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Primary OSCE 64

Created: 26/6/2012
1. Anatomy/nerve blocks
Explain how Biers block is performed.
- What are its limitations?
- What are the side effects of prilocaine?
- Discuss the safety aspects of the double cuff and the length of time for cuff inflation.

2. Scans
You are asked to interpret a chest X-ray showing tension pneumothorax.

3. Communication skills
Talk to a 23-year-old woman who is on insufficient analgesia following a laparotomy. Discuss patient controlled analgesia, non-steroidal anti-inflammatory drugs etc.

4. Resuscitation
A 70-year-old man with chronic renal failure has collapsed on the ward. Describe the advanced life support and basic life support algorithms.
- What is the most likely cause of arrest?
- How would you treat it?
- Explain how to examine pulses and measure jugular venous pressure (JVP). Draw and label a JVP trace.
- Explain how to take a BP.
- What is the relevance of cuff size?

5. Statistics
You are asked to interpret some statistical data.

6. Scans
You are asked to interpret an ECG showing atrial fibrillation. Discuss rate, calibration, axis and treatment.

7. Critical incident
A 25 year-old woman has aspirated during an arthroscopy. What are the potential signs and symptoms, complications and treatment?

8. Clinical measurement
You are shown a vitalograph trace and asked to read off the forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), and calculate the FEV1:FVC ratio. What is the normal ratio?
- What diagnosis is suggested by the trace? (Is it restrictive or obstructive?)

9. Communication skills
Reassure a 45-year-old woman presenting for an elective abdominal hysterectomy, who has a benign heart murmur and is worried about undergoing general anaesthesia for the first time. She is otherwise fit and well. Discuss the anaesthetic plan and postoperative pain relief.

10. Examination/skills
You are asked to assess a 16-year-old with poor asthma control for a semi-elective appendicectomy.
- Discuss asthma signs, tests, treatment and which drugs to avoid.

11. Equipment
You are shown pictures of gas cylinders and VIE and asked about the contents, pressures and the significance of markings (i.e. test date etc).

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