Corticosteroid

Question 1

Which feature best describes glucocorticoid steroids?
A. Low anti-inflammatory effect and high fluid retention
B. High anti-inflammatory effect and low fluid retention
C. High mineralocorticoid activity
D. No systemic effects

Answer 1

Correct answer: High anti-inflammatory effect and low fluid retention. Explanation: Glucocorticoids primarily reduce inflammation with minimal fluid retention.

Question 2

Which glucocorticoids have the highest glucocorticoid activity?
A. Hydrocortisone and fludrocortisone
B. Prednisolone and prednisone
C. Dexamethasone and betamethasone
D. Deflazacort and prednisone

Answer 2

Correct answer: Dexamethasone and betamethasone. Explanation: These have the highest glucocorticoid potency.

Question 3

Which glucocorticoids are considered high activity?
A. Hydrocortisone and fludrocortisone
B. Prednisolone, prednisone and deflazacort
C. Dexamethasone and betamethasone
D. Fludrocortisone only

Answer 3

Correct answer: Prednisolone, prednisone and deflazacort. Explanation: These are high-activity glucocorticoids.

Question 4

When are glucocorticoids preferred?
A. When fluid retention is required
B. When mineralocorticoid effects are needed
C. When fluid retention is not wanted
D. When blood pressure needs increasing

Answer 4

Correct answer: When fluid retention is not wanted. Explanation: Glucocorticoids have low mineralocorticoid activity.

Question 5

Which is a recognised long-term side effect of glucocorticoids?
A. Hyperthyroidism
B. Osteoporosis and fractures
C. Hypoglycaemia
D. Bradycardia

Answer 5

Correct answer: Osteoporosis and fractures. Explanation: Long-term steroid use weakens bone.

Question 6

Which serious musculoskeletal complication can occur with corticosteroids?
A. Rheumatoid arthritis
B. Avascular necrosis of the femoral head
C. Osteomalacia
D. Gout

Answer 6

Correct answer: Avascular necrosis of the femoral head. Explanation: Steroids impair blood supply to bone.

Question 7

Which describes mineralocorticoid steroids?
A. High anti-inflammatory, low fluid retention
B. Low anti-inflammatory, high fluid retention
C. No effect on electrolytes
D. No cardiovascular effects

Answer 7

Correct answer: Low anti-inflammatory, high fluid retention. Explanation: Mineralocorticoids mainly affect sodium and water balance.

Question 8

Which steroid has the highest mineralocorticoid activity?
A. Hydrocortisone
B. Prednisolone
C. Fludrocortisone
D. Dexamethasone

Answer 8

Correct answer: Fludrocortisone. Explanation: Fludrocortisone has the strongest mineralocorticoid effect.

Question 9

Which side effect is associated with fludrocortisone?
A. Hypotension
B. Postural hypotension
C. Bradycardia
D. Hyperkalaemia

Answer 9

Correct answer: Postural hypotension. Explanation: Fludrocortisone affects fluid and electrolyte balance.

Question 10

Which electrolyte abnormality can occur with mineralocorticoids?
A. Hyperkalaemia
B. Hypokalaemia
C. Hypercalcaemia
D. Hyponatraemia

Answer 10

Correct answer: Hypokalaemia. Explanation: Aldosterone effects increase potassium loss.

Question 11

Why are mineralocorticoid effects negligible with dexamethasone?
A. Short half-life
B. High mineralocorticoid activity
C. High glucocorticoid potency
D. Poor absorption

Answer 11

Correct answer: High glucocorticoid potency. Explanation: Potent glucocorticoids have minimal mineralocorticoid effects.

Question 12

Which MHRA warning is associated with corticosteroids?
A. QT prolongation
B. Early psychiatric side effects
C. Renal failure
D. Pulmonary fibrosis

Answer 12

Correct answer: Early psychiatric side effects. Explanation: Mood changes, mania and suicidal thoughts can occur early.

Question 13

What visual symptom may indicate central serous chorioretinopathy?
A. Complete blindness
B. Blurred or distorted vision in one eye
C. Eye pain
D. Redness

Answer 13

Correct answer: Blurred or distorted vision in one eye. Explanation: This is a known corticosteroid adverse effect.

Question 14

What risk is associated with prolonged corticosteroid use?
A. Hyperaldosteronism
B. Secondary adrenal insufficiency
C. Hyperthyroidism
D. Diabetes insipidus

Answer 14

Correct answer: Secondary adrenal insufficiency. Explanation: Long-term steroids suppress the HPA axis.

Question 15

Why is abrupt withdrawal of corticosteroids dangerous?
A. Causes hypertension
B. Causes acute adrenal insufficiency
C. Causes hypoglycaemia
D. Causes fluid overload

Answer 15

Correct answer: Causes acute adrenal insufficiency. Explanation: Sudden withdrawal can be fatal.

Question 16

What should be done with corticosteroid doses during intercurrent illness or surgery?
A. Stop corticosteroids
B. Reduce the dose
C. Temporarily increase the dose
D. Switch to topical therapy

Answer 16

Correct answer: Temporarily increase the dose. Explanation: Stress dosing prevents adrenal crisis.

