Peri-op

Question 1

Answer 1

Question 2

How long before a general surgery do you hold oral solids before? [1]
What about fluids and clear fluids? [1]

Answer 2

Food: 6hrs before
Fluids: 2hrs before

Question 3

Answer 3

6hrs

Question 4

Give 4 pieces of advise on how should optimise DM patients prior to surgery [4]

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

How do you manage glicazide, pioglitazone or sitagliptin before a surgery? [3]

Answer 7

Question 8

What advise do you give about stopping doacs prior to surgery? [2]

Answer 8

Question 9

Answer 9

Question 11

Answer 11

Question 12

When do you stop the following prior to surgery:
- antiplatelets
- MAIOs
- Statins
- BBs

Answer 12

Question 13

How do you manage tramadol, COCP, ACEin and Lithium prior to surgery? [4]

Answer 13

Question 14

[6]

Answer 14

Question 15

Which ONE of the following statements is CORRECT regarding the risk of post-operative nausea and vomiting?

Opioids accelerate gastric emptying and this can increase the risk
Intravenous anaesthetic agents increase the risk in comparison to inhaled anaesthetic agents
Ferrous sulfate can increase the risk
Males are more at risk in comparison to females
Total knee replacement surgery is a surgery associated with a higher risk
1 OF 10

Answer 15

Question 16

A 76-year-old woman with a history of recurrent DVT and PE is currently prescribed long-term phenindione. She presents for her preoperative assessment prior to a total hip replacement. Which ONE of the following is the MOST appropriate option regarding managing her phenindione prescription?

Continue perioperatively
Stop at least 7 days preoperatively
Stop at least 5 days preoperatively
Stop at least 2 days preoperatively
Convert to parenteral treatment preoperatively

Answer 16

Convert to parenteral treatment preoperatively
Vitamin K antagonists (e.g. phenindione, warfarin) should be stopped 4-5 days before surgery and parenteral anticoagulants administered perioperatively.

Question 17

When indicated, prophylactic intravenous antimicrobial infusions should be administered how long before skin incision?

Immediately prior to skin incision
15 minutes
30-60 minutes
60-90 minutes
90 minutes

Answer 17

30-60 minutes

Question 18

A 26-year-old woman attends a preoperative assessment appointment prior to her cholecystectomy. She is currently prescribed Microgynon 30®. Which ONE of the following is the CORRECT option regarding perioperative management of her Microgynon® prescription?

Continue perioperatively
Stop at least seven days before surgery
Stop at least two weeks before surgery
Stop at least four weeks before surgery
Change the prescription to a combined transdermal patch

Answer 18

Stop at least four weeks before surgery

Question 19

Which ONE of the following medicines is MOST likely to increase the risk of hypotension if co-prescribed with propofol?

Chlorphenamine
Digoxin
Haloperidol
Levothyroxine
Tamoxifen

Answer 19

Haloperidol

Question 20

Which ONE of the following medicines should be stopped at least two weeks before surgery?

Amitriptyline
Lithium Carbonate
Citalopram
Phenelzine
Mirtazapine

Answer 20

MAOIs should be stopped 2 weeks before surgery, due to the risk of hypo- and hypertension.

Question 21

Which ONE of the following is the MOST appropriate option regarding the management of dabigatran prior to elective surgery?

It should be stopped 7 days prior to surgery.
It should be stopped 5 days prior to surgery.
Omit only on the day of surgery.
Stopping rules are dependent on the risk of bleeding.
Stopping rules are dependent on the risk of bleeding and the patient’s renal function as creatinine clearance.

Answer 21

Question 22

On the operative day, which ONE of the following medicines would you recommend was omitted?

Atorvastatin 20 mg
Calcichew D3 Forte
Hydrocortisone 20 mg
Metoprolol 50 mg
Perindopril 4 mg

Answer 22

ACE inhibitors as a class are associated with marked hypotension following induction of anaesthesia. Therefore, should be omitted.