Osce 3

	Fcarcsi.co.uk OSCE 2004 & 2005 Patient A is listed for an elective TAH and BSO. He cannot open his mouth more than 1 cm. Explain him about the anaesthetic management. (awake intubation) Patient A is known to have a heart murmur and is fixed for elective TAH and BSO. She is very anxious and thinks she might die. Discuss and explain her about anaesthetic management. Anatomy of intercostals nerve block. Photograph of single rib cross section Questions. ECG. Two ECG in this station Atrial Fib. Causes and management. MI - management and complication Malignant Hyperthermia. Critical scenario question .Unmanned station Pace maker photograph. Examiner ask many questions. Indication, explain different letters, symptoms before fixing the pacemaker, does the symptoms improve after? What do you tell the surgeon? BLS and ALS. Patient is on total parenteral nutrition. Photograph of peak flow meter. Unmanned station with many questions Patient A had a spinal anaesthic for caesarean section and c/o numbness. Examine the peripheral nervous system. Chest x-ray. Name the parts marked in numbers. Statistics. Unmaned station with many questions linear coeff Unmaned station .Patient A is an afro-carrebian. Blood results given. Questions about sickle cell. Critical scenario station .Patient A had a central line put in for a total parenteral nutrition. After half an hour the patient had hypotension and tachycardia. Diagnosis and management. Patient XX had a laparotomy for ectopic pregnancy. Now she is on PCA morphine 1mg bolus and five min lockout. Ward nurse bleeped you to tell the patient is in severe pain. Access the patient.(actor in the station) Patient A is a known asthmatic and is fixed for an elective XXX surgery. What are the important things you need to know. (the examiner asks you questions about pre intra and post op). BLS and ALS. Patient has renal failure and collapsed in the ward. Check pulse, CVP and blood pressure on an actor. Examiner ask you various question including korotkoff sounds Pictures of VIE(pressure and temperature inside), flow meter, N2O cylinder, pressure relief valve. All in one station. Biers block. Examiner asks lots of questions including prilocaine. Statistics about quantitative datas of two different studies. CVP catheter is kept. Skills station. Brachial plexus block.Various questions Penile block. Various question (remember bucks fascia) Statistics about chi sq test. Statistics (about basics). Critical incident Anaphylaxis (remember new anaphylaxis guidelines published. Link published in EBM section) Chest x-ray of a patient with pace maker. Different question Upper limb examination communication. You are asked to speak to a mother of a child. The child you anaesthetised had malignant hyperthermia and is now in ITU.(candidates get mixed up with sux apnea.) OSCES ACLS 55yr old man left sided chest pain collapsed in A&E dept. You are alone at the site EXAMINATION 22 yr old COAD &heavy smoker examine RESPIRATORY SYSTEM CRITICAL INCIDENCE 90KG man with fracture femur app blood volume app blood loss in this scenario S/S How to manage? Minimum urinary output after resuscitation CRITICAL INCIDENCE After infusion of gelofusine patient’s pulse is 160/m,BP60/20mmhg Diagnosis S/S Immediate management & doses of drugs used Secondary management COMMUNICATION Sux apnoea explain to the patient Nervous child for circumcision ! explain to the mother the procedure. ECG Marking 12 lead ECG on the diagram What are unipolar leads What are bipolar leads ECG with bradycardia &1^st degree block; describe rate rhythm, causes &treatment. EQUIPEMENT N2O cylinder Identify normal pressure of a full cylinder, pressure of half emptied cylinder, total volume of gas delivered when full VIE Pressure inside the chamber,temp.inside the chamber,uses BAINS CIRCUIT Identify ,methods of checking the circuit.FGF required in sp.breathing patient as a fraction of MV PULSE OXIMETER Draw a diagram to show its principle Factors affecting its performance EPIDURAL Indications ,landmarks,layers of the skin-ep space Drugs used dosages,boundaries,complications SPINAL Stuctures in order from skin-space Level where sp.cord ends in adult Level where meninges end in an adult XRAY Pneumothorax with fracture ribs S/S and management DATA ETCO2 traces CVP traces labelling. OSCES OCT 2005 PRIMARY FRCA 1.ACLS-33 yr male patient with cardiac arrest, bleeding stab wound to the left groin in A&E !(approach via ACLS &ATLS guidelines) 2. Examination of hand 3. (A)ECG- A trail flutter with variable block a)whats the diagonasis? b) whats the cause of this condition? c)what drugs are required to treat this condition? d)name the side effect of the drugs used? B)DIAGRAM OF THE CHEST show where to put the chest leads V1-V6? What do you understand by unipolar leads? 4.Preoperative assessment of an Obese patient What do you look in anaesthetic visit? How do you anaesthetise this patient? What equipment will you get ready? What are immediate post op complications? What are late post op complications? 5. TURP SYNDROME What is TURP SYNDROME? What are s/s What are its complications? How do you treat TURP syndrome? 6. A young man brought to operating theatre with history of closed fracture femur Whats the approximate blood volume? Whats the approximate blood loss? Name atleast 6 complications involving CNS/RS/CVS/Musculoskeletal systems? 7. Equipment HME Whats its mechanism?How much humidity it can achieve?Will it prevent passage of hepatitis virus? Whats the maximum size of particle which can pass through it? IV CANNULA What are factors governing flow through it? Name different terms involved? Flow become turbulent above Reynauld No of 2000 true/false SCAVENGING APPARATUS (ACTIVE) Whats the equipment shown? What is the negative pressure generated? Diameter of connecting tube with rest of berathing circuit? 8. Communication Mother of 6 year old going for circumcision ,She is anxious about the child because the child is very nervous! She is concerned of the pain relief?and also how the child would be put to sleep?When the child can go home? 9. Epidural block Indications! Land marks! Layers from the skin-epidural space How would you give epidural? Complications of epidural? 10. Statistics 11. Vitalographpicture Whats FEV1? Whats FEV1/FEV ratio? How do you measure FEV1? What is TLC? How do you measure TLC? What are S/S of obstructive lung disease? What are its causes? What is the treatment for acute severe asthma? 12. Diagram of dermatomes. Name the marked areas Supraclavicular nerves.T2.T4.Dorsal nerve of penis. Lateral cut nerve of thigh. Deep personeal nerve.Nerves blocked by three in one block? 13. X RAY Normal marked –aortic knuckle,pulmomary hilum-left border of heart etc Left lobar collapse! What are its causes?D/D How to treat? 14. A 23 year old female coming for varicose veins as aday case patient previous history of DVT,on OCP,Chronic smoker and was on warfarin Pre anaesthetic assessement Make an anaesthetic plan. Fcarcsi.co.uk

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