Gen Surg

Question 1

ASA grades

Answer 1

1: no problems
2: minor
3: severe with functional limitations
4: severe and life-threatening
5: moribund
6: brain-dead

Question 2

first on op list vs last on op list

Answer 2

diabetics, infection

Question 3

rule for dual antiplatelets

Answer 3

Stop 10 days prior to surgery

Resume day after surgery unless contraindication

Question 4

DOACs and surgery

Answer 4

No specific reversal agent
Usually need to wait 24 hours for elective surgery

(for dabigatran can wait 12h)

Question 5

INR threshold for elective surgery

Answer 5

1.5

Question 6

when should anticoag be stopped

Answer 6

5 days before surgery (continue to give lmwh in interim)

Question 7

when should therapeutic dose lmwh be stopped

Answer 7

48h before surgery

Question 8

fasting rules for surgery

Answer 8

6h food

2h clear fluids

Question 9

if INR too high and on warfarin (elective surgery)

Answer 9

give 5-10 mg IV vit K
repeat INR after 6h
if still too high, d/w haematology re: giving PCC

Question 10

if INR too high due to liver disease (elective surg)

Answer 10

give 10 mg IV vit K
repeat INR after 6h
if still high d/w haem re: FFP/ cryoprecipitate

Question 11

when should UH be stopped

Answer 11

4h

Question 12

when should antiplatelets never be stopped before talking to cardiologist

Answer 12

stents within 1 year

Question 13

when should insulin be stopped?

Answer 13

avoid morning dose (no long-acting)

Question 14

when should oral hypoglycaemics be stopped?

Answer 14

avoid on day of op if short-acting
3 days before if long-acting
metformin: 2 days before + withhold 2 days after

Question 15

when should cocp be stopped/ restarted?

Answer 15

stopped 4 weeks before

started 2 weeks after

Question 16

what should be avoided on day of op?

Answer 16

ACEi, diuretics

Question 17

What is re-feeding syndrome? When does it occur?
What are the hallmarks?
How do you avoid?

Answer 17

occurs 24-72h after reintroduction of nutrition in someone who has had little food for over 5 days

large shifts in electrolytes. hallmark is low phosphate

in pts at high risk, check U&Es, bone profile, mg
administer thiamine, vit B, multivits
feed slowly

Question 18

5 Ws of post-op fever

Answer 18

wind (atelectasis)
water (UTI)
wound (infection)
walking (DVT)
wonder drugs (drug fever)

Question 19

when to return to work post- elective surgery

Answer 19

light work: 1-2 weeks
minimal lifting: 2-3 weeks
heavy labour: 6 weeks