Paper II — 2025 March (Supplementary (SAY)) (2019 Scheme) — Q3
3 min read
Paper II
2025 March (Supplementary (SAY)) (2019 Scheme) · 100 marks · 180 min
Question
A 30 year old female with systemic lupus erythamatosis was given prednisolone 40 mg/day
(a) What are the precautions to be taken in this patient. Why. 4 mark(s)
(b) Enumerate four clinical uses of corticosteroids, with its rationale for use 4 mark(s)
(c) Enumerate four serious adverse effects of prolonged steroid use 2 mark(s)
Q310 marksEssays
Answer
a) Precautions in this patient, and why
Monitor for hyperglycemia — corticosteroids promote gluconeogenesis and reduce peripheral glucose uptake, risking steroid-induced hyperglycemia/diabetes.
Monitor blood pressure — mineralocorticoid-mediated sodium/water retention can worsen hypertension.
Gastroprotection (PPI co-prescription) — reduces peptic ulceration risk, particularly if the patient is also on NSAIDs for lupus-related joint symptoms.
Bone protection (calcium/vitamin D, consider bisphosphonate) — long-term corticosteroid use accelerates osteoporosis and fracture risk.
Screen for latent infection (e.g. TB) and avoid live vaccines — immunosuppression increases infection risk and reactivation of latent infections.
Never stop abruptly — risk of adrenal crisis from HPA axis suppression; taper gradually when discontinuing.
b) Four clinical uses of corticosteroids, with rationale
SLE and other autoimmune disease (as in this patient) — anti-inflammatory/immunosuppressive action suppresses the pathological autoimmune inflammatory process.
Addison’s disease — physiological replacement for absent endogenous cortisol.
c) Four serious adverse effects of prolonged steroid use
Osteoporosis with fracture risk, adrenal suppression (risk of adrenal crisis on abrupt withdrawal), steroid-induced diabetes/hyperglycemia, and increased susceptibility to infection (including reactivation of latent TB).
