OSCE Flashcards

Question 1

Q

EQUIPMENT:
Anaesthetic equipment: circle absorber
(B1P1)

Answer

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

Question 2

Q

DATA INTERPRETATION:
ECG
(B1P7)

Answer

A

WPW syndrome

Question 3

Q

DATA INTERPRETATION:
Haemodynamic data
(B1P12)

Answer

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

Question 4

Q

DATA INTERPRETATION:
Statistics
(B1P15)

Question 5

Q

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

Answer

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?

Question 6

Q

COMMUNICATION:
Awake tracheal intubation
(B1P21)

Question 7

Q

TECHNICAL SKILL:
Cricothyrotomy
(B1P26)

Answer

A

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

Question 8

Q

CLINICAL EXAMINATION:
Assessment of Trauma patient
(B1P30)

Answer

A

ABCDE
Know GCS
Treatment for extradural hematoma (and other hematomas)
Indications for CT scan

Question 9

Q

MEASUREMENT AND MONITORING:
Pulmonary artery flotation catheter
(B1P33)

Answer

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

Question 10

Q

RESUS & SIMULATION:
Paediatric resuscitation
(B1P37)

Answer

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?

Question 11

Q

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

Answer

A

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

Question 12

Q

HISTORY TAKING:
Teeth extraction
(B1P46)

Question 13

Q

RESUS & SIMULATION:
Anaphylaxis
(B1P50)

Answer

A

Know management (Primary/Secondary/Investigations)

Question 14

Q

MEASUREMENT AND MONITORING:
Capnography
(B1P54)

Answer

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

Question 15

Q

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

Answer

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?

Question 16

Q

RADIOLOGY:
Chest X-Ray
(B1P63)

Answer

A

Borders of a heart in a CXR

Question 17

Q

HISTORY TAKING:
Arthroscopy of the knee
(B1P67)

Question 18

Q

COMMUNICATION:
Awareness under anaesthesia
(B1P69)

Question 19

Q

ANATOMY:
Intercostal nerve block
(B1P72)

Answer

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

Question 20

Q

CLINICAL EXAMINATION:
Cranial nerves
(B1P75)

Answer

A

Signs of complete paralysis of 3rd cranial nerve

Question 21

Q

EQUIPMENT:
Humphrey ADE breathing system
(B1P81)

Answer

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

Question 22

Q

DATA INTERPRETATION:
Drug overdose (salicylate)
(B1P87)

Question 23

Q

DATA INTERPRETATION:
Neuro-obs chart
(B1P90)

Question 24

Q

ANATOMY:
Stellate ganglion
(B1P94)

Answer

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?

Question 25

Q

COMMUNICATION:
Brain Stem Test
(B1P98)

Question 26

Q

TECHNICAL SKILL:
Lumbar puncture for spinal anaesthesia
(B1P103)

Answer

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

Question 27

Q

CLINICAL EXAMINATION:
Cardiovascular system
(B1P106)

Question 28

Q

MEASUREMENT AND MONITORING:
Wright respirometer
(B1P109)

Answer

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?

Question 29

Q

RESUS & SIMULATION:

Basic Life Support of a pregnant mother

Question 30

Q

ANATOMY:
Vagus nerve
(B1P115)

Answer

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?

Question 31

Q

HISTORY TAKING:
Laparoscopic cholecystectomy
(B1P118)

Question 32

Q

RESUS & SIMULATION:
Failed intubation
(B1P121)

Question 33

Q

MEASUREMENT AND MONITORING:
Peripheral Nerve Stimulator
(B1P124)

Answer

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?

Question 34

Q

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

Answer

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?

Question 35

Q

RADIOLOGY:
Chest X-Ray
(B1P132)

Question 36

Q

HISTORY TAKING:
Varicose veins
(B1P137)

Question 37

Q

COMMUNICATION:
Sux Apnea
(B1P138)

Question 38

Q

ANATOMY:
Cubital fossa
(B1P142)

Answer

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

Question 39

Q

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

Answer

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?

