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FRCA Primary OSCE/VIVA > OSCE > Flashcards

OSCE Flashcards

1
Q

EQUIPMENT:
Anaesthetic equipment: circle absorber
(B1P1)

A
  • Can you please check this system
  • Benefits of using this system
  • What happens if unidirectional valve malfunctions
  • Explain 4-8 mesh
  • Constituents of soda lime
  • Name some contaminants
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2
Q

DATA INTERPRETATION:
ECG
(B1P7)

A
  • WPW syndrome
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3
Q

DATA INTERPRETATION:
Haemodynamic data
(B1P12)

A
  • SVR: (MAP-CVP/CO) x 80
  • PVR: (PAP-PAWP/CO) x 80
  • SVRI: (MAP-CVP/CI) x 80
  • PVRI: (PAP-PAWP/CI) x 80
  • DO2: CO x CaO2 x 10
  • CaO2: Hb x SaO2 x 1.34/100
  • Oxygen extraction ratio: CaO2-CvO2 / CaO2
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4
Q

DATA INTERPRETATION:
Statistics
(B1P15)

A

.

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5
Q

ANATOMY:
Internal Jugular Vein / Neck
(B1P17)
(B2P7)

A
  • Describe course of IJV
  • State the relations of IJV
  • Name the tributaries that drain into IJV
  • Demonstrate the insertion of this central line via IJV (Manikin)
  • Complications of central line placement
  • which sinuses combine to form the IJV
  • what is the relationship btw the IJV and carotid artery
  • where does the IJV terminate
  • which veins combine to form EJV
  • where do the anterior and external jugular veins join?
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6
Q

COMMUNICATION:
Awake tracheal intubation
(B1P21)

A

.

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7
Q

TECHNICAL SKILL:
Cricothyrotomy
(B1P26)

A
  • Perform on manikin
  • Equipment needed
  • Why choose cricothyroid mb
  • Give two complications of cricothyrotomy
  • Describe 2 precautions you would take to prevent barotrauma
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8
Q

CLINICAL EXAMINATION:
Assessment of Trauma patient
(B1P30)

A
  • ABCDE
  • Know GCS
  • Treatment for extradural hematoma (and other hematomas)
  • Indications for CT scan
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9
Q

MEASUREMENT AND MONITORING:
Pulmonary artery flotation catheter
(B1P33)

A
  • Can you identify this?
  • Normal Pulmonary capillary wedge pressure?
  • Where will the proximal lumen open? How far is it from the top and what does it measure?
  • What is the volume of the balloon in the tip?
  • Can you draw the various traces as the pulmonary artery flotation catheter is inserted and wedged?
  • What will the trace resemble if the catheter coils back into the right atrium?
  • Where is the thermistor situated in the catheter?
  • State at least 2 uses of this catheter
  • State 3 complications of using this catheter
  • State at least 2 measured values and 2 derived hemodynamic variables obtained from a pulmonary artery catheter
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10
Q

RESUS & SIMULATION:
Paediatric resuscitation
(B1P37)

A
  • Know PILS algorithm
  • what is IV dose of adrenaline
  • what is IO dose of adrenaline
  • how much to give through tracheal tube?
  • Approximate weight of child
  • Volume of IV fluid to administer as initial bolus?
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11
Q

ANATOMY:
Base of the Skull
(B1P40)
(B2P21)

A
  • Know Foramen / Location / Content
  • how would you test trigeminal nerve function
  • what are the functions of cranial nerve VII
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12
Q

HISTORY TAKING:
Teeth extraction
(B1P46)

A

.

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13
Q

RESUS & SIMULATION:
Anaphylaxis
(B1P50)

A
  • Know management (Primary/Secondary/Investigations)
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14
Q

MEASUREMENT AND MONITORING:
Capnography
(B1P54)

A
  • Can you identify this?
  • Other types of CO2 analyser used in clinical practice
  • Differences between 2
  • Advantages of main stream analyser
  • Name the factors that can affect the response time
  • Name different phases of capnograph
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15
Q

CLINICAL SAFETY / HAZARDS:
Diathermy and Clinical safety
(B1P60)

A
  • Clinical uses of this equipment?
  • Physical principles involved?
  • Frequency of current used?
  • how does diathermy cause coagulation?
  • Why does pt plate have large area?
  • What happens if plate disconnected and diathermy activated?
  • Are there any other problems or hazards while using diathermy?
  • Difference btw monopolar and bipolar diathermy
  • What safety features are incorporated to avoid electrical hazards?
  • What precautions do you need to take to prevent electrical hazards from diathermy to the patient?
  • Know Type CF/BF… logo
  • can diathermy be used on patients with pacemakers?
  • what is capacitive coupling?
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16
Q

RADIOLOGY:
Chest X-Ray
(B1P63)

A
  • Borders of a heart in a CXR
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17
Q

HISTORY TAKING:
Arthroscopy of the knee
(B1P67)

A

.

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18
Q

COMMUNICATION:
Awareness under anaesthesia
(B1P69)

A

.

