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Primary OSCE 24

Created: 16/2/2006

1. You are shown various laser tubes

– When would you use a metal tube?

– Why would you not use other tubes in this situation?

– What risks would be incurred with other types of laser tube?

– Can these laser tubes be used in gynaecological procedures?

– Name three safety precautions that must be taken in the operating theatre when using lasers.

– Why are goggles needed for protection only when using a carbon dioxide laser?

2. The spinal cord

– What volume of epidural anaesthetic blocks one vertebral segment?

– You are shown a spinal cord; identify the spinocerebellar tract and the gracilis tract.

– Describe the blood supply to the spinal cord; where does it come from and what does it supply?

– Which tract carries pain and temperature?

– What is the normal volume of cerebrospinal fluid, and what is its specific gravity?

3. History taking

An Afro-Caribbean patient presents for day-case arthroscopy. He has previously undergone general anaesthesia for a splenectomy following a road traffic accident, and experienced heavy blood loss, with a 3-day stay in the intensive care unit, where he was ventilated. He was no longer taking any antibiotics or vaccines. Assess the patient for suitability for this day-case procedure.

4. Ankle block

– What nerve supplies the foot? (Peroneal nerve)

– How would you block this nerve?

– how would you block the tibial nerve?

– Discuss the cutaneous innervation of the saphenous nerve, medial plantar nerve, dorsal and superficial peroneal nerves.

– Describe the course of the saphenous nerve; where does it become superficial?

– What doses of lignocaine, bupivicaine and prilocaine are considered safe?

5. Cardiovascular examination

– What are you generally looking for when measuring a pulse rate?

– What is the cause of a collapsing pulse?

– Give two causes for an irregular radial pulse.

– What is the significance of radio-femoral delay?

– You are asked to examine the praecordium; carry out an inspection for visible apex beats; describe the features and assess if it is normal.

– Show how you would examine the mitral and aortic areas for murmurs.

6. You are shown a flow-volume loop diagram of a patient with obstructive lung disease.

- Illustrate which points correspond to inspiration and expiration, and which points represents premature airway closing.

7. ECG

– You are asked various questions about an ECG

8. Defibrillation

You are presented with an ecg trace showing ventricular fibrillation (VF); what is VF, and how would you treat it?

– Demonstrate the proper use of a defibrillator

– Is the fact that the paddles are labelled “apex” and “sternum” of consequence?

– What precautions should be taken in regard to the pacemaker?

– What other paddle positions are there?

– When would you defibrillate – during expiration or inspiration? Why?

9. History

Take a history from an Asian woman who is presenting for laparoscopic sterilisation. She has had a cough for two months, night sweats, and has lost weight, although her appetite has been unaffected; she has not seen a doctor. The patient has a previous history of unexplained jaundice, from few years back, for which she did not attend hospital. She takes diazepam occasionally, which is prescribed by her GP. (Ask the patient about any previous drug injecting, which she has done on one occasion)

10. Communication

You are asked to reassure a woman with a mask phobia who needs pre-oxygenation. The phobia is due to a traumatic experience as a child at the dentist. Explain that nasal cannulae, instead of a mask, can be used to administer pre-operative oxygen, and that flavoured masks can be used, to disguise the smell of the anaesthetic vapour; moreover, the patient can hold the mask on herself. Explain the need for pre-operative oxygen, and that a tight seal is necessary - if she is to hold the mask on herself, this is essential. Explain that there may also be a need for a mask postoperatively; make a deal with the patient: you will only use the mask postoperatively if it is absolutely necessary, but then she must allow it.

11. Oxygen measurement

You are shown a picture of a fuel cell. What is it used for?

– You are then shown a circuit diagram for a fuel cell. What is solution is contained in a fuel cell?

– What is the anode made of?

– What sort of reaction occurs at the anode?

– Does a fuel cell need replacing after use? Why?

– How is a fuel cell calibrated?

– What is the other circuit called? – polarographic electrode

12. Circle check

Faults with this included: not being connected to the fresh gas flow, a stuck expiratory valve, soda lime not full.

– What comes out of the apl valve?

– Can the circle be used without a CO2 absorber?

– What colour are the indicators?

13. Pulse oximetry

You are shown a picture of a pulse oximeter.

– What two pieces of information does this equipment provide?

– what are the values of p50 and p90?

– Why is the p50 value useful?

– You are shown graph for myoglobin: what does this represent?

How does a pulse oximeter work?

– How does pulse oximetry differentiate between arterial, venous and tissue oxygen absorption? – What is the difference between pulse oximeters and oximeters found in laboratories?

14. barium contrast films

You are shown a series of barium films showing swallowing with a pharyngeal pouch.

– Is the cricoid cartilage essential?

– What is the level of origin?

–Is a constriction present?

– Can you see solid food?

15. Statistics

You are shown a graph of Age (x-axis) versus Height (y-axis), and asked about Correlation and regression.

– What symbol is used for the regression coefficient? ( r)

– How is correlation determined? (line of best fit)

– Is it possible to have a correlation coefficient of 1.1?

– Is it possible to have a correlation coefficient of –0.7?

– Which type of test is more appropriate for analysing these data: parametric or non-parametric? (non-parametric)

– Is the X variable a dependant variable? (yes)

– Would changing the axes around have an effect on the correlation coefficient? (no)

16. Resuscitation

You come across a six-year-old child who is unconscious.

– What would you do?

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