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Primary OSCE 7
|1. Chest X-ray
A 2-year-old child who has been eating peanuts suddenly develops dyspnoea and presents to the Accident & Emergency department. Answer the following true/false questions about the child's chest X-ray:
- It is adequate in position
- It shows pneumothorax
- It shows collapse
- The appropriate treatment is needle thoracostomy
- Bronchoscopy is needed
- The mediastinum is normal
A 70-year-old male presents with chest pain; he is on digoxin and warfarin. Answer the following true/false questions on the patient's ECG:
- The rate is 75 per min
- The axis is normal
- It shows atrial fibrillation
- It shows bifascicular block
- It shows ischaemic changes
- It shows signs of hypokalaemia
- It may be a feature of digoxin toxicity
You are shown a graph representing data from 10 children, with age plotted on the x-axis and weight on the y-axis. Answer the following true/false questions relating to correlation-regression analysis:
- This is a regression analysis
- XX is the regression factor
- The correlation coefficient can be 0.7
- The correlation coefficient can be 1.3
- The correlation coefficient of 0.7 is statistically significant
4. Safety Station
You are asked to demonstrate the use of defibrillator in a dummy (it is essential to check that it is safe, and to state out loud that you are shocking the patient)
You are asked about the dose of shocks:
- Describe the different positions and benefits of paddles
- What will you do after shock?
- When will you shock again?
You are asked about the monoaural stethoscope:
- What is it?
- Where should it be positioned?
- For which group of patients is it used?
- What does it help in diagnosing?
- Give two examples of critical incidents in which this equipment is helpful
6. Venous air embolism
- In which position does this occur commonly?
- How would you manage this?
- How is it diagnosed?
- What happens to end-tidal CO2?
Metal endotracheal tube for laser surgery:
- What is it used for?
- Why is it used in laser surgery?
- What is a laser?
- What are the hazards of laser?
- What precautions would you take if laser is used?
You are shown some glass goggles which are labelled: "only for CO2"
- Why is this only used for CO2?
- What is the wavelength of CO2?
- What laser types do you know of?
- What is the wavelength range of lasers?
A 47-year-old woman presents for a D&C surgery as a day-case. She has history of palpitations, has had an appendicectomy and is very much afraid of anaesthetics.
- Ask about her fears (fear of masks)
- ask about her history of anaesthetics (mask phobia still)
- Explain the importance of preoxygenation
- Explain what is going to happen in the anaesthetic room (patient is still unhappy about masks; she feels OK about holding the mask herself, but is still unconvinced)
- Explain the option of nasal prongs before operation and postoperatively
- Discuss how you monitor oxygenation
- Assure the patient that you will be there to take care of her
- Explain premedication
You are shown a diagram of the spinal cord:
- You are shown various tracts and asked to name them
- What volume of local anaesthetic is needed in the lumbar epidural space to block one vertebra?
- What is the specific gravity of cerebrospinal fluid?
- Describe the blood supply to the spinal cord (number of arteries)?
- What happens if blood supply is cut off to anterior cord, and what are the features of this (anterior spinal artery syndrome)?
Base of skull, periorbital block:
- Point out the optic foramen ona model of the skull
- What is length of the optic nerve in the foramen?
- Identify the cribriform plate
- What does it transmit? (olfactory nerve fibrils)
- Trace the optic nerve back to the cortex
- How is a periorbital block performed?
- What should be the direction of needle?
11. Machine check
Check the breathing system attached to the anaesthetic machine and state whether you would use this breathing system (circle absorber). Possible faults include:
- fresh gas flow was not connected
- inspiratory unidirectional valve not working
- soda lime not filled properly (not full)
You are asked questions about soda lime:
- What is it?
- What colour change occurs?
- Would you use the circle system with the soda lime off?
- What flow rates would you use?
- What gas is expired out of this?
12. History taking
Take a history from a middle-aged male presenting for carotid endarterectomy, with a history of reflux and cerebrovascular accident; he is currently taking Gaviscon and aspirin.
13. History taking
Take a history from a middle-aged man presenting for nasal/pharyngeal surgery. He has a history of heavy snoring, and his wife has to sleep in a separate room. He does not have positional dyspnoea but gets up during sleep. He has undergone sleep breathing studies, which showed that he stops breathing in sleep. He is not on ventilators, but doctors have suggested that he may need a breathing machine attached to his nose after surgery (nasal continuous positive airway pressure). He is taking atenolol and Gaviscon.
14. Physical examination
Carry out a neurological examination on a middle-aged male (an actor)
- What is his Glasgow coma scale score?
- Asked of specific components (how do you arrive at your score?)
- Examine the reactivity of his pupils
15. Equipment station
You are asked about a nitrous oxide cylinder pressure gauge:
- What makes this specifically a nitrous oxide gauge?
- Can this be used for oxygen? Why?
- What happens during usage? Why does it not fall?
- What state is the nitrous oxide in?
- What is the critical temperature?
- What is gas and vapour?
- Where is it used? what is entonox?
16. Data interpretation
You are shown two graphs generated by a Swan-Ganz pumonary artery flotation catheter; the first curve is correct, while second is not. Answer the following questions:
- Which is the correct wave form?
- Is the wedge pressure normal?
- Give five complications of pulmonary artery catheters
You find a 2-year-old child collapsed in a road; you are given an Ambu bag and mask and asked to perform basic life support:
- Check that it is safe to approach
- Gently check responsiveness
- Shout for help
- You are told that the cervical spine is normal
- Check airway, breathing and circulation (ABC)
- Demonstrate the correct ratio of for the paediatric age group
- Carry out 1 minute of cardiopulmonary resuscitation before going to get help
You are then shown a rhythm on simulator, which indicates that there is no pulse.
- Give five causes for this, and suggest treatment
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