Preoperative assessment: steroid cover: practice question

A Anaesthesia 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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Anaesthesia · Preoperative assessment: steroid cover

Sample item

A patient on prednisolone 10 mg daily for 6 months is scheduled for a major abdominal surgery. What perioperative step is needed?

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

The answer and the reasoning

B. Give stress-dose hydrocortisone cover

Prolonged steroid use suppresses the hypothalamic-pituitary-adrenal axis, so the patient cannot mount a stress response. Hydrocortisone cover, for example 100 mg at induction for major surgery, prevents hypotension and adrenal crisis.

Option by option

  • A. Stop prednisolone 1 week before

    Stopping would precipitate adrenal insufficiency.

  • B. Give stress-dose hydrocortisone cover (correct)

    Correct. Stress-dose hydrocortisone prevents adrenal crisis.

  • C. Give fludrocortisone instead

    Fludrocortisone has mineralocorticoid effect and does not provide glucocorticoid stress cover.

  • D. No change is needed

    Continuing the usual dose alone gives inadequate cover for 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 Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, Give stress-dose hydrocortisone cover. Prolonged steroid use suppresses the hypothalamic-pituitary-adrenal axis, so the patient cannot mount a stress response.

Why is "Stop prednisolone 1 week before" not the answer?

Stopping would precipitate adrenal insufficiency.

Why is "Give fludrocortisone instead" not the answer?

Fludrocortisone has mineralocorticoid effect and does not provide glucocorticoid stress cover.

Why is "No change is needed" not the answer?

Continuing the usual dose alone gives inadequate cover for major surgery.

What concept does this question test?

It tests Preoperative assessment: steroid cover in Anaesthesia. Hydrocortisone cover, for example 100 mg at induction for major surgery, prevents hypotension and adrenal crisis.

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 Preoperative assessment: steroid cover?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia 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.