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19
Q

ANATOMY:
Intercostal nerve block
(B1P72)

A
  • Label structures
  • 3 important structures passing through intercostal space? how are they arranged?
  • how many veins in each space?
  • 3 indications for intercostal nerve block?
  • btw which 2 muscles are these inercostal nerves and vessels found?
  • 3 complications of intercostal nerve block?
  • what type of nerve is the intercostal nerve
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20
Q

CLINICAL EXAMINATION:
Cranial nerves
(B1P75)

A
  • Signs of complete paralysis of 3rd cranial nerve
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21
Q

EQUIPMENT:
Humphrey ADE breathing system
(B1P81)

A
  • Name the various components of this system
  • At what pressure does the safety valve open
  • Advantages of this system?
  • Explain MOA
  • What is the FGF required during SV
  • What is FGF required during CV
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22
Q

DATA INTERPRETATION:
Drug overdose (salicylate)
(B1P87)

A

-

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23
Q

DATA INTERPRETATION:
Neuro-obs chart
(B1P90)

A

-

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24
Q

ANATOMY:
Stellate ganglion
(B1P94)

A
  • identify stellate ganglion and vertebral artery
  • at what vertebral level is the stellate ganglion located
  • describe the technique of blocking the stellate ganglion?
  • if stellate ganglion at level 7 why are you aiming at C6 tubercle?
  • 2 indications for stellate ganglion block
  • 2 features for a successful block?
  • what are the features of Horner’s syndrome?
  • Name 4 complications of stellate ganglion block?
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25
Q

COMMUNICATION:
Brain Stem Test
(B1P98)

A

-

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26
Q

TECHNICAL SKILL:
Lumbar puncture for spinal anaesthesia
(B1P103)

A
  • Indicate space
  • Describe how you usually perform a spinal
  • which of the following needles would you prefer to use?
  • what would you do if fluid was blood stained?
  • how much local anaesthetic would you use for each spinal segment to be blocked
  • Name 2 factors affecting the spread of local anaesthetic in spinal anaesthesia?
  • 4 contra-indications to performing spinal anaesthesia
  • Blood supply to spinal cord
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27
Q

CLINICAL EXAMINATION:
Cardiovascular system
(B1P106)

A

-

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28
Q

MEASUREMENT AND MONITORING:
Wright respirometer
(B1P109)

A
  • Name this device
  • what does it measure
  • mechanism involved?
  • can it be used to measure bidirectional flow
  • Advantage of Wright respirometer?
  • Disadvantages?
  • Resistance to breathing through this?
  • Name 2 devices to measure flow?
  • Principle behind a pneumotachograph?
  • Advantages of pneumotachohraph?
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29
Q

RESUS & SIMULATION:

Basic Life Support of a pregnant mother

A

-

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30
Q

ANATOMY:
Vagus nerve
(B1P115)

A
  • name the structures labelled
  • origin of vagus nerve
  • how many nuclei does it have and what are they
  • through which foramen does it leave the skull?
  • name 2 other structures that pass through this foramen
  • state the relations of vagus nerve in the neck?
  • what is the course of the R vagus inside the thorax
  • what is the course of the L vagus nerve inside the thorax?
  • apart from the laryngeal branches can you name 3 other branches of the vagus nerve?
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31
Q

HISTORY TAKING:
Laparoscopic cholecystectomy
(B1P118)

A

-

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32
Q

RESUS & SIMULATION:
Failed intubation
(B1P121)

A

-

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33
Q

MEASUREMENT AND MONITORING:
Peripheral Nerve Stimulator
(B1P124)

A
  • what is this equipment and what is its clinical use?
  • Name 2 factors which determine the energy requirement to propagate a nerve impulse?
  • Why would you use a supramaximal stimulus?
  • Indicate where you would place the electrodes for stimulating the ulnar nerve?
  • Indicate how you would connect the leads?
  • Which muscle contraction would you observe when the ulnar nerve is stimulated?
  • State 3 methods available to assess muscle contractio?
  • What is DBS?
  • What is PTC?
  • What is the mechanism behind a PTC?
  • What is the significance of a PTC?
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34
Q

CLINICAL SAFETY / HAZARDS:
Defibrillator
(B1P129)
(B2P77)

A
  • check leads: position on pt and monitor
  • confirm rhythm
  • applies gel pads and correctly places paddles
  • charges safely to correct energy level (150-360J) in a biphasic defibrillator or 360J on monophasic defibrillator
  • Visual sweep prior to delivering shock “stand clear”
  • Removes oxygen
  • Delivers shock while looking at monitor
  • how would you place the paddles if someone has a pacemaker
  • what do these symbols indicate?Type BF and CF equipement
  • what types of defib are there
  • how do external defib work
  • what are the advantages of biphasic defibrillators
  • look at this defib circuit diaphragm and name the components? and their role?
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35
Q

RADIOLOGY:
Chest X-Ray
(B1P132)

A

-

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36
Q

HISTORY TAKING:
Varicose veins
(B1P137)

A

-

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37
Q

COMMUNICATION:
Sux Apnea
(B1P138)

A

-

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38
Q

ANATOMY:
Cubital fossa
(B1P142)

A
  • Name the structures
  • Name the nerves supply areas
  • how would you block the lateral cutaneous nerve of the forearm
  • what movements would you elicit by stimulating the median nerve of the axilla?
  • how would you block the lateral cutaneous nerve of the forearm?
  • what movements would you elicit by stimulating the median nerve of the axilla?
  • how would you block the median nerve at the elbow?
  • how would you block the ulnar nerve at the elbow?
  • where would you find the radial nerve in the cubital fossa and how would you block it?
  • What would be the response if the radial nerve was stimulated at this level?
  • Know boundaries/contents/radial nerve block at elbow/ median nerve block at elbow/ulnar nerve block at elbow/use of PNS for nerve blocks
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39
Q

