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Primary OSCE 14

Created: 7/9/2004
1. History taking
Take a history from a woman listed for hysterectomy. She is from Bangladesh and has a history of night sweats, weight loss, low Hb and cough. She is known to have thalassaemia.

2. Examination
Examine the respiratory system and also show how to use a peak flow meter.

3. Anatomy
- Discuss the anatomy of the heart, its blood supply and the pressures in various chambers.
- You are shown a coronary angiogram - name the arterial branches pointed out.
- Give a detailed description of the pathway of the Vagus nerve.

4. Equipment
- Diathermy: you are shown two plates (one for a child, one for an adult); discuss the current density and frequency used.
- Discuss pacemakers in detail; what codes are used (e.g. VVI or DDD etc)?
- You are shown four graphs; which is the correct one for clotting and which for coagulation?

5. Anatomy
- Discuss the base of the skull and the pathway of the trigeminal nerve (which holes in the skull do the branches pass through, which branches/ganglia are motor/sensory?).
- Discuss trigeminal neuralgia.

- You are shown a stethoscope with an ear piece attached; where could it be used?
- Discuss how to confirm correct intubation and what CO2 traces you would expect to see.

Carry out a Bain circuit check; discuss the volume of the circuit, what happens if the tubing is very long and the flow rates required.

8. Equipment
Defibrillation: you are shown a mannequin attached to a defibrillator, with the monitor showing ventricular fibrillation.
- Demonstrate the use of the defibrillator and discuss its use in different circumstances.

9. Anatomy
Discuss an X-ray of the cervical spine.

10. MCQs

11. Equipment
Rotameters: examine various pictures and discuss (flow in rotameter and function of the bobbin etc.).

11. Resuscitation
You are shown a mannequin on the floor who you are told is a victim of near drowning.
- Perform basic life support and go through the algorithm for ventricular fibrillation.

12. History taking
Take a history from a 69-year-old man listed for transurethral resection of the prostate. He has a history of mild bronchitis.

13. Communication
Explain to a very angry man that you have knocked his tooth out while trying to intubate him!

14. Data interpretation
- Discuss pulmonary artery catheters.
- Discuss various statistical terms (regression lines etc).
- Discuss the results of a cardiac output study (systemic vascular resistance/pulmonery artery pressures etc.)

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