Surgery osce

Question 1

What investigations are required prior to an elective surgery?

Answer 1

• Consider pre admission clinic to address medical issues.
• Blood tests including FBC, U+E, LFTs, Clotting, Group and Save
• Urine analysis
• Pregnancy test
• Sickle cell test
• ECG/ Chest x-ray

Question 2

What are the fasting rules?

Answer 2

6 hours- no food

4 hours- non clear fluids, juice with pulp, milk

2 hours-clear fluids- water, tea, coffee without milk

Question 3

What are the following medication rules before a surgery
a) ACEIs/ARBs
b) clopidogrel
c) warfarin
d) aspirin
e) COCP

Answer 3

• ACEIs/ARBs- stop 48 hours before procedure
• clopidogrel- stop 7 days before
• warfarin- stop 5 days before
• aspirin- stop 7 days before
  -COCP- stop 4-6 weeks before

Question 4

What are the following medication rules for T2DM?
a) SGLT-2 and sulfonylureas?
b) rest of anti-diabetic meds
c) short and long acting insulin

Answer 4

• SGLT2 and Sulfonylureas- ommit dose in morning
• long acting insulin- reduce day before and day of surgery by 20%
• short acting insulin- halve usual dose day before and morning of