TECHNICAL SKILL:
Ankle block
(B1P148)
(B2P11: better)

A
  • name nerves that need to be blocked in order to provide anaesthesia for this surgical procedure?
  • what are the other 2 nerves in the ankle that are required to be blocked for a complete ankle block?
  • of the 5 nerves which one is not a branch of the sciatic nerve?
  • name the structures labelled
  • name the terminal branches of the tibial nerve
  • how would you block the tibial nerve at ankle
  • how would you block the deep peroneal nerve
  • where would you inject LA to block the sural nerve?
  • where would inject LA to block the saphenous nerve?
  • indications for ankle block?
  • what dose of adrenaline would you use to prolong the block?
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40
Q

EQUIPMENT:
Anaesthetic equipment: anaesthesia machine check
(B1P153)

A
  • check if connected to electrical supply
  • check monitoring devide and recognise that there is no EtCO2 monitor
  • check O2 analyser on the machine that is working and calibrates it for 100% and 21%
  • Tug test
  • check pipe line pressure gauge (4 bar)
  • check that O2 cylinder available
  • check that blanking plug is fitted to empty cylinder yoke
  • flow meters (check all 3 valves operational / check for anti-hypoxia device (mention it)/ check for emergency flush)
  • check vaporisers (adequately filled / correctly seated / check for leak (on off position) / turns vaporiser off when check completed)
  • what precautions would you take before fitting a cylinder to machine
  • why would you do this?
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41
Q

DATA INTERPRETATION:
Biochemistry
(B1P158)

A

-

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42
Q

DATA INTERPRETATION:
ECG
(B1P162)

A
  • Pacemaker generic code 5 letter format
    • 1st letter chamber paced (Atrium A Ventricule V or Dual D)
    • 2nd letter chamber sensed (Atrium A Ventricule V or Dual D)
    • 3rd letter response to sensing (None N Triggered T, Inhibited I or Dual D)
    • 4th letter rate modulation or programmability (Rate modulated R, Communicating C, Multiprogrammable M, Simple programmable P, None N)
    • 5th letter anti-tachycardia function: Paced P, Shocks S, Dual D
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43
Q

DATA INTERPRETATION:
Coagulation studies
(B1P165)

A
  • Dose of platelet tranfusion = “one adult pack” or 10 ml/kg BW in children
  • Aim for PT and APTT < 1.5x mean control (to minimise surgical bleeding) and fibrinogen <1 g/L
  • Dose of FFP is 4 units (about 1L) in adults or 10-15 ml/kg in children
  • Fibrinogen <0.5g/L associated with microvascular bleeding
  • Low fibrinogen prolongs both PT and APTT
  • Cryoprecipitate specific for replacing fibrinogen
  • Dose is 2x5 donation pools for adult
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44
Q

ANATOMY:
Neck and Thorax
(B1P167)

A
  • name the structures labelled
  • name 3 structures encountered during surgical tracheostomy
  • know anatomy relevant to tracheostomy
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45
Q

COMMUNICATION:
Postponed surgery
(B1P171)

A

-

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46
Q

TECHNICAL SKILL:
Tracheostomy tube exchange
(B1P173)

A
  • ensure appropriate monitoring
  • …
  • what to do if unable to re-insert the tube?
  • available options to manage the airway?
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47
Q

CLINICAL EXAMINATION:
Respiratory system
(B1P176)

A
  • Position
  • Inspection
  • Palpation
  • Percussion
  • Auscultation
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48
Q

MEASUREMENT AND MONITORING:
Temperature measurement
(B1P178)

A
  • Identify equipment
  • principle behind its function
  • advantage?
  • disadvantages?
  • what are the non-electrical methods available to measure temperature?
  • name 3 other sites to measure temperature
  • what are the disadvantages of mercury thermometer
  • what electrical methods of measuring temperature are you aware of ?
  • what is the physical principle behind the thermocouple?
  • what are thermistors
  • name one disadvantage of thermistor
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49
Q

RESUS & SIMULATION:
Atrial Fibrillation
(B1P182)

A
  • how would you treat
  • what clinical signs indicate that pt is unstable
  • how would you ttt the pt considering he is stable
  • how much amiodarone would you give
  • the pt now deteriorates and has a BP of 70 and HR 160. how would you ttt the pt
  • what energy level would you choose
  • know really well the ALS algorithm
  • know about narrow complex tachycardia
50
Q

ANATOMY:
Trigeminal nerve
(B1P186)

A
  • which cranial nerve provide sensory innervation to face
  • describe the origin of the trigeminal nerve
  • what is the intracranial course of the roots soon after their origin
  • what is the other name for this ganglion
  • where is this ganglion located and what other structures is it related to
  • name the 3 divisions of the trigeminal nerve
  • state the course of the opthalmic nerve
  • what is the course of the maxillary nerve
  • distribution of the maxillary nerve
  • what structures does the maxillary nerve innervate
  • indicate where the foramen ovale is in the base of the skull
  • what division passes through the foramen ovale
51
Q

HISTORY TAKING:
Mastectomy
(B1P190)

