids as supportive care.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.