Metabolic, Endocrine, Haematological, and Pharmacological Pre-Assessment & Perioperative Optimization — WACS Viva & Clinical Scenarios (Pre-Op & Pain Clinic Rotation)

Exam-style metabolic, endocrine, haematological, and pharmacological pre-assessment & perioperative optimization viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 24-year-old female with homozygous sickle cell disease (HbSS) is scheduled for elective open cholecystectomy for symptomatic cholelithiasis. Her baseline steady-state haemoglobin is 6.2 g/dL, reticulocyte count is 10%, and she has had one episode of acute chest syndrome two years ago. She has no active crisis. How will you systematically evaluate, risk-stratify, and optimize this patient haematologically and metabolically in the pre-anaesthetic clinic to prevent perioperative sickling crises?
• SCENARIO 2: A 58-year-old male with Type 2 diabetes mellitus and chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) presents for elective total hip replacement. He is currently taking empagliflozin, metformin, sitagliptin, and subcutaneous glargine insulin. His HbA1c is 8.8% and serum potassium is 5.2 mmol/L. Outline your comprehensive pharmacological management plan, detailing when each oral hypoglycaemic agent should be stopped, how insulin should be transitioned, and how you will prevent euglycaemic DKA and perioperative acute kidney injury.
• SCENARIO 3: A 42-year-old female with Graves' disease presents with severe obstructive goitre causing mild positional stridor and is booked for subtotal thyroidectomy. In the clinic, she is anxious, tremulous, has a resting heart rate of 124 bpm, blood pressure 150/70 mmHg, free T4 >60 pmol/L (markedly elevated), and undetectable TSH. The surgical team wants to operate in 3 days. What is your clinical assessment, what is your stance on proceeding, and how will you medically optimize her to an euthyroid state prior to induction of anaesthesia?
• SCENARIO 4: A 65-year-old male with mechanical mitral valve replacement on long-term warfarin and low-dose aspirin requires elective radical prostatectomy for localized adenocarcinoma. His current INR is 3.1. Describe your step-by-step pre-anaesthetic bridging anticoagulation protocol, detailing cessation timelines, therapeutic low-molecular-weight heparin or unfractionated heparin bridging, monitoring, and restart criteria.