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Primary OSCE 23

Created: 7/9/2004

1. Filters
Discuss depth, screen, leucocyte, and epidural
– What is each type used for?
– What might each one filter out?
– What problems are associated with paediatric heat and moisture exchanging filters?
– Rank the following, from largest to smallest: red blood cells, platelets, cocci

2. Femoral nerve block
– Demonstrate the landmarks for this block. Describe the dermatomes of the lower limb

3. Standard Bain circuit check.
– Hole in tubing noted.
– What would happen if the bag fell off?
– What length should the tubing be?

4. Cranial nerve examination
Given torch, cotton wool, tuning fork. Don’t forget to gag! , Describe examination of the cranial nerves.

5. Cardiac vessels
– Where is the sinoatrial (SA) node?
– Where is the atrioventricular (AV) node?
– Where is the coronary sinus?
– Where is the origin of the coronary arteries?
– Which veins drain the heart?
– You are presented with a coronary angiogram; what does it show?.(stenosis of the left anterior descending artery). Which disease process gives rise to this appearance? (atherosclerosis)
– What is the usual ratio of depth of RV: LV?
– What are the sinuses of Valsalva?

6. Airway assessment
– Carry out the following assessments: a Mallampati test; Wilson risk score; temporomandibular joint distance; Neck movements; temporomandibular joint instability
– How would you prepare if you anticipated a difficult intubation?

7. Data interpretation
You are presented with the following patient data:
K+: 6.0 mmol/L; HCO3–: 14 mmol/L; pH 7.21; Urea 20; PCO2 4.0 kPa; PO2 14.0 kPa
Answer the following true/false questions:
 This patient has a compensated metabolic acidosis
 This patient requires dialysis prior to a general anaesthetic
 These results could have been obtained as a result of sample haemolysis

8. Data interpretation
You are presented with a capnograph and asked a series of true/false questions.

9. Statistics
– You are asked a series of true/false questions
– Explain the following terms:
 Nominal, interval, continuous data
 Beta error
 Predictive values
 Students t test

10. Computed tomography
You are presented with a CT scan of a lumbar spine. Answer the following true/false questions:
 There is a crush fracture of L2
 This patient could be treated with steroids
 This patient will have damage to the anterior longitudinal ligament
 This patient may be paralysed from L2 down

11. Communication
A Jehovah’s Witness presents for hysterectomy. Go through the consent form with the patient and explain the risks. Ascertain the products that the patient would accept (for example, is autotransfusion acceptable?) The patient’s current haemoglobin level is low; how would you treat this? (erythropoietin, iron, need for senior involvement).

12. History taking
Take the history of a woman presenting for hysterectomy with a history of night sweats, red tongue, weight loss and foreign travel.

13. History taking
Take a full anaesthetic history of a woman presenting for cataract surgery, (elicit non-insulin-dependent diabetes mellitus, eye and foot problems, control of diabetes). Ask the patient her weight (if the patient is overweight - e.g. 130 kg - you may have to explain that a local anaesthetic would be more appropriate)

14. Resuscitation
You are presented with an adult who is the victim of a drowning incident. Perform basic life support and put the patient into the recovery position; fill in a ventricular fibrillation protocol.

15. Equipment
You are shown a photograph of a cylinder; what does it contain? (Entonox)
– What is the definition for pseudocritical temperature?
– Besides the anaesthetist, who else is authorized to administer entonox?
– Describe how the demand valve works
– Discuss the risks of entonox in different climates

16. Arterial line set-up
You are presented with an arterial line set-up. Check the equipment for faults (e.g. glucose in the bag, no heparin, no pressure, compliant tubing). Explain how the equipment should be zeroed and calibrated

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