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Primary OSCE 29

Created: 24/11/2005
1. History taking
You are presented with a patient undergoing inguinal hernia repair, with ischaemic heart disease, who now has angina at rest.

2. Data interpretation
You are shown an observation chart from a female patient on the ward, post-cholecystectomy. She has an increasing temperature and pulse rate, and decreasing blood pressure.

3. Trauma
Assess a trauma patient (played by an actor). Conduct a primary and secondary survey, and resuscitation.

4. Case scenario
You are called to the ward, where a woman has collapsed. The nurses have commenced cardiopulmonary resuscitation and connected her to the ECG monitor. This shows sinus rhythm at a rate of 60 bpm. Describe the causes and management of pulseless electrical activity. What are the 4Hs & 4Ts?

5. Equipment
You are shown an old hot water bath humidifier and asked questions on humidification, importance of this equipment, safety etc.

6. Pressure measurement
Discuss non-invasive blood pressure measurement, oscillometry, measurement of mean arterial pressure, time cycle, maximum rate of measurement and potential nerve damage.

7. Equipment
You are shown a picture of a TEC5 plenum vaporiser.
- How is it different to a draw-over vaporiser?
- Discuss the use of vaporisers inside the circle versus vaporisers out of the circle.
- What is the latent heat of vaporisation?
- What is temperature compensation?
- How is the concentration and partial pressure of the volatile affected by altitude?

8. History taking
A patient is due to undergo a septoplasty. He/she has obstructive sleep apnoea and is on nasal continuous positive airway pressure. The patient has symptomatic gastro-oesophageal reflux and is a smoker.

9. Chest X-ray
You are shown the chest X-ray of a female patient who works as a cleaner, smokes 40 cigarettes/day and is unwell, with a productive cough. The X-ray appears to show that she has bronchopneumonia. Does she need to be admitted to the intensive care unit? Should she be given nitric oxide etc?

10. Equipment
What is an intraosseous needle?
- Demonstrate the insertion points and insert the needle into a manikin.
- How are fluids administered?
- What are the contraindications and complications of using this type of needle?

11. ECG
You are shown the ECG of a 50-year-old woman, who is a long-distance runner. She has sinus bradycardia (34 bpm).
- Does she have Wolf–Parkinson–White syndrome?
- Does she need perioperative pacing?

12. Simulator manikin
Insert a laryngeal mask airway into the manekin. Describe the contraindications, number of uses and cleaning of this equipment.

13. Anatomy and function of the nerves
You are shown a diagram of the brachial plexus, with numbered points. You are then shown pictures of patients in various positions.
- Indicate which points could be injured.
- Which nerve is damaged by the blood pressure cuff?
- Describe how you would test the sensation of the radial and ulnar nerves.
- Describe how you would test ulnar nerve motor function.

14. Skills
Demonstrate an ankle block.

15. Anatomy of the larynx
Identify the structures and describe the nerve and artery supply.

16. Communication
Obtain consent from a Jehovah’s Witness for administering an anaesthetic. The patient in question is undergoing a hysterectomy for menorrhagia, and her haemoglobin level is 90 g/L. Give the patient the consent form and discuss the various options.

17. Simulator manikin
You are asked to assess and resuscitate a trauma patient. The patient has a falling blood pressure and a rising heart rat

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