Surgery

Question 1

What is the first-line treatment for thromboprophylaxis in patients with CrCl ≥30 mL/min?

Answer 1

Low Molecular Weight Heparin (LMWH - Enoxaparin) 40mg SC OD

This is a guideline by NICE for VTE prevention.

Question 2

What should be administered for thromboprophylaxis if CrCl <30 mL/min?

Answer 2

Unfractionated Heparin (UFH) 5000 units SC BD

This is an alternative when LMWH is not suitable.

Question 3

What is a common mechanical prophylaxis method for VTE prevention?

Answer 3

Anti-embolism stockings (AES) unless contraindicated

Mechanical methods are used alongside pharmacological methods.

Question 4

What is the recommended antibiotic prophylaxis for general surgery?

Answer 4

IV Co-amoxiclav 1.2g stat pre-op

Alternatives include IV Cefuroxime and IV Metronidazole for penicillin allergy.

Question 5

What antibiotic regimen is recommended for orthopaedic surgery?

Answer 5

IV Cefuroxime 1.5g pre-op, then 750mg TDS for 24 hours

If MRSA risk, use IV Vancomycin 15mg/kg pre-op instead.

Question 6

What is the antibiotic prophylaxis for C-section?

Answer 6

IV Co-amoxiclav 1.2g pre-incision

If penicillin allergy, administer IV Clindamycin 600mg pre-op.

Question 7

What is the first-line treatment for postoperative mild pain?

Answer 7

Paracetamol 1g QDS

This treatment is part of the WHO Pain Ladder Approach.

Question 8

What is the recommended analgesia for moderate postoperative pain?

Answer 8

Paracetamol 1g QDS + Codeine 30-60mg QDS

This combination helps manage moderate pain effectively.

Question 9

What is the first-line treatment for severe postoperative pain?

Answer 9

Morphine 5–10mg IV every 4 hours PRN

PCA may be used for ongoing severe pain.

Question 10

What are the maintenance fluid requirements for surgical patients?

Answer 10

25–30mL/kg/day of water + 1mmol/kg/day of sodium, potassium, chloride

Example: 1L 0.9% NaCl + 20mmol KCl over 8 hours.

Question 11

What is the first-line treatment for postoperative nausea and vomiting (PONV)?

Answer 11

Ondansetron 4mg IV/PO every 8 hours PRN

This is a 5-HT3 antagonist.

Question 12

What is the treatment for superficial surgical site infection (SSI)?

Answer 12

Flucloxacillin 500mg QDS for 7 days

If MRSA is suspected, consider Doxycycline 100mg BD for 7 days.

Question 13

What should be done for patients with well-controlled T2DM on the day of surgery?

Answer 13

Omit oral hypoglycaemics

Monitor capillary blood glucose (CBG) every 4 hours.

Question 14

What is the first-line treatment for postoperative ileus?

Answer 14

Supportive: NBM + IV fluids

Nasogastric tube decompression may be necessary if vomiting or distension occurs.

Question 15

What is the first-line treatment for acute postoperative bleeding?

Answer 15

IV fluids (crystalloids) to maintain BP

Tranexamic Acid 1g IV may be given if major bleeding risk.

Question 16

What is the first-line treatment for postoperative constipation?

Answer 16

Senna 7.5–15mg OD/BD (stimulant) if soft stools but reduced motility

Macrogol (Movicol) 1 sachet BD for hard stools.