Steroid Management — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardHuman Disease & Dental ManagementSteroid ManagementORE Part 1

A patient takes prednisolone 20 mg once daily long term for autoimmune hepatitis and is scheduled for a surgical dental extraction under local anaesthesia. The procedure is expected to be uncomplicated and the patient can take oral medication. Which is the most appropriate steroid-management plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Continue the usual prednisolone dose without routine additional steroid cover

**A is correct.** Although long-term prednisolone can suppress the HPA axis, this patient already receives prednisolone 20 mg daily, which exceeds the UK guidance threshold for a supraphysiological dose (10 mg daily). For dental extraction under local anaesthesia with expected rapid, uncomplicated recovery, routine dose doubling is probably not required; the usual steroid dose should be continued. Intravenous hydrocortisone 100 mg is used for procedures under general anaesthesia or major surgical stress, not routine extraction under local anaesthesia. Withholding prednisolone risks adrenal insufficiency and may precipitate deterioration of the underlying autoimmune hepatitis. Intramuscular dexamethasone is not routine dental stress cover in this circumstance. If the procedure becomes prolonged/complicated, the patient is unwell, or oral absorption is unreliable, obtain urgent medical advice regarding supplemental steroids.

Reference: NHS Highland, Peri-operative guidance for patients with or at risk of adrenal insufficiency, dental surgery and switching back to oral glucocorticoids sections, updated 27 October 2025. https://www.rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/adult-therapeutic-guidelines/endocrine/peri-operative-guidance-for-patients-with-or-at-risk-of-adrenal-insufficiency-guidelines/?searchTerm=TAM452