Preoperative assessment: sulfonylurea on the day of surgery: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: sulfonylurea on the day of surgery

Sample item

A type 2 diabetic takes glibenclamide every morning. He is nil by mouth from midnight for an elective morning operation. What is the best advice for the morning of surgery?

ATake the usual dose and delay the first meal until the afternoonBTake the usual dose with a sip of water, to avoid stress hyperglycaemiaCOmit the morning dose, because it can cause hypoglycaemia during fastingDTake double the usual dose, to blunt the surgical stress response

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Omit the morning dose, because it can cause hypoglycaemia during fasting

Sulfonylureas keep stimulating insulin release whether or not the patient eats, so a dose taken while fasting risks hypoglycaemia, which is hard to detect under anaesthesia. They are omitted on the day of surgery and glucose is monitored.

Option by option

A. Take the usual dose and delay the first meal until the afternoon
Delaying the meal while taking the drug deliberately prolongs the period at risk.
B. Take the usual dose with a sip of water, to avoid stress hyperglycaemia
Taking the usual dose while fasting is the situation that produces hypoglycaemia.
C. Omit the morning dose, because it can cause hypoglycaemia during fasting (correct)
Correct. Insulin secretion continues despite fasting, so omitting the dose avoids hypoglycaemia.
D. Take double the usual dose, to blunt the surgical stress response
A double dose would increase the hypoglycaemia risk further.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Omit the morning dose, because it can cause hypoglycaemia during fasting. Sulfonylureas keep stimulating insulin release whether or not the patient eats, so a dose taken while fasting risks hypoglycaemia, which is hard to detect under anaesthesia.

Why is "Take the usual dose and delay the first meal until the afternoon" not the answer?

Delaying the meal while taking the drug deliberately prolongs the period at risk.

Why is "Take the usual dose with a sip of water, to avoid stress hyperglycaem…" not the answer?

Taking the usual dose while fasting is the situation that produces hypoglycaemia.

Why is "Take double the usual dose, to blunt the surgical stress response" not the answer?

A double dose would increase the hypoglycaemia risk further.

What concept does this question test?

It tests Preoperative assessment: sulfonylurea on the day of surgery in Anaesthesia. They are omitted on the day of surgery and glucose is monitored.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: sulfonylurea on the day of surgery?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.