A
  • order of pre-anaesthetic Hx taking

- if pts on meds, ask about side effects

52
Q

RESUS & SIMULATION:
ST depression
(B1P192)

A
  • what does ST depression imply
  • how would you manage this suspected intra-operative ischemia?
  • monitor shows HR of 126 BP 190/120 and progressive ST depression. What would you do?
  • despite the above measures ST segment depression and HTN persists. Is there any other drug you would consider?
  • Even after optimising fluid status, balanced anaesthesia, and EtCO2, the HR remains high HR 140. how to manage tachycardia
  • how would you manage this patient postoperatively
53
Q

MEASUREMENT AND MONITORING:
Pulse oximeter
(B1P199)

A
  • what are the components of the pulse oximeter
  • what are the 2 wavelengths of the source of light
  • know the absorbance spectrum graph
  • what is the name of the point where the absorbance for the 2 forms of Hb meet?
  • what is the principle of a pulse oximeter
  • what are beer and lamber’s law
  • at what range of SO2 does the pulse oximeter maintain reasonable accuracy
  • give 4 situations where pulse oximeter readings may not be accurate
  • does anemia affect the accuracy of pulse oximetry
    how is the background noise such as that due to bright external lights eliminated
54
Q

CLINICAL SAFETY / HAZARDS:
Administration of blood to a patient
(B1P203)

A
  • check the wrist band
  • check cross-match report form
  • check the blood bag (pt details, blood group, unit number, expiry date, volume of blood)
  • what would you record on the X-match form
  • What parameters would you monitor during transfusion
  • during GA how would you recognise a transfusion reaction in this patient
  • how would you manage a transfusion reaction
  • what are the indications for cryoprecipitate
55
Q

RADIOLOGY:
CT scan of the head
(B1P206)

A
  • Know different types of hematomas and CT scans observations
56
Q

HISTORY TAKING:
Hernia Repair
(B1P210)

A

-

57
Q

EQUIPMENT:
Anaesthetic equipment: entonox valve
(B1P1)

A
  • identify equipment
  • what is the pressure in the entonox cylinder
  • state how entonox is formed
  • what is the critical temperature of the gas mixture in this cylinder
  • what is the Poynting effect
  • what would the problem be of storing the cylinder at a very low temperature (e.g. -10oC)
  • at what temperature would these gases separate in a pipeline at 4 bar
  • what precautions should be taken during storage of this cylinder
  • how does this pressure relief valve differ from others
  • name some clinical uses of entonox
  • what advice would you give for its use during labour
  • what are the contra-indications for its use
  • what is the maximum recommended concentration of nitrous oxide in the theatre atmosphere?
58
Q

TECHNICAL SKILL:
IO infusion
(B1P216)

A
  • what is the indication for IO infusion of fluids
  • can you demonstrate how you would perform intra-osseous puncture
  • why should the needle be directly caudally
  • how would you confirm the correct placement of the needle
  • what are the complications
  • state 2 relative contra-indications for IO infusion
59
Q

TECHNICAL SKILL:
Intravenous regional anaesthesia
(B1P219)

A
  • Know Indications / CI / Drug to be used / recommended dose / checks required beforehand…
60
Q

EQUIPMENT:
Anaesthetic equipment: Bain breathing system
(B1P223)

A
  • connects all components correctly
  • connects proximal end to common gas outlet
  • visually inspects the outer tubing
  • sets FGF at 5L/min
  • Confirms flow into system by occluding tube at pt end and ensures that reservoir bag fills, turns off the flow meter and ensures that the reservoir bag does not collapse
  • makes sure that inner tube not disconnected, sets gas flow at 5L/min, then occludes the inner tube using a plunger of a 2ml syringe, and the bobbin should dip due to back pressure
  • checks function of APL valve
  • checks the filter and angle piece for any defect or blockage
  • what happens if inner tube is disconnected at the machine end
  • what is the FGF required for SV for avoiding rebreathing
  • what should the FGF during CV to maintain normocapnia
61
Q

DATA INTERPRETATION:
Lung Function Tests
(B1P227)

A
  • what is a vitalograph

- know vitalograph and different types of pathologies observed

62
Q

DATA INTERPRETATION:
ECG
(B1P234)

A
  • AV block
  • RBBB
  • LBBB
  • ECG criteria for LVH
  • Indications for implantation of permanent pacemaker
  • Blood supply / RCA/LCA
63
Q

DATA INTERPRETATION:
Vital parameters
(B1P239)

A

-

64
Q

ANATOMY:
The orbit and ophthalmic anaesthesia
(B1P1244)

A
  • name the foramen labelled
  • what structures pass through this foramen
  • name structures labelled
  • what structure pass through fissure
  • what is the normal axial length of the eye ball and what is the significance
  • describe the motor nerve supply to the extra-ocular muscles
  • what are the various regional techniques available in providing anaesthesia for eye surgery
  • can you describe the procedure of subtenon block
  • where would you inject the LA
  • what LA would you use and what volume is needed
  • why is hyaluronidase used
  • know anatomy of orbit
  • complications related to ophtalmic regional block
65
Q

COMMUNICATION:
Jehova’s Witness
(B1P253)

A
  • Anaesthetic Mx for JW
  • Pre-op Mx
  • Intra-op Mx
  • Post-op Mx
66
Q

TECHNICAL SKILL:
LMA insertion
(B1P255)

