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Primary OSCE 36

Created: 23/5/2007
1. Equipment
You are asked to check an arterial line and demonstrate how to zero the system.

2. Resuscitation
Demonstrate advanced trauma life support in a man (actor) presenting to the Accident and Emergency department with a haemothorax and in shock.

3. Simulator manikin
Following rapid sequence induction, the patient decompensated and went into circulatory collapse. Discuss your management.

4. Equipment
Carry out a Bain circuit check.
- What is the volume of the expiratory limb?
- What would be the fresh gas flow in a 100 kg man?
- What would happen if the reservoir bag were to be removed?

5. Equipment
Foley catheter with thermistor. Discuss how temperature is measured using a thermistor.

6. Equipment
Discuss the working principles of the thermocouple.
- Describe two causes of heat loss through conduction.
- What do you understand by core temperature?

7. History taking
Take a history from a woman presenting for mastectomy. She has recently undergone chemotherapy and has a sister with malignant hyperthermia.

8. Communication
A woman is about to undergo surgery, but she is concerned as her daughter experienced awareness during a general anaesthetic for a lower segment Caesarean section.

9. Chest X-ray
You are shown a chest X-ray showing aspergillosis and asked to interpret it.
- Would you administer p.o. antibiotics?
- Will the patient require ventilation?

10. Equipment
Describe the working principles of DINAMAP.

11. History taking
Take a history from a patient presenting for surgery for varicose veins. The patient has previously been admitted to the intensive care unit with asthma and atrial fibrillation.

12. Anatomy
You are shown a diagram of the larynx and asked to label the various parts.
- What elevates and depresses the larynx?
- Describe the origin and course of cranial nerve (CN) V.
- Where is the ganglion of CN V?
- What diseases affect CN V?

13. Skills
Demonstrate spinal anaesthesia on an actor.
- What needle would you choose and why?
- What level of block would you perform for transurethral resection of the prostate?

14. Equipment
Chest drain bottles - two tier. Discuss their use.

15. ECG
You are asked to interpret an ECG showing Wolff-Parkinson-White syndrome.
- Would you give this patient verapamil?
- Is there a high risk of ventricular fibrillation?

16. Resuscitation
Perform basic life support on a 6-year-old child and advanced life support on an adult in asystole.

17. Examination
You are asked to see a patient on the intensive care unit whose intracerebral pressure is up at 40 mmHg.
- You are asked a few questions about his blood pressure and heart rate and his expected urine osmolality.
- You are shown some photographs of potential nerve injuries; which ones would you find on examination, and how would you manage them?

18. Anatomy
Describe the course and origin of the vagus and optic nerves.

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