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Primary OSCE 34

Created: 9/1/2007
1. Anatomy
Locate the femoral artery on a volunteer.
- Where do the nerve and vein lie in relation to this?
- What are the roots of the femoral nerve?
- Which nerves are blocked in a three-in-one block?
- What do these nerves supply?.
- How would you block the ilioinguinal nerve?
- What other nerve is blocked when you do this?
- Which two muscles are you infiltrating between in this block?

2. Anatomy
Examine the third to the twelfth cranial nerves on a volunteer, explaining which nerves you are checking as you do so.

3. Resuscitation
You are walking past a river when you come across an unconscious patient who is not breathing but has a pulse. Demonstrate how you would react.

4. ECG
You are asked to interpret an ECG (showing ventricular fibrillation); fill in the blanks on this algorithm to explain how you would treat the condition.

5. Data interpretation
You are presented with a computer screen showing 3D CT scan image of an L1 wedge fracture. This is the CT scan of a 27-year-old builder who has fallen off a building. He has also fractured both femurs and his left tibia. His pulse is 120 bpm and his blood pressure is 90/60 mmHg. You are asked to answer true/false questions relating to your management of this patient.

6. ECG
You are asked to answer some true/false questions relating to an ECG showing left ventricular hypertrophy and T wave inversion in leads V3–V6.

7. Data interpretation
You are shown a capnography tracing, with two normal traces followed by a sudden absent trace. This is the capnography tracing of a 26-year-old man who is undergoing a lumbar discectomy and is currently prone and ventilated. Answer some true/false questions.

8. Communication
A patient is about to undergo a total abdominal hysterectomy. She does not wish to have any blood products on religious grounds. Obtain her signature for this consent form.

9. History taking
Obtain an anaesthetic history from a fit 25-year-old male who is about to undergo a knee arthroscopy. He was involved in a road traffic accident three years previously, fracturing a femur, his pelvis and a couple of ribs, and was ventilated overnight in an intensive care unit.

10. History taking
Obtain an anaesthetic history from a 45-year-old female who is about to undergo a hysterectomy. The patient appears fit and healthy, but has undergone a previous Caesarean section under general anaesthetic and remembered the laryngoscope being passed into her mouth. She also suffered a deep vein thrombosis, which led to a pulmonary embolism.

11. Equipment check
You are asked to perform a machine check, with no breathing system attached. The points you should note are that the vaporiser is empty and that there is no interlocking device between the O2 and the N2O rotameters.

12. Simulator manikin
Demonstrate on a manikin how to perform cricoid pressure.
- What are the indications and contraindications for performing this procedure?
- How much force should be applied?
- When should the pressure be released?
- Who should perform this?

13. Equipment
You are shown a variety of filters (e.g. a leukocyte filter, a filter in a standard blood giving set, an epidural catheter filter and a heat-and-moisture-exchanger (HME) with a bacterial filter) and asked about the use of each one.
- What is the problem of using the HME in a paediatric patient?
- What does the epidural filter actually filter?
- Rank the following in order of size: a bacterium, a platelet and an erythrocyte.

14. ECG
You are shown an ECG recording.
- What is the usual speed?
- What is the calibration signal?
- How can interference be reduced?

15. Anatomy
You are asked about the anatomy of the heart.
- Where are the sinoatrial and atrioventricular nodes?
- Name and locate the coronary arteries and veins.
- What are the sinuses of Valsalva and what is their function?
- You are shown a coronary angiogram and asked what pathological process is demonstrated at the labelled points, and which artery this was affecting.

16. Statistics
You are asked a series of true/false questions (e.g. about the type of data quoted and whether non-parametric equations required equal numbers in each group).

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