Perioperative medicine
Preoperative assessment, medication management, consent, postoperative complications and fluid management. Safe medication handling around surgery is the most tested area.
High-yield points
ASA grade describes fitness for anaesthesia (I healthy to VI brain dead donor).
Fasting: usually 6 hours for food; clear fluids are allowed until closer to surgery according to local ANZCA-based policy.
SGLT2 inhibitors must be withheld for 2-3 days before major surgery or procedures needing fasting because of euglycaemic DKA risk.
Anticoagulants: plan interruption based on drug, renal function and bleeding risk; bridging with heparin is only for high-thrombotic-risk patients (e.g. mechanical mitral valve).
VTE prophylaxis: assess every surgical patient; mechanical and/or pharmacological prophylaxis.
Post-op fever: think of timing (atelectasis early, then UTI, wound infection, VTE, anastomotic leak).
Post-op confusion: delirium until proven otherwise; check oxygen, glucose, urinary retention, drugs and infection.
WHO surgical safety checklist (sign in, time out, sign out) is used in all Australian theatres.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Informed consent | Often a signed form with general risks, sometimes signed by family. | Rogers v Whitaker: disclose material risks, those a reasonable person or this patient would consider significant. Generic 'risks explained' isn't enough. |
| Language barriers | Family members commonly interpret. | Use a professional interpreter (TIS National is free for doctors), not family, for consent. |
| Diabetes drugs before surgery | Focus on insulin and glucose control. | Stop SGLT2 inhibitors a few days before surgery because of euglycaemic ketoacidosis risk. |
| Antibiotic prophylaxis | Prolonged postoperative courses are common. | Single dose within 60 minutes before incision, usually cefazolin, per eTG. |
Informed consent
India (MBBS)
Often a signed form with general risks, sometimes signed by family.
Australia (AMC): what the exam expects
Rogers v Whitaker: disclose material risks, those a reasonable person or this patient would consider significant. Generic 'risks explained' isn't enough.
Language barriers
India (MBBS)
Family members commonly interpret.
Australia (AMC): what the exam expects
Use a professional interpreter (TIS National is free for doctors), not family, for consent.
Diabetes drugs before surgery
India (MBBS)
Focus on insulin and glucose control.
Australia (AMC): what the exam expects
Stop SGLT2 inhibitors a few days before surgery because of euglycaemic ketoacidosis risk.
Antibiotic prophylaxis
India (MBBS)
Prolonged postoperative courses are common.
Australia (AMC): what the exam expects
Single dose within 60 minutes before incision, usually cefazolin, per eTG.
The Australian context
Informed consent in Australia follows Rogers v Whitaker (1992): the doctor must disclose material risks, meaning risks a reasonable person, or this particular patient, would consider significant. A generic 'risks were explained' note is not enough.