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Primary OSCE 61

Created: 3/2/2012
Updated: 21/10/2014
1. Statistics
You are asked to compare two sets of data regarding the mean, mode and confidence interval.

2. ECG
You are shown a paced ECG trace.
- Is atrial activity present?
- Comment on the width of the QRS complex. What underlying disease is present?

3. Data interpretation
You are shown an expiratory flow curve indicating airway obstruction.

- Is the obstruction extrathoracic?
- Is spinal anaesthesia advisable?
- Is the functional residual capacity increased?

4. Chest X-ray
A patient has a history of laryngeal tumour, and has experienced a change in his voice. The X-ray shows elevation of the right diaphragm.
- What does this indicate?
- Would you perform rapid sequence induction?
- Is the patient safe in the right lateral position postoperatively?
- Is there intrathoracic gut?

5. Anatomy
Describe the anatomy of the larynx.
- Describe the nerve supply to the muscles and mucosa.
- Which muscles elevate thyroid cartilage?
- Which muscles open the vocal cords?

6. Anatomy
Demonstrate how you would perform cricoid pressure.
- How much force do you use?
- When should this technique be used and when is it contraindicated?

7. Equipment
You are shown a Clark electrode and a fuel cell; how can you distinguish between them?
- Which reaction takes place at the Ag/AgCl anode?
- What voltage is applied across the Clark electrode?

8. History taking
Take a history from a woman presenting for elective hysterectomy. She has anaemia, and says she is tired all the time.

9. History taking
Take a history from a woman presenting for partial thyroidectomy. She has hyperthyroidism, and is on propanolol and carbimazole. She is fit and well, but has several allergies.

10. Simulator manikin
A 25-year-old male has presented with a fractured femur. You are asked to help a novice SHO who has just performed a rapid sequence induction in the anaesthetic room. The patient is hypotensive, tachycardic, and his O2 saturation and end-tidal CO2 are decreasing.

11. Resuscitation
Discuss how you would recognise and treat supraventricular tachycardia according to the standard algorithm.

12. Anatomy
Discuss the anatomy of the heart
- Describe the arterial supply to the heart. You are asked to identify arteries on an angiogram, and discuss the areas they supply and the implications of blockage.
- Where is the atrioventricular node located?
- Describe the sympathetic and parasympathetic nerve supply. Describe the route of the vagal nerve. Name the nuclei of the vagus nerve.

13. Equipment
How would you set up an arterial line? What are the possible faults that can arose during set-up?

14. Communication
A dural tap has occurred during an epidural for labour. The patient has a severe headache. Talk to her.

15. Examination
You are asked to resuscitate a patient with a head injury. Check for a stiff neck, the Glasgow coma scale score, pupils, AVPU (alert, verbal, painful, unresponsive).

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