A
  • choose correct size of LMA for this pt
  • insert LMA on this manikin
  • what material used in manufacturing these masks
  • does it contain latex
  • advantages of LMA over tracheal intubation
  • limitations of LMA
  • size of LMA to choose in a 2y old child weighing 13kg. how much air would you use to inflate t
  • what is function of mask aperture bars
67
Q

CLINICAL EXAMINATION:
Airway examination
(B1P258)

A
  • Inspection front and side
  • MO and measure inter-incisor distance
  • mandible protrusion
  • Mallampati test
  • Sternomental distance
  • TM distance
  • Full range of neck movements
  • patency of nasal passages
  • what would you see and what info would you obtain from Mallampati test
  • what are the risk factors included in Wilson risk sum scoring
  • what is the significance of this scoring system
68
Q

MEASUREMENT AND MONITORING:
Bourdon gauge
(B1P261)

A
  • identify equipment
  • use of Bourdon gauge
  • can this be used for measuring BP
  • what P does it measure - gauge or absolute?
  • what P does a mercury barometer measure
  • what is the difference btw absolute and gauge pressure
  • what is principle of measuring P in Bourdon gauge
  • what units are used to measure cylinder pressure
  • what is the pressure in a full oxygen cylinder
  • what factors affect the pressure in an oxygen cylinder
  • what are the uses of an aneroid gauge
69
Q

RESUS & SIMULATION:
Broad complex tachycardia
(B1P264)

A
  • how would you treat this pt
  • what clinical features will help you in deciding whether this pt is stable or unstable
  • pt maintaining an airway, conscious, no CP, and SBP 105. how would you ttt this pt?
  • how would you dilute amiodarone
  • what is the max dose of amiodarone in 24h
  • what are the AEs of amiodarone
  • what is the differential diagnosis
  • how would you ttt previously confirmed SVT with BBB
  • If this pt unstable, what ttt would you instigate?
  • know mx of broad cpx tachycardia
70
Q

ANATOMY:
Larynx
(B1P267)
(B2P31)

A
  • name the structures
  • name intrinsic muscles of larynx
  • nerve supply to larynx
  • what happens if unilateral recurrent laryngeal nerve is damaged
  • techniques of anaesthetising the larynx for awake intubation
  • blood supply to larynx
  • at what vertebral level is the thyroid notch
  • when can recurrent laryngeal nerve be damaged
  • clinical difference btw unilateral and bilateral recurrent laryngeal nerve damage
71
Q

HISTORY TAKING:
Tympanoplasty
(B1P274)

A
  • Introduce and confirm pt’s identity
  • confirm proposed surgical procedure, side and indication
  • consider presenting symptoms and whether they have any systemic effect
  • Cause of current surgical condition, and does it have any systemic complications? Any predisposing or risk factors for the presenting problem
  • PSH: previous anaesthetics
  • FHx of anaesthetic related concerns, diabetes and heart attack
  • PMHX
  • Drugs and AEs from them
  • Allergy
  • Smoking and alcohol
  • Hx of reflux
  • Airway assessment
72
Q

RESUS & SIMULATION:
Post-induction hypotension
(B1P278)

A
  • Recognition
  • Check for other vital parameters
  • Structured approach: ABC, replenishing circulating volume (fluids), maintaining perfusion (vasopressors), increasing O2 carrying capacity (blood transfusion), and surgical control of bleeding
  • ask for help and inform the surgeon to proceed to laparotomy to control bleeding
73
Q

MEASUREMENT AND MONITORING:
Oxygen analyser
(B1P281)

A
  • Name equipment (galvanic fuel cell)
  • indicate which one of these figures best match the above equipment
  • name the parts labelled
  • how would you check the calibration of this equipment
  • explain the principle of oxygen measurement used in a fuel cell
  • can you use this equipment for breath to breath analysis of FiO2
  • list some other methods of measuring oxygen
74
Q

CLINICAL SAFETY / HAZARDS:
Peripheral nerve injury
(B1P287)

A
  • Identify the problem with regards to positioning of pt (arm hyperabducted and neck rotated to other side)
  • nerves likely to be damaged in this position
  • precautions to be taken to avoid nerve damage
  • nerves likely to be damaged in position of proning
  • …
75
Q

RADIOLOGY:
Chest X-Ray
(B1P292)

A
  • hiatus hernia
76
Q

HISTORY TAKING:
THR
(B1P295)

A

-

77
Q

COMMUNICATION:
Labour analgesia
(B1P297)

A
  • Introduction
  • Pt concerns
  • details about previous epidural (duration, resiting)
  • details about backache and any neuro problems
  • Procedure: explain
  • Complications
78
Q

TECHNICAL SKILL:
Cricoid pressure
(B1P)

A
  • ensure procedure has been explained
  • correctly locate cricoid cartilage on manikin
  • uses correct method of applying pressure
  • purpose of cricoid pressure
  • why is cricoid cartilage chosen
  • how much pressure should you apply
  • who first described the technique and when
  • what are the complications of this technique
  • name parts labelled
79
Q

ANATOMY:
Caudal block
(B1P305)

A
  • name the structures
  • how is sacral hiatus formed
  • at what level do the spinal cord and dura end
  • describe the technique of performing a caudal block
  • volume used in adults?
  • benefits of caudal block in child
  • complications of caudal block
  • anatomy of caudal epidural space
80
Q

