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Primary OSCE 51

Created: 24/3/2010
Updated: 24/3/2010
1. Anaesthetic machine check
– Carry out a machine check; there is a fault with 02 calibration, O-ring on empty vaporiser.

2. Equipment
You are shown a photograph of some rotameters and asked the following questions:
- Where do you read the value from?
- What shape are the rotameters?
- What is the purpose of the dot?
- What are the sources of error?
- Describe the different types of flow.
- What is the equation for flow?

3. Examination
Demonstrate taking blood pressure and discuss:
- Korotkoff sounds
- Size of cuff selected
- What is mean arterial pressure?
- Why is it one-third of pulse pressure, rather than half?

4. Anatomy
Describe the anatomy of:
- Base of skull
- Cribriform plate
-- What passes through it? (Name two things)
- Optic canal
Where do the majority of fibres from each optic nerve terminate?
- Superior orbital fissure
.. What passes through it?
Describe the pathway of the ophthalmic branch of the trigeminal nerve and then name the terminal branches.
Demonstrate on a skull how to perform a peribulbar block.

5. Clinical scenario
An intubated patient is being ventilated; the rhythm shows ventricular tachycardia, the blood pressure is 70/40 mmHg. When you shock the patient:
- Where do you place the paddles and why?
- What should you do next?
- How much energy would you choose and why?
- What medications would be suitable?

6. Nerve injuries
You are shown a photograph of a patient and asked what nerve is being damaged by being in the shown position.
- Carry out a detailed examination of the named nerve (radial nerve).

7. Examination
Examine a head injury in an actor.
– assess the Glasgow Coma Scale and pupils
- How would you immobilise the c-spine?
- You are asked some questions about head injury signs and management.

8. Equipment
- When is a mono-auricular stethoscope used?
- Name three respiratory problems it will pick up.
- Name three cardiac problems it will pick up.
- What other devices can be used in the monitoring of airway placement?

9. Simulator manikin
You are asked to demonstrate the treatment of tension pneumothorax on a simulator manikin.
- Decompress
- Insert a chest drain

10. History taking
Take a history from a woman with an arteriovenous fistula.

11. Chest X-ray
You are asked to interpret a chest X-ray of a patient with a pacemaker.
- Should this device be reset with a magnet preoperatively?
- Would you administer antibiotic prophylaxis to this patient?

12. Nerve blocks
- Describe the course of the saphenous nerve.
- Describe the distribution of the medial plantar nerve.
- Describe the surface anatomy of the tibial nerve and how it is blocked.
- Demonstrate this technique on an actor.
- What volumes would you use?
- What are the safe doses of prilocaine, bupivicaine and lidocaine?

13. Communication skills
Explain rapid sequence induction to an operating department practitioner.

14. History taking
Take a history from a 22-year-old woman presenting for laparoscopy. She has not previously undergone general anaesthesia. She has a history of rheumatic fever at the age of aged 6, lower abdominal pain and a cough. Where is this patient from? What did her most recent chest X-ray show? Why is she having a laparoscopy? How heavy are her periods? How frequently does she get her cough? When does it get worse? What dental work has she had done? What is her sickle status? What is her HIV status?

15. Chest X-ray
You are given a chest X-ray showing cardiomegaly and pericardial effusion.
- What signs might this person show?
- What is the maximum dose for digoxin?
- What does digoxin overdose lead to?
- What co-morbidities might this patient have? (pulsus paradoxus)
- Should this patient have antibiotic prophylaxis?
- Is neuroaxial blockade contraindicated?

16. Skills
- Demonstrate on a manikin how to insert a laryngeal mask airway (LMA).
- What volume of air is required for the LMA?
- In what types of patient is this contraindicated?
- How many times can this be reused?
- What size would you use in a two-year-old child?

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