|1. Chest X-ray
You are shown a lateral chest X-ray of a 56-year-old female admitted with right upper quadrant pain and pyrexia, with a clinical diagnosis of gall bladder empyema. The X-ray shows lower lobe collapse/consolidation.
– You are asked some equations about the diagnosis of empyema versus chest X-ray findings and whether to proceed with laparotomy.
2. Anaesthetic machine check
You are asked to carry out a check on a machine with the following faults: a leak on the back bar, no pipeline gases, O2 analyser no batteries, machine not plugged in.
You are shown a diagram of a pH electrode (gas analyser type) and asked to identify components.
You are asked about the anatomy of the orbit.
- Identify the cribriform plate. What goes through it?
- Identify the optic canal, superior and inferior orbital fissures; what passes through them?
- Describe the technique of peribulbar block and the complications associated with it.
You are asked to identify C7, the posterior superior iliac spine and the L3-4 space on an actor.
- Describe the technique of administering an epidural using the equipment
- Describe the spaces that the needle passes through on the way to the epidural space. List three potential complications.
Tell an actor that his operation has been cancelled because the list over-ran due to an emergency.
7. Simulator manikin
A 34-year-old woman with a diagnosis of ectopic pregnancy has collapsed on the ward. The cardiac monitor shows sinus bradycardia. She has no pulse. She has 20G intravenous access.
- What would you do?
You are shown an ECG showing supraventricular tachycardia.
- Describe the medical management and direct current cardioversion.
Describe the immediate management of needle stick injury.
- Who should it be reported to?
- Do you need consent to test the patient?
- What drugs are used for post-exposure prophylaxis?
- Name the national reporting systems.
Describe the pulse oximeter.
- How does it work?
- Identify the wavelengths on a diagram of oxy-/deoxyhaemoglobin and name the isosbestic point.
11. History taking
Take a history from a patient with well-controlled asthma and family history of postoperative nausea and vomiting scheduled for varicose vein surgery.
12. Simulator manikin
Demonstrate the use of needle cricothyrotomy in the “can't intubate, can't ventilate” scenario.
13. Chest X-ray
You are shown a chest X-ray (anteroposterior view). It shows a large heart, upper lobe diversion and prominent vasculature.
- You are asked some questions about pulmonary hypertension and requirement for echocardiography.
You are asked about the anatomy of the first rib and lower rib.
- Describe the attachments and relationships of first rib.
- Describe the technique and complications of intercostal nerve block on an actor.
- Identify the correct anatomical space and describe the emergency decompression of a tension pneumothorax.
- Describe the site of chest drain insertion.
- Demonstrate where to find the apex beat.
15. History taking
Take a history from a patient with porphyria and penicillin allergy who presents for wisdom tooth extraction. You are asked questions on the nature of teeth problems, complications associated with porphyria and drugs to avoid. Can Augmentin be used in this patient?