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Primary OSCE 11

Created: 20/7/2004
1. Data interpretation
A 60-year-old man presents for elective transurethral resection of the prostate. He had a cerebrovascular accident one month earlier, and still has a left hemiparesis. He has been given an anticoagulation therapy. His lab results are: International Normalized Ratio (INR) 3.5, activated partial thromboplastin time (APTT) 45 seconds, thrombin clotting time (TCT) 15 seconds.
Answer the following true/false questions:
a. The patient is on warfarin. (T/F)
b. It is safe to give this patient a spinal anaesthetic. (T/F)
c. The patient will be deficient in clotting factors 2, 7, and 9. (T/F)
d. The patient should be given vitamin K immediately. (T/F)
e. The patient’s hemiparesis is a contraindication to using muscle relaxants. (T/F)

2. You are presented with a pulmonary artery flotation catheter , showing trace A and trace B
Trace A shows the correct trace of a catheter going from the right atrium, right ventricle, pulmonary artery, and is wedged but the pressures are very high. Trace B shows the catheter passing back into the right atrium from the right ventricle. Answer 10 true/false questions.

3. Equipment
Demonstrate safe defibrillation on a pulseless dummy in ventricular tachycardia.
- Where should the paddles be placed?
- Demonstrate an alternative position for the paddles
- What would you do if the patient has a pacemaker? What energy levels would you apply?

4. Safety
You are shown two endotracheal tubes, one is laser resistant, and the other is a standard portex endotracheal tube.
- Which of these is used in ear, nose and throat surgery?
- Which is safe to use in gynaecological surgery?
- What safety precautions should be taken, both for patients and staff, during laser use?
- Shown goggles for CO2 laser
- Why are goggles required for CO2 laser surgery?

5. Anatomy
You are shown a diagram of the cross-section of the spinal cord.
- Identify the tracts
- What is in the gray matter
- Describe the blood supply to the spinal cord
- What happens in the case of an anterior spinal artery thrombosis?

6. History
Take a history from a pregnant woman, at 37 weeks’ gestation, and give her advice about pain relief during labour.

7. Examination
You are asked to examine a head injury patient in the Accident and Emergency department. (Examine particularly the Glasgow Coma Score).

8. Anatomy
Name the nerves supplying the foot. How would you perform an ankle block? 
Describe the course of the saphenous nerve.

9. Data interpretation.
 50-year-old woman presents for a rigid bronchoscopy. Her lateral chest X-ray shows a fluid level in the chest.
- Answer 10 true/false questions

10. Data interpretation
Statistics: what is a correlation and regression coefficient?

11. Resuscitation
Perform basic life support on a 6-year-old child who has collapsed, assuming no trauma. The monitor shows sinus rhythm but no pulse. Give five reversible causes of this rhythm and describe what immediate actions you would take.

12. History
Take a history from a man presenting for nasal surgery. He has a history of hypertension, and maintains that he needs the surgery because he stops breathing at night.

13. Communication
A patient you have seen a day earlier, who is on your list for minor gynaecological surgery, comes into reception, appearing nervous. She has a history of controlled hypertension. You had planned to pre-oxygenate her, but she says she is anxious about the mask, as she remembers having an anaesthetic mask held over her face as a child.

14. Machine check.
Carry out a check on a circle system.
- Can this be used without soda lime?

15. Monitoring
You are shown some capnograph traces.
- What do they show?
- What can capnography be used to monitor?
- What is the principle behind this equipment?

16. Equipment
You are shown a picture of Dinamap
- What are its operating principles?
- You are shown a trace of pressure oscillations within the system; explain how you would derive the systolic blood pressure, diastolic blood pressure and mean arterial pressure from this.
- What is the correct size for the blood pressure cuff?

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