Endocrine drugs: perioperative steroid cover: practice question

A Pharmacology 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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Pharmacology · Endocrine drugs: perioperative steroid cover

Sample item

A 50-year-old man has taken prednisolone 10 mg daily for rheumatoid arthritis for two years. He is posted for major abdominal surgery. What is the correct perioperative step?

AContinue the usual dose only, since the adrenal axis is intactBGive a single dose of fludrocortisone before surgeryCAdd hydrocortisone cover and taper back afterwardsDStop prednisolone two days before the operation

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

The answer and the reasoning

C. Add hydrocortisone cover and taper back afterwards

Long-term glucocorticoids suppress the hypothalamic-pituitary-adrenal axis, so the adrenal glands cannot raise cortisol output in response to surgical stress. Extra intravenous hydrocortisone is given around major surgery to avoid adrenal crisis and then tapered to the usual dose.

Option by option

A. Continue the usual dose only, since the adrenal axis is intact
The axis is suppressed after prolonged therapy, so the usual dose alone is inadequate under stress.
B. Give a single dose of fludrocortisone before surgery
Fludrocortisone provides mineralocorticoid action and does not replace glucocorticoid needs.
C. Add hydrocortisone cover and taper back afterwards (correct)
Correct. A suppressed axis needs stress-dose hydrocortisone around major surgery.
D. Stop prednisolone two days before the operation
Stopping the drug would risk adrenal insufficiency and a flare of arthritis.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is C, Add hydrocortisone cover and taper back afterwards. Long-term glucocorticoids suppress the hypothalamic-pituitary-adrenal axis, so the adrenal glands cannot raise cortisol output in response to surgical stress.

Why is "Continue the usual dose only, since the adrenal axis is intact" not the answer?

The axis is suppressed after prolonged therapy, so the usual dose alone is inadequate under stress.

Why is "Give a single dose of fludrocortisone before surgery" not the answer?

Fludrocortisone provides mineralocorticoid action and does not replace glucocorticoid needs.

Why is "Stop prednisolone two days before the operation" not the answer?

Stopping the drug would risk adrenal insufficiency and a flare of arthritis.

What concept does this question test?

It tests Endocrine drugs: perioperative steroid cover in Pharmacology. Extra intravenous hydrocortisone is given around major surgery to avoid adrenal crisis and then tapered to the usual dose.

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 Endocrine drugs: perioperative steroid cover?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.