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Primary OSCE 68
|1. History taking
Take a history from a 35-year-old Indian woman listed for total abdominal hysterectomy. She has symptomatic anaemia, not necessarily ONLY iron deficiency, as she tells you “I have been told my children may have the same condition”.
- You are asked to present the history and then answer relevant questions, including questions on beta–thalassaemia and inheritance.
You are asked to check a Bain circuit.
- There is no Venturi effect. Are you happy to use the circuit?
- What is the volume of the outer tubing of the Bain circuit?
- Why is this important?
- What gas flow would you use for a spontaneously ventilating patient?
- What would happen if the bag fell off while a patient was SV? What would happen to staff in the anaesthetic room?
3. Data interpretation
You are asked to interpret a vitalograph showing severe restrictive lung disease in a symptomatic patient.
- You are asked questions on FEV1/FVC, and calibration of the vitalograph.
- Is upper abdominal surgery contraindicated?
4. Data interpretation
A man presents with intermittent upper abdominal pain. The surgical SpR wants to take him to theatre, as feels there is an abdominal cause. The ECG shows inferior myocardial infarction with a nodal escape rhythm.
- You are asked questions on aspects of the ECG, including calibration, calculating heart rate, PR interval, QRS interval, and about the management of the patient.
5. Clinical scenario
A patient with type 1 diabetes, on insulin/Dextrose Sliding Scale fails to wake up following abdominal surgery. He has received 7 mg morphine. His observations were stable: respiratory rate 15/min; capillary blood gas glucose 7mmol/L pre-operatively, 3.5mmol/L in the operating theatre.
- How should the patient be managed?
- What is the likely diagnosis?
You are asked to interpret a lateral chest X-ray showing a large hiatus hernia, and asked about the management of the patient.
You are shown some diagrams of O2 analysers.
- Identify a polarographic analyser and label the components.
- What size of power source is needed?
- Identify a paramagnetic analyser.
8. Communication skills
A 30-year-old man is listed for arthroscopy as a day case. The procedure needs to be cancelled, as systemically unwell with a lower respiratory tract infection.
- Explain why the case must be cancelled.
- The patient is not happy, as he has trouble getting time off work. He asks about having a spinal anaesthetic. What would you tell him?
9. Practical skills
Demonstrate how you would perform a spinal anaesthetic.
- What sort of needle would you use?
- Why would you choose a Whitacre needle?
- What level of block is required for a Caesarian section?
- Why would you use hyperbaric bupivacaine?
10. Resuscitation skills
Discus the management of stable/compromised ventricular tachycardia.
11. History taking
Take a history from a patient undergoing elective carotid endarterectomy.
12. Equipment station
You are asked questions about chest drain bottles.
13. Simulator manikin
Take the patient’s pulse and blood pressure and listen to the heart sounds. You hear an ejection systolic murmur.
- What are implications of central neuraxial block in this patient?
- What is the total volume of the cerebrospinal fluid (CSF)?
- Identify the tract that carries pain and temperature sensation on a cross-section of the spinal cord.
- What is the specific gravity of CSF?
- What changes occur to the CSF during pregnancy?
- What clinical signs would a patient have following hemisection of the cord/occlusion of anterior spinal artery?
You are shown a stethoscope with a hearing-aid style ear-piece.
- What is this piece of equipment used for?
- Where would you position this piece of equipment?
- What two respiratory/cardiovascular complications could this equipment detect?
- What term is given to the clinical sign heard when an air embolism is present?
- What other changes would be seen in other monitoring equipment during a gas embolism?
- Describe the management of a gas embolism.
16. Clinical examination
Examine the jugular venous pressure.
- What causes the different parts of the waveform?
- What does absent ‘a’ waves imply?
- What causes large ‘v’ waves?
- What causes large ‘a’ waves?
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