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Primary OSCE 22

Created: 7/9/2004

1. Anatomy of the anterior cranial fossa
- What passes through the cribriform plate? 
- Describe Le Fort fractures and the anatomy of the optic foramen 
- Describe the technique of performing regional eye blocks using the skull provided
- Answer follow-up questions on needle characteristics/complications

2. Anatomy of the lumbar vertebrae
- Discuss the atlas and axis 
- Describe the ligamentous relationships of the spine
- Describe the anatomy of the sacral hiatus
- Where does the cord end in the adult/child?
- Discuss the relations of the epidural space

3. Statistics
Answer questions on normal distribution curves.

4. Resuscitation
- Perform basic life support with a bag/valve/mask on an adult mannekin
- Interpret an ECG shown on an oscilloscope
- Fill in the blanks in a supraventricular tachycardia algorithm

5. Data interpretation
An 86-year-old male patient is admitted for a transurethral prostatectomy. He has a history of controlled atrial fibrillation and recent hemiplegia. His blood results show an international normalised ratio (INR) of 3.5, thrombin time (TT) of 12 seconds and an activated partial thromboplastin time (APTT) of 35 seconds.
- Is the patient fit for surgery? 
- Should he be on warfarin? 
- Does he have normal liver function? 
- Is he at risk from hypertensive stroke?

6. ECG
A 25-year-old male patient is admitted for day-case herniorraphy. He has a history of palpitations, and his ECG shows that he has Wolff-Parkinson-White (WPW) syndrome.
- What is the calibration time for a 1 mV spike? 
- Does the patient have normal atrioventricular conduction? 
- Is there any p-wave activity? 
- Is pre-operative pacing required?

7. Chest X-ray
You are shown a mislabelled right lateral chest X-ray. It shows a hiatus hernia.
- What is the fluid level in the chest? 
- Would you give pH-raising agents? 
- Is it safe to use cricoid pressure? 
- Can you see the hemi-diaphragm?

8. Equipment
You are shown an oesophageal stethoscope (what are its uses?) and a urethral catheter with a thermocouple attached to it for bladder temperature monitoring. 
- Answer questions on temperature
- What is the SI unit for temperature? 
- Calibration scales? 
- Describe the use of a thermocouple? 
- Can you see the beck effect? 
- What is the triple-point of water?

An actor poses as a patient; apply peripheral nerve stimulation (PNS) electrodes to his wrist and describe their operation.

You are shown pictures of train-of-four (TOF) and double-burst stimulation (DBS), showing various types of block: discuss the use and specifications of nerve stimulators.

9. Safety
Answer questions on diathermy plates.

10. Equipment check
You are shown a metal Miller blade and a plastic fibreoptic Macintosh blade
- Discuss the differences and uses of the two pieces of equipment
- What is the pressor response to intubation?
- List four uses of Magills forceps

11. History
a) Take a history from a 35-year-old patient presenting for elective thyroidectomy. The patient is allergic to shellfish.

b) Take a history from a 40-year-old patient presenting for TAH. The patient has previously been admitted to the intensive care unit with renal failure, although this information was not volunteered initially.

12. Communication
Explain to a lay-person about a failed intubation drill.

13. Examination
An actor poses as a patient; examine his arterial and venous pulses (he is poorly positioned for examination of the jugular venous pulse, and his left radial pulse is absent: take his blood pressure manually).

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