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You are in Home >> Exams >> Primary FRCA >> OSCE and SOE

Primary OSCE 80

Created: 24/7/2015
1. Anatomy
You are shown a cross-section of the spinal cord, with some tracts highlighted and are asked to identify them.
- Describe the blood supply to the spinal cord.

2. Anatomy
You are shown a skull with parts of the orbit and cribriform plate colour coded. You are asked to identify these parts and the various structures that go through them.
- Discuss the different types of facial fracture.
- To perform a peribulbar block, where would you put the needle (use a pointer to demonstrate on skull)?

3. Simulator manikin
An ST1 asks you to review a patient who has aspirated on the intensive care unit. His oxygen saturation is 80% on 100% O2. His heart rate and blood pressure are OK. You are shown his arterial blood gases: pH 7.30, pO2 6 kPa, pCO2 5 kPa. The tube is in too far. Assess the situation and give a differential diagnosis. Then reposition the tube under direct vision, applying cricoid pressure. Then explain why his oxygen saturation is low and explain the shunt.

4. Anaesthetic monitoring and measuring equipment
You are shown pictures of the hair hygrometer and Regnault’s hygrometer and are asked to identify them. You are then shown a humidity graph and are asked how to work out the relative humidity using Regnault’s hygrometer. Define absolute and relative humidity.

5. Electrical safety
You are shown a picture of a patient on a table. The table is earthed, and a cardiac catheter and ECG are connected, and are also earthed. Are all earths the same? Why not? Describe the safety features of an ECG machine. You are shown a picture of an equipotentiality point and asked to identify it. You are then asked to identify other electrical symbols.

6. Airway management
What simple strategies can be used for airway management? Demonstrate on a dummy. How is this different for children? You are asked to identify Guedel and nasopharyngeal airways. What are the contraindications and risks associated with the nasopharyngeal airway?

7. Examination/skills
You are asked to examine an actor’s arterial pulses and praecordium, and to talk through what you are looking for/checking for.

8. Anaesthetic machine check
Check this equipment for a rapid sequence induction. What other equipment would you need?

9. History taking
Take a preoperative history from a 42-year-old woman presenting for total abdominal hysterectomy (TAH). She has concerns as she has had previous awareness while undergoing general anaesthesia for lower segment Caesarian section, and also postoperative nausea and vomiting. She also has had a fear of the mask since undergoing a dental operation as a child. She is undergoing TAH for menorrhagia; her haemoglobin level is 9 g/dl, she is on iron, and is lethargic. She has previously suffered from deep-vein thrombosis/pulmonary embolism, and 3 years ago was on warfarin for 6 months. She suffers from migraines and takes aspirin prn. She has no allergies.

10. Communication skills
Talk to the daughter of a patient with abdominal aortic aneurysm rupture. Explain the implications of the patient’s condition.

11. History taking
Take a preoperative history from a woman presenting with an atrioventricular fistula. She has chronic renal failure secondary to glomerulonephritis. She previously underwent dialysis from a left arm fistula. She has not undergone continuous ambulatory peritoneal dialysis and has no other medical problems.

12. Scans
You are asked to interpret an X-ray from a patient presenting for laryngeal resection. It shows a tumour and a large hiatus hernia. Would the patient need a preoperative H2 blocker? Is a preoperative nasogastric tube needed? Would you use a laryngeal mask airway? Would the application of cricoid pressure be inappropriate in view of the tumour? Is an anteroposterior X-ray needed? Which hemidiaphragm is higher? Is the fluid level above the diaphragm?

13. Scans
You are asked to interpret an X-ray from a patient who is asymptomatic but found to have a murmur preoperatively.

14. Resuscitation
A pregnant woman has collapsed after an injection of 20 ml local anaesthetic down her epidural. She has suffered a pulseless electrical activity arrest and is bradycardic. You are asked to demonstrate your treatment on an actor and then to answer questions about resuscitation. What would be your differential diagnosis? How would you treat local anaesthetic toxicity? What dose of intralipid would you use?

15. Anaesthetic monitoring and measuring equipment
Explain the oxy-deoxyhaemoglobin absorption graph. Indicate the isosbestic points. What can be measured at these? Compare the pulse oximeter with co-oximeter – what are differences?

16. Anaesthetic monitoring and measuring equipment
You are asked to demonstrate neuromuscular monitoring on an actor; put the electrodes on the actor’s arm – where should the black and red electrodes be placed? Where else can the electrodes be placed? Which nerves are being stimulated? What is the size of the current and why? You are shown pictures of train-of-four/tetanus – what do they show? Explain the difference between depolarising versus non-depolarising block.

17. Scans
You are shown an ECG trace showing ventricular fibrillation (VF). What would you do? Discuss the advanced life support (ALS) protocol. What other drugs can be given for refractory VF?

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