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Primary OSCE 77

Created: 24/11/2014
1. Anatomy
Which nerves supply the foot?
- What is the name of the tibial nerve? (Anterior or posterior?)
- How can you identify the deep and superficial peroneal nerves?
- What is the dose of local anaesthetic required to block the deep peroneal nerve?
- Describe the course of the saphenous nerve.
- The saphenous nerve is a branch of which nerve?

2. Anatomy
You are shown a photograph of a man lying in the prone position.
- Which nerves can you injure?
- How do you test the ulnar nerve?
- How can the ulnar nerve be injured during surgery?
- What is the interosseous nerve?

3. Examination/skills
You are asked to perform an epidural, identifying landmarks.
- What are the different doses of local anaesthetic used, with and without adrenaline?

4. Anatomy
You are shown a cross-section of a spinal cord.
- Identify the different tracts.
- What do they carry?
- What is the specific gravity of the cerebrospainal fluid?
- Describe anterior spinal artery syndrome.
- Describe the blood supply to the spinal cord.

5. Simulator manikin
Demonstrate your treatment of malignant hyperpyrexia.

6. Simulator manikin
Demonstrate the intrathecal injection of local anaesthetic in a pregnant lady.
- Demonstrate the management of bradycardia and pulseless electrical activity.
- What are the signs of local anaesthetic toxicity?

7. Resuscitation
You are given an ECG trace showing bradycardia and asked to discuss its management.

8. Equipment
You are shown two intravenous cannulae, of sizes 16 G and 20 G.
- Name four differences in their physical properties, apart from colour.
- What is the flow through each?
- What is the Hagen–Poiseuille equation?
- Can you use these cannulae for invasive blood pressure measurement? Why not?

9. Equipment
You are shown a photograph of a pH and a Severinghaus electrode. Identify which is the severinghaus electrode.
- What reactions occur in the electrode?
- Write the equation for the reaction between carbon dioxide and water.

10. Anaesthetic monitoring & measuring equipment
You are shown capnography traces and asked to identify the different phases.

11. History taking
Take a history from a patient presenting with an atrioventricular fistula for dialysis, with a history of anaesthetic awareness.

12. History taking
Take a history from a patient presenting for transurethral resection of the prostate (TURP). His daughter had problem after an epidural.

13. Communication skills
Talk to an Afro-Caribbean patient presenting for knee surgery. He has sickle cell trait/disease. Surgeons want to use a tourniquet. The patient has a needle phobia. Discuss EMLA cream with him.

14. Data interpretation
You are shown an X-ray of a stag-horn calculus and blood results showing normal potassium but raised urea and creatinine.
- Would you carry out dialysis?
- The haemoglobin level is 8.1 g/dl. Would you transfuse prior to surgery?
- Could you use nitrous oxide in this patient?

15. Scans
You are shown a CT scan of the chest of a 30% burns patient. It shows a pnemothorax.
- What is the 24-hour fluid requirement?
- What is the Parkland formula?
- Can you use suxamethonium on the evening of presentation?

16. Measuring equipment
Describe the capnographic measurement of CO2.

17. Examination/skills
You are asked to carry out an examination of the respiratory system.

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