(1)   A 75 years old woman with COPD, type 2 diabetes and coronary artery disease has a fall and fracture of her right hip. Her orthopedic surgeon has planned a total hip replacement and has asked the physician for fitness for surgery. The important preoperative advice would be all EXCEPT:

 (a)    Controlling sugars

(b)   Continuing inhaler steroids

(c)    Doing an ACTH stimulation test due to long term steroid use

(d)   Stopping inhaled  steroids 

Answer: The answer is (d). This woman is a diabetic and hence requires pre operative sugar control. Since she has COPD, and there is long term use of steroids, an ACTH stimulation test is needed to check for stress induced  adrenal insufficiency. There is no need to stop the inhaled steroids.