Question 17

How do corticosteroids affect infection risk?
A. Reduce severity of infections
B. Increase susceptibility and mask symptoms
C. Prevent viral infections
D. Have no effect

Answer 17

Correct answer: Increase susceptibility and mask symptoms. Explanation: Immunosuppression can delay diagnosis.

Question 18

Why is chickenpox dangerous in patients on corticosteroids?
A. Causes mild illness only
B. Can be fatal due to immunosuppression
C. Causes rash only
D. No increased risk

Answer 18

Correct answer: Can be fatal due to immunosuppression. Explanation: Urgent action is required if exposed.

Question 19

What prophylaxis is needed after chickenpox exposure in non-immune patients on steroids?
A. Antivirals only
B. Varicella zoster immunoglobulin
C. Antibiotics
D. Vaccination

Answer 19

Correct answer: Varicella zoster immunoglobulin. Explanation: Passive immunisation is required.

Question 20

What advice is given after measles exposure in a patient on corticosteroids?
A. No action needed
B. Immediate medical advice and possible immunoglobulin
C. Vaccinate immediately
D. Stop steroids abruptly

Answer 20

Correct answer: Immediate medical advice and possible immunoglobulin. Explanation: Measles can be severe in immunosuppressed patients.

Question 21

When should live vaccines be avoided with corticosteroids?
A. Always
B. When on high-dose corticosteroids
C. Only in children
D. Only with topical steroids

Answer 21

Correct answer: When on high-dose corticosteroids. Explanation: Immune response is impaired.

Question 22

How long should live vaccines be postponed after stopping corticosteroids?
A. 1 month
B. 6 weeks
C. 3 months
D. 12 months

Answer 22

Correct answer: 3 months. Explanation: Immune function recovery takes time.

Question 23

What features suggest iatrogenic Cushing’s syndrome?
A. Weight loss and fatigue
B. Moon face, striae and hirsutism
C. Hypotension
D. Hyperpigmentation

Answer 23

Correct answer: Moon face, striae and hirsutism. Explanation: Chronic steroid excess causes Cushingoid features.

Question 24

When is intracranial pressure rise most likely with corticosteroids?
A. At initiation
B. During stable dosing
C. After treatment withdrawal
D. With topical use

Answer 24

Correct answer: After treatment withdrawal. Explanation: Raised intracranial pressure may occur post-withdrawal.

Question 25

When is the best time to take oral corticosteroids? A. Evening B. Night C. Morning D. With meals only

Answer 25

Correct answer: Morning. Explanation: Reduces insomnia and mimics natural cortisol rhythm.

Question 26

Which strategy reduces corticosteroid side effects? A. High dose long-term B. Alternate day dosing C. Multiple daily doses D. Abrupt withdrawal

Answer 26

Correct answer: Alternate day dosing. Explanation: Minimises adrenal suppression.

Question 27

Why is a steroid card important? A. Identifies allergy B. Indicates anticoagulant use C. Alerts healthcare professionals to steroid use D. Replaces prescription

Answer 27

Correct answer: Alerts healthcare professionals to steroid use. Explanation: Essential in emergencies.

Question 28

How should corticosteroids be used in pregnancy? A. Contraindicated B. Only in first trimester C. If benefit outweighs risk D. Always avoided

Answer 28

Correct answer: If benefit outweighs risk. Explanation: Maternal benefit may justify use.

Question 29

What breastfeeding advice applies to corticosteroids? A. Always stop breastfeeding B. Avoid all doses C. Avoid prolonged high doses and wait 4 hours before feeding D. No precautions needed

Answer 29

Correct answer: Avoid prolonged high doses and wait 4 hours before feeding. Explanation: Reduces infant adrenal suppression risk.

Question 30

Which parameters should be checked before starting corticosteroids? A. ECG only B. BP, weight, glucose, lipids and potassium C. Liver enzymes only D. INR

Answer 30

Correct answer: BP, weight, glucose, lipids and potassium. Explanation: Baseline monitoring is essential.

Question 31

When can short courses of oral corticosteroids be stopped abruptly? A. Always B. If less than 3 weeks C. Only if low dose D. Never

Answer 31

Correct answer: If less than 3 weeks. Explanation: Short courses do not suppress adrenal function.

Question 32

When must corticosteroids be tapered? A. Any duration B. More than 40mg prednisolone for over a week C. Topical use only D. Inhaled steroids only

Answer 32

Correct answer: More than 40mg prednisolone for over a week. Explanation: High doses suppress adrenal function.

Question 33

What is a mild topical corticosteroid? A. Clobetasol B. Betamethasone C. Clobetasone D. Hydrocortisone

Answer 33

Correct answer: Hydrocortisone. Explanation: Hydrocortisone is mild potency.

Question 34

Which topical steroid is very potent? A. Hydrocortisone B. Clobetasone C. Betamethasone D. Clobetasol

Answer 34

Correct answer: Clobetasol. Explanation: Clobetasol is a very potent topical steroid.