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Perioperative adrenal suppression — SCE Acute Medicine MCQ

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EasyPerioperative, Safety and End-of-Life CarePerioperative adrenal suppressionSCE Acute Medicine

A 71-year-old woman presents with postoperative deterioration, treatment refusal or advanced illness. Relevant history includes recent surgery, frailty or a governance issue. On assessment, physiology and communication context require senior decision-making. Investigations show postoperative shock in a patient on long-term prednisolone. What is the most appropriate next step in management?

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

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Correct answer: D — Give stress-dose intravenous hydrocortisone

The key discriminator is that postoperative shock in a patient on long-term prednisolone, which makes Give stress-dose intravenous hydrocortisone the single best answer. Arrange urgent CT imaging is less appropriate because it does not address the dominant acute risk in the vignette; Arrange routine outpatient follow-up would fit a different presentation or later stage of care. Give targeted antidote or reversal therapy and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology adrenal crisis guidance