EQUIPMENT:
Anaesthetic equipment: airway equipment
(B1P309)

A
  • name the equipment:
  • *gum elastic bougie (Eschmann tracheal tube introducer)
  • *Magill’s forceps
  • *Intubating stylet
  • what are Magill’s forceps used for
  • what is the bougie used for
  • how would you grade the laryngoscopic view
  • manoeuvres useful in improving the laryngoscopic view
  • what signs would indicate that the bougie is in the trachea rather than in the oesophagus
  • complications of using bougie
  • what should you do if the bougie is in the correct place but the tube is caught at laryngeal inlet
  • name the laryngoscope (McCoy)
81
Q

DATA INTERPRETATION:
Lung Function Tests
(B1P312)

A
  • FEV1, FEV1/FVC/ TLC…
82
Q

DATA INTERPRETATION:
Statistics
(B1P316)

A

-

83
Q

DATA INTERPRETATION:
Arterial blood gas result
(B1P321)

A

-

84
Q

ANATOMY:
Sciatic nerve block
(B1P324)

A
  • name the nerve supplying the following (label)
  • describe the origin of the sciatic nerve and its relation in the gluteal region
  • name the various approaches to blocking the sciatic nerve
  • describe the technique of sciatic nerve block using the classic posterior approach
  • what is the desired motor response after placement of the stimulator needle, while performing a sicatic nerve block?
  • how much LA is required
  • anatomy of femoral nerve
85
Q

COMMUNICATION:
Dental injury
(B1P328)

A

-

86
Q

TECHNICAL SKILL:
Chest drain insertion
(B1P330)

A
  • pt SO2 is 90% on 100% oxygen and most likely have a tension pneumothorax on the R side. Immediate management?
  • how would you perform the procedure? indicate the landmarks (on manikin or actor)
  • how would you locate the 2nd intercostal space
  • on insertion of the cannula there is a sudden escape of air and now the oxygen saturation is 96%
  • what would you do next
  • how would you insert the chest drain? indicate the landmarks
  • complications of chest drain insertion? State 3
87
Q

CLINICAL EXAMINATION:
Arterial and venous pulses, and pressures
(B1P335)

A
  • Introduction
  • Feel radial pulses
  • Elicit rate and rhythm
  • Look for collapsing pulse
  • Feel for brachial and carotid pulse, listen for carotid bruits
  • correctly measure BP (values +/- 10 mmHg of the examiner’s readings)
  • Measures or mentions that he will measure on both sides
  • uses correct method of examining the jugular venous pulse
  • how would you measure the height of the JVP
  • how would you differentiate btw JVP and carotid pulse
88
Q

MEASUREMENT AND MONITORING:
Severinghaus CO2 electrode
(B1P338)

A
  • state how you would measure PaCO2 from a given blood sample
  • Name the parts labelled
  • What is the principle involved measuring PCO2 using this electrode
  • How would you calibrate a CO2 electrode
  • What methods are available for measuring CO2 in a gas mixture?
  • What is the principle of an infrared analyser?
  • At what wavelength does CO2 absorb infrared light?
  • What are the sources of error in an infrared analyser?
89
Q

RESUS & SIMULATION:
Pulseless electrical activity
(B1P341)

A

Surgical pt post-laparoscopy

  • Safe approach
  • Assess
  • Help (+ surgeon)
  • Apply pads and assess rhythm
  • PEA. CPR for 2 min, IV access, tracheal intubation, ventilate with 100% oxygen, adrenaline 1 mg every 3-5 min
  • Reversible causes: 4H and 4T
  • Most likely cause in this patient
  • Next management
90
Q

ANATOMY:
Arterial system of the hand
(B1P344)
(B2P29)

A
  • name the parts labelled
  • which arteries can you cannulate in the forearm
  • what precaution would you take before cannulating the radial artery?
  • what test would you do?
  • what are the relations of the radial artery at the wrist?
  • describe the collateral circulation in the hand?
  • how would you perform Allen’s test (demonstrate on the actor)
  • what are the complications of radial artery cannulation
  • what nerve is most likely to be damaged?
  • what are the indications for wrist block
  • describe landmark technique for blocking the median and ulnar nerves
  • complications of wrist blocks
91
Q

HISTORY TAKING:
Septoplasty
(B1P347)

A
  • Specifically about OSA
92
Q

RESUS & SIMULATION:
Bronchospasm
(B1P350)

A
  • Recognised increased airway pressure
  • check sats, HR and BP
  • hand ventilates and confirm the reduced compliance of the bag
  • auscultate chest and identifies wheezing
  • checks ETT position/suction the ETT
  • increase depth of anaesthesia
  • Administer bronchodilator (nebs salbutamol through catheter mount)
  • ask for IV salbutamol or IV aminophylline
  • inform surgeon and ask for help
  • what dose of aminophylline
  • what to do if despite all above measures pt still wheezy and Sats 92%
93
Q

MEASUREMENT AND MONITORING:
Invasive BP monitoring
(B1P353)

A
  • Check arterial pressure monitoring system and outline faults (infusion bag not pressurised/transducer system loosely attached/wrong catheter tubing (catheter tubing not stiff) / nb of 3 way stopcocks more than required / arterial cannula (22G IV) too narrow for adult pt
  • What info can be obtained from arterial waveform
  • describe how you would perform zero calibration of transducer?
  • how would you calibrate for higher pressure
  • which of these is a normal arterial waveform? what is the problem with the other two
  • what will happen if the reading in a trace which is overdamped?
94
Q

