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You are in Home >> Exams >> Primary FRCA >> OSCE and SOE

Primary OSCE 16

Created: 7/9/2004


1. Examine a patient in the Accident and Emergency Department with a head injury
- Does the patient respond to commands?
- Does he open his eyes to commands?
- A cervical collar has been kept on – what does this suggest?
- Check the pupillary reflex with a torch
- Check if the patient moves all four limbs in response to commands
- Is the gag reflex present?
- What is his Glasgow Coma Scale score?

2. Anatomy: base of skull and peribulbar block
- Identify the cribriform plate, optic canal and supraorbital fissure
- What structures pass through the cribriform plate?
- What happens in the Leforte 3 fracture and what are the signs?
- What is the length of the optic nerve in the orbit?
- Describe the somatosensory supply of the eyeball
- Describe how to perform a peribulbar block and its complications
- Describe how to perform a retrobulbar block

3. ECG
True/false questions on rate and sinus rhythm
- Is LVH or LV strain present?
- Is a prolonged PR interval present?
- Is a prolonged QRS complex present?
- What could the tall T waves be due to?

4. Pulmonary artery (PA) catheter trace
Short history: A patient is in pulmonary oedema, and you are inserting the PA catheter through the right internal jugular vein. You are shown the following PA catheter trace. Answer the following true/false questions:
- Point A represents systolic pressure in the PA
- Point B could be a giant V wave
- Point C could be due to catheter whip
- Point D appears after the T wave in the ECG, CPAP would decrease the cardiac output
- The patient is in sinus rhythm
- Nitrates will decrease the LV compliance
- Frusemide might improve his condition

5. Rapid sequence induction (RSI)
- Why would you perform a rapid sequence induction?
- Why do we prefer to apply pressure to the cricoid cartilage?
- What section of the spine should be compressed?
- Name a condition in which you would not apply cricoid pressure in emergency surgery
- When should the pressure be released?
- What should be checked before releasing the pressure?
- How much pressure is needed?
- How would you demonstrate this to the operating department assistant?
- Demonstrate on a manikin how much pressure should be applied

6. Electrical hazard
You are shown a picture of a man lying on a surgical table connected to a central venous pressure transducer with current leaking. He is also connected to an ECG monitor:

- How much current is needed to produce a microshock?
- Why is the microshock current not being transmitted to the ECG?
- In an isolated floating circuit, how is the patient protected from electric shock?
- What happens if a 1 amp current is delivered to you?
- How is the earth potential made uniform?
- What do the electrical symbols represent?

7. Anatomy: Rib
- Identify the rib as right/left sided
- Is it an upper or lower rib?
- What are the surfaces?
- What structures pass under it?
- In what order do these structures occur?
- You are shown a first rib: identify the structures passing over it and muscles attaching to it
- What are the complications of intercostal nerve block?

8. History
A middle-aged woman comes in for a laparoscopic cholecystectomy. Her sister had previously experienced some problems in recovery and been sent to the ICU with suxamethonium apnoea, cough, lower respiratory tract infection and regurgitation. The present patient is an ex-smoker. Take a full history and elucidate all of the salient points relevant to this patient’s anaesthetic.

9. Bain circuit
Carry out a circuit check.

10. Intra-arterial blood pressure set-up
- Identify the faults concerned with this set-up
- What is the flow rate of the heparinised saline?
- Why is the pressure not transmitted to the trace?
- What is meant by ‘high calibration’?

11. X-ray
An 8-year-old child has aspirated a peanut.

Answer the following true/false questions:
- There is complete collapse of left lung
- The Heimlich manoeuvre is contraindicated
- Urgent bronchoscopy is needed
- Antibiotics and a chest drain should be given during the first 24 hours
- A fracture is seen in the head of the humerus - what might this be caused by?

12. Statistics
Answer a series of true/false questions.

- Correlation coefficient: two graphs are presented, each one representing two cities relating height to drug dose. Describe the correlation in each case.

13. Resuscitation
Paediatric basic life support.
- Fill in the algorithm for asystole

14. History
A patient presents for septoplasty, giving a history of snoring, hypertension and reflux

15. Communication
A child undergoing an emergency appendicectomy stopped breathing after the operation and is now in recovery (suxamethonium apnoea). Explain the proceedings to the parents.

16. Equipment

You are shown a photograph of a Dinamap.
- What is the operating principle for this equipment - i.e. what does it actually measure and what is derived?
- What is the size of the cuff?
- What are the sources of error?
- Why does it take at least 2 minutes to perform the measurement?
- What happens when measurements are repeated?
- Which nerves are affected?

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