Perioperative: adrenal suppression: practice question

A General Surgery 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 Surgery · Perioperative: adrenal suppression

Sample item

A 52-year-old woman with rheumatoid arthritis has taken prednisolone 10 mg daily for 2 years and is undergoing right hemicolectomy. Under anaesthesia she develops hypotension of 70/40 mmHg that does not respond to fluid boluses, and there is no bleeding. What is the next step?

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

The answer and the reasoning

C. Intravenous hydrocortisone

Long-term glucocorticoid therapy suppresses the hypothalamic-pituitary-adrenal axis, so the stress response to surgery may be inadequate and cause refractory hypotension (adrenal crisis). Patients on steroids need perioperative cover, and unexplained fluid-resistant hypotension is treated promptly with intravenous hydrocortisone 100 mg. Delay for testing can be fatal.

Option by option

  • A. Oral fludrocortisone

    Oral fludrocortisone is slow and cannot be relied upon in an anaesthetised patient in shock.

  • B. Rapid blood transfusion

    There is no sign of bleeding, so transfusion does not address the cause.

  • C. Intravenous hydrocortisone (correct)

    Hydrocortisone replaces the missing stress-level cortisol and corrects the shock.

  • D. Intravenous dexamethasone only after cortisol result

    Waiting for a cortisol result delays life-saving treatment, and hydrocortisone is the preferred agent.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is C, Intravenous hydrocortisone. Long-term glucocorticoid therapy suppresses the hypothalamic-pituitary-adrenal axis, so the stress response to surgery may be inadequate and cause refractory hypotension (adrenal crisis).

Why is "Oral fludrocortisone" not the answer?

Oral fludrocortisone is slow and cannot be relied upon in an anaesthetised patient in shock.

Why is "Rapid blood transfusion" not the answer?

There is no sign of bleeding, so transfusion does not address the cause.

Why is "Intravenous dexamethasone only after cortisol result" not the answer?

Waiting for a cortisol result delays life-saving treatment, and hydrocortisone is the preferred agent.

What concept does this question test?

It tests Perioperative: adrenal suppression in General Surgery. Patients on steroids need perioperative cover, and unexplained fluid-resistant hypotension is treated promptly with intravenous hydrocortisone 100 mg. Delay for testing can be fatal.

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 Perioperative: adrenal suppression?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.