CLINICAL SAFETY / HAZARDS:
Patient positioning
(B1P358)

A
  • Position shown in picture? (knee elbow position)
  • for what surgical procedures is this position used?
  • problems associated with this position?
  • which nerves can be injured and what is the mechanism?
  • problems associated with lateral position
  • problems associated with lithotomy position
  • problems associated with sitting position
95
Q

RADIOLOGY:
Cervical spine X-Ray
(B1P365)

A

-

96
Q

HISTORY TAKING:
Abdominal hysterectomy
(B1P369)

A

-

97
Q

COMMUNICATION:
Abdominal aortic aneurysm
(B1P371)

A

-

98
Q

ANATOMY:
Spine and vertebrae
(B1P375)

A
  • Name the vertebrae in picture (cervical, thoracic and lumbar) and the different structures
  • what are the differences btw thoracic and lumbar vertebrae
  • you are asked to perform epidural at L1-L2. describe procedure
  • how much of the catheter would you insert into the space
  • would you use a test dose? what is a purpose of test dose?
99
Q

TECHNICAL SKILL:
Supraclavicular brachial plexus block
(B1P380)

A
  • describe relations of brachial plexus in the neck
  • indications for supraclavicular brachial plexus block
  • technique of performing the supraclavicular block
  • indicate the landmarks and point of needle entry (on actor)
  • what part of the brachial plexus would you stimulate with this approach
  • what are contra-indications for this block
  • what movements are elicited when you stimulate 1) the lateral cord and 2) the posterior cord
100
Q

ANATOMY:
Trachea
(B2P1)

A

Cross-section C5

  • Label structures
  • what are proximal and distal borders of the trachea
  • what forms the wall of the trachea
  • which type of mucosa lines the trachea
  • what lies immediately posterior to trachea
  • which major vascular structures traverse the trachea anteriorly
  • what is the blood supply to the trachea
  • what is the nerve supply to the trachea
101
Q

ANATOMY:
Brachial plexus
(B2P3)

A
  • Label
  • origins of brachial plexus
  • course of brachial plexus until it reaches clavicle
  • branches of lateral cord
  • branches of medial cord
  • how would you perform a block of the plexus using an axillary approach
  • which nerves may be missed using the axillary approach
  • what complications are associated with supraclavicular nerve blocks
102
Q

ANATOMY:
Circle of Willis
(B2P15)

A
  • Label
  • which arteries supply circle of Willis
  • where do they enter the skull
  • what is normal cerebral blood flow
  • how does the blood flow to white matter and grey matter differ
  • list the factors affecting cerebral blood flow
  • describe the production and circulation of CSF
103
Q

ANATOMY:
Coronary circulation
(B2P17)

A
  • Label branches of aorta
  • where do L and R coronary arteries arise from
  • describe the venous drainage of the heart
  • what is the innervation of the heart
  • what signs and symptoms might arise from reduced blood flow to the R coronary artery
104
Q

ANATOMY:
Diaphragm
(B2P23)

A
  • Label structures
  • at what levels are the 3 diaphragmatic foramina
  • what does each of them transmit
  • what is the function of the diaphragm
  • what is it composed of
  • what are its attachments
  • what is the nerve supply
  • what is a Bochdalek hernia
105
Q

ANATOMY:
Spinal cord
(B2P25)

A
  • Label structures
  • functions of spinothalamic tracts
  • blood supply to spinal cord
  • what is artery of Adamkiewicz
  • what is its venous drainage
  • what is anterior spinal artery syndrome
  • how many pairs of spinal nerves are there
  • what are the anterior primary rami
  • what are the features of spinal shock
106
Q

EQUIPMENT:
Laryngoscopes
(B2P79) + See youtube

A
  • Name the different laryngoscopes
  • features of Macintosh laryngoscope blade
  • how should reusable laryngoscopes be cleaned
  • why are there straight and curved laryngoscopes blades
  • outline the cormack and lehane grades of view at laryngoscopy
  • what is the difference btw a traditional Macintosh laryngoscope and a rigid fibreoptic laryngoscope such as the glidescope or McGrath video laryngoscope
  • there are a large nb of different rigid fibreoptic laryngoscopes available. why have these not replacd flexible fibreoptic laryngoscopes
  • pt presents for emergency laparotomy, and tells you that due to previous radiotherapy he has very limited MO (only 1.5cm) and poor neck movement. outline a reasonable technique for intubation of this patient
107
Q

EQUIPMENT:
Endotracheal tubes
(B2P89)

A
  • Look at picture. What is it?
  • explain the different types of cuffs found on tracheal tubes and the rationale for each type
  • when are uncuffed tubes used
  • what are the hazards of ETT
  • what is an endobronchial blocker? how is it placed?
  • what is the alternative to an endobronchial blocker?
  • Name different ETT on pictures
  • how does jet ventilation work? when is it CI?
  • outline the differences btw a percutaneous and surgical tracheostomy
108
Q

EQUIPMENT:
Breathing circuit: Jackson-Rees modification
(B2P95)

