Endocrinology and diabetes: perioperative steroid cover: 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.

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General Medicine · Endocrinology and diabetes: perioperative steroid cover

Sample item

A 50-year-old man has taken prednisolone 10 mg daily for two years for polymyalgia rheumatica. He needs elective hip replacement under general anaesthesia. What is the most appropriate perioperative steroid plan?

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

The answer and the reasoning

B. Give extra hydrocortisone cover around surgery

Prolonged steroid use suppresses the HPA axis, so the patient cannot mount a stress cortisol response. Supplemental hydrocortisone is given perioperatively to prevent adrenal crisis, with the dose scaled to the surgical stress.

Option by option

  • A. Stop prednisolone a week before surgery

    Stopping the drug would invite adrenal crisis and a flare of the disease.

  • B. Give extra hydrocortisone cover around surgery (correct)

    Correct. A suppressed axis needs supplemental glucocorticoid for the stress of surgery.

  • C. Substitute fludrocortisone for the surgical period

    Fludrocortisone has mineralocorticoid action and little glucocorticoid effect.

  • D. Continue the usual dose with no additional cover

    Usual dosing alone may not cover the stress response during major surgery.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Give extra hydrocortisone cover around surgery. Prolonged steroid use suppresses the HPA axis, so the patient cannot mount a stress cortisol response.

Why is "Stop prednisolone a week before surgery" not the answer?

Stopping the drug would invite adrenal crisis and a flare of the disease.

Why is "Substitute fludrocortisone for the surgical period" not the answer?

Fludrocortisone has mineralocorticoid action and little glucocorticoid effect.

Why is "Continue the usual dose with no additional cover" not the answer?

Usual dosing alone may not cover the stress response during major surgery.

What concept does this question test?

It tests Endocrinology and diabetes: perioperative steroid cover in General Medicine. Supplemental hydrocortisone is given perioperatively to prevent adrenal crisis, with the dose scaled to the surgical stress.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 and diabetes: perioperative steroid cover?

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.