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Primary OSCE 57

Created: 30/3/2011
1. ECG
You are shown a diagram of patient with a central venous pressure line connected to an ECG and earthed. The ECG box was also earthed.
- What is microshock?
- Would all earth connections be at an equal potential?
- Discuss monitoring in magnetic resonance imaging (MRI).

2. History taking
Take a history from a lady due to have a mastectomy and latissimus dorsi flap. She has had an initial lumpectomy followed by chemotherapy, and her last cycle was 8 weeks ago. She is anaemic and on iron. She has previously had postoperative nausea and vomiting, and is allergic to iodine and elastoplast. She is on tamoxifen and fluoxetine.

3. Equipment
You are shown an epidural catheter and needle pack, and asked questions about what you would check for on the sealed package, and how you would check the catheter and needle prior to an epidural. You are then asked general questions on epidurals.

4. Statistics
You are shown a negatively skewed curve, and asked to answer 10 true/false questions.

5. Data interpretation
You are shown arterial blood gas results from a young woman with pneumonia who has type 2 respiratory failure. You are asked to answer 10 true/false questions.

6. ECG
You are shown an ECG showing a broad complex tachycardia. You are asked whether the tachycardia is ventricular, and are asked to answer 10 true/false questions.

7. Anatomy
Describe the anatomy of the cervical and thoracic spine.

8. Communication
You have to have a phone conversation with a laboratory technician to order six units of packed cells, fresh frozen plasma and platelets for a patient undergoing a laparotomy for a bleeding duodenal ulcer. Haemostasis has been achieved and there are a further two units in the fridge. Your registrar is worried about a transfusion reaction, since the patient has already received a substantial amount of blood. The laboratory is obviously busy and you have to negotiate with the technician about urgency and to formulate a plan.

9. Examination/skills
You are asked how you would diagnose a tension pneumothorax. You then have to demonstrate how you would carry out a needle decompression followed by an intercostal drain insertion. You are then asked about the complications associated with these procedures.

10. Examination/skills
You are asked to examine someone with a head injury. A neck collar is available if you ask for it. Demonstrate how you would use it. A penlight is also available. Assess the patient for Glasgow Coma Score, and test his arms and legs for movement.

11. ECG
You are asked questions asked about broad complex tachycardia.

12. Equipment
You are asked questions about an entonox cylinder.

13. Anatomy
Describe the anatomy of the brachial plexus and the nerve supply to the upper arm. Describe the structures related to the plexus and the roots, trunks, divisions and cords.

14. History taking
Take a history from a patient undergoing an inguinal hernia repair. He has a history of ischaemic heart disease, had a myocardial infarction 6 years ago, is on nifedipine, glyceryl trinitrate and aspirin.

15. Chest X-ray
You are shown a chest X-ray of allergic alveolitis in a young man who keeps pigeons. His respiratory rate is 33 breaths/min and he is on steroids. You are asked a series of true/false questions on spirometry, anaesthesia and steroids.

16. Simulator manikin
You are asked to take the pulse and blood pressure on a simulator manikin. There is a narrow pulse pressure (110/90 mmHg). On auscultation you detect an ejection systolic murmur, and the ECG shows significant hypertrophy. You are asked about the diagnosis and differential diagnoses, and whether you would administer a spinal anaesthetic.

17. Equipment
You are asked to assemble a Bain circuit with a heat and moisture exchanger.
- Three different sizes of tubing are available for sampling - which would you choose?
- You are then shown three capnography tracings and asked questions on rebreathing, disconnection, end tidal carbon dioxide and where inspiration and expiration start.

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