A
  • What is the name of this circuit?
  • what is Mapleson circuit
  • the circuit is attached to an anaesthetic machine at the common gas outlet. Check that circuit is safe to use
  • you discover a tear in the bag. if you had not discovered it, what problems could this generate during anaesthesia
  • what could you do to eliminate this problem
  • name 2 components commonly attached to all circuits that are not on this one
  • what is the volume of the bag? what is the volume of the reservoir tubing
  • what group of pts is this circuit used for? up to what weight?
  • name 2 advantages of using it in this population
  • name 2 disadvantages
  • what modifications could eliminate these disadvantages
  • what is the minimum FGF required for SV to prevent rebreathing
  • how does one perform IPPV with this circuit
  • how can PEEP be applied for SV
  • Which MApleson system is most efficient for SV breathing pts and which for ventilated pt
109
Q

EQUIPMENT:
Airways
(B2P99)

A
  • What are the components of an anaesthetic mask
  • what airway adjuncts are available
  • what are the indications for using an LMA
  • what are the CI
  • what are the 2nd generation supraglottic airway devices
110
Q

EQUIPMENT:
Vaporisers
(B2P103)

A
  • Define the term vapour
  • What is saturated vapour pressure
  • What classes of vaporisers are there
  • What does Tec stand for in the Tec 7 vaporiser
  • How is this achieved
  • Which volatile anaesthetic agents can be used in a sevoflurane analyser
  • why does the desflurane vaporiser require mains electricity to function
  • what is the pumping effect
  • What is the Datex-Ohmeda Aladin Cassette vaporiser?
111
Q

EQUIPMENT:
Scavenging
(B2P107)

A
  • What does a scavenging system do?
  • What are the key components of a scavenging system?
  • Why is the receiving system open to air
  • How does the Cardiff Aldasorber work
  • What are the potential risks of chronic nitrous oxide and volatile anaesthetic agent exposure
  • Name some situations where exposure is more likely
112
Q

EQUIPMENT:
Medical gases
(B2P109)

A
  • what are oxygen cylinder made of
  • what P exists in a half-full size D oxygen cylinder? what volume of oxygen remain?
  • what pressure exists in a 1/2 full size D cylinder of nitrous oxide? What volume of nitrous oxide remains?
  • what is the filling ratio and why is it important?
  • what colour is a heliox 2L cylinder
  • What is the pin-index system?
  • what are the key features of a vacuum insulated evaporator (VIE)
  • what safety features are there to prevent the wrong gas being piped to the anaesthetic machine
113
Q

EQUIPMENT:
Filters
(B2P113)

A
  • What levels of temperature and humidity are normal in - the oropharynx
  • What problems can be caused by dry inspired gases
  • Explain how an HME device works
  • What sort of filters are commonly added to HME devices?
  • What problems can be causes by HME devices?
114
Q

EQUIPMENT:
Ventilators
(B2P115)

A
  • explain how ventilators may be classified in terms of cycling
  • explain the difference btw pressure and volume control
  • draw the pressure-time and flow-time curves produced during PCV
  • explain the differences btw CMV, SIMV and PSV
  • what is PEEP
  • outline the ventilation strategy for a pt with adult respiratory distress syndrome ARDS
115
Q

CLINICAL SAFETY / HAZARDS:
Electricity
(B2P119)

A
  • what are the potentially harmful effects of electric current passing through the body
  • what is the frequency of mains (AC) current
  • what magnitude of mains current is required to produce:
    • pain
    • muscle contraction
    • VF
  • what is microshock
  • how do we prevent shocks in the theatre setting
  • what do these safety symbols represent?
116
Q

CLINICAL SAFETY / HAZARDS:
Lasers
(B2P123)

A
  • what does the acronym LASER mean
  • what are the benefits of using laser in clinical practice
  • what are the potential hazards of laser use in the theatre
  • how are these hazards mitigated
  • name some different types of laser and their surgical uses
  • what does Nd-YAG stand for
  • how would you manage an airway fire in an intubated patient
117
Q

CLINICAL SAFETY / HAZARDS:
Positioning
(B2P127)

A
  • What are the 3 most common nerves injured as a result of pt positioning during surgery
  • What risk factors are associated with perioperative peripheral nerve injury
  • What are the signs and symptoms of ulnar nerve damage
  • What areas may be injured during lithotomy positioning on the operating table
  • what are the hazards of the prone position
  • how can anaesthetists reduce the incidence if peri-operative peripheral nerve injury
  • what is bone-cement implantation syndrome
  • in relation to clinical errors, what are human factors
118
Q

CLINICAL SAFETY / HAZARDS:
Blood transfusion
(B2P131)

A
  • What determines ABO blood grouping
  • what is meant by the terms universal donor and universal recipient
  • in what media can packed red cell be stored
  • what is Prothrombin cpx concentrate
  • what is recombinant factor VII
  • what are the different modes of life threatening transfusion rxns
  • what signs of severe/life-threatening transfusion reaction might a pt under GA display
  • What would be your initial management of a severe transfusion reaction
119
Q

RADIOLOGY:
Angiogram
(B2P145)

A

-

120
Q

HISTORY TAKING:
Obstetric preoperative assessment
(B2P159)

A
  • brief obs history, covering previous pregnancies, modes of delivery.
  • ask about problems during this pregnancy (hyperemesis, back trouble and reflux)
  • enquire about date of last scan and what the scan has showed (breech, placental position)

FRCA Primary OSCE/VIVA (2 decks)

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