Question 40

Q

EQUIPMENT:
Anaesthetic equipment: anaesthesia machine check
(B1P153)

Answer

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?

Question 41

Q

DATA INTERPRETATION:
Biochemistry
(B1P158)

Question 42

Q

DATA INTERPRETATION:
ECG
(B1P162)

Answer

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

Question 43

Q

DATA INTERPRETATION:
Coagulation studies
(B1P165)

Answer

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

Question 44

Q

ANATOMY:
Neck and Thorax
(B1P167)

Answer

A

name the structures labelled
name 3 structures encountered during surgical tracheostomy
know anatomy relevant to tracheostomy

Question 45

Q

COMMUNICATION:
Postponed surgery
(B1P171)

Question 46

Q

TECHNICAL SKILL:
Tracheostomy tube exchange
(B1P173)

Answer

A

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

Question 47

Q

CLINICAL EXAMINATION:
Respiratory system
(B1P176)

Answer

A

Position
Inspection
Palpation
Percussion
Auscultation

Question 48

Q

MEASUREMENT AND MONITORING:
Temperature measurement
(B1P178)

Answer

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

Question 49

Q

RESUS & SIMULATION:
Atrial Fibrillation
(B1P182)

Answer

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

Question 50

Q

ANATOMY:
Trigeminal nerve
(B1P186)

Answer

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

Question 51

Q

HISTORY TAKING:
Mastectomy
(B1P190)

Answer

A

order of pre-anaesthetic Hx taking

- if pts on meds, ask about side effects

Question 52

Q

RESUS & SIMULATION:
ST depression
(B1P192)

Answer

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

Question 53

Q

MEASUREMENT AND MONITORING:
Pulse oximeter
(B1P199)

Answer

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

Question 54

Q

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

Answer

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

Question 55

Q

RADIOLOGY:
CT scan of the head
(B1P206)

Answer

A

Know different types of hematomas and CT scans observations

Question 56

Q

HISTORY TAKING:
Hernia Repair
(B1P210)

Question 57

Q

EQUIPMENT:
Anaesthetic equipment: entonox valve
(B1P1)

Answer

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?

Question 58

Q

TECHNICAL SKILL:
IO infusion
(B1P216)

Answer

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

Question 59

Q

TECHNICAL SKILL:
Intravenous regional anaesthesia
(B1P219)

Answer

A

Know Indications / CI / Drug to be used / recommended dose / checks required beforehand…

Question 60

Q

EQUIPMENT:
Anaesthetic equipment: Bain breathing system
(B1P223)

Answer

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

Question 61

Q

DATA INTERPRETATION:
Lung Function Tests
(B1P227)

Answer

A

what is a vitalograph

- know vitalograph and different types of pathologies observed

Question 62

Q

DATA INTERPRETATION:
ECG
(B1P234)

Answer

A

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

Question 63

Q

DATA INTERPRETATION:
Vital parameters
(B1P239)

Question 64

Q

ANATOMY:
The orbit and ophthalmic anaesthesia
(B1P1244)

Answer

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

Answer 46

A

Anaesthetic Mx for JW
Pre-op Mx
Intra-op Mx
Post-op Mx

Answer 47

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

Answer 48

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

Answer 49

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

Answer 50

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

Answer 51

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

Answer 52

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

Answer 53

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

Answer 54

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

Answer 55

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
…

Answer 56

A

hiatus hernia

Answer 57

A

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

Answer 58

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

Answer 59

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

Answer 60

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)

Answer 61

A

FEV1, FEV1/FVC/ TLC…

Answer 62

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

Answer 63

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

Answer 64

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

Answer 65

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?

Answer 66

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

Answer 67

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

Answer 68

A

Specifically about OSA

Answer 69

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%

Answer 70

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?

Answer 71

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

Answer 72

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?

Answer 73

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

Answer 74

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

Answer 75

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

Answer 76

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

Answer 77

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

Answer 78

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

Answer 79

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

Answer 80

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

Answer 81

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

Answer 82

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

Answer 83

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

Answer 84

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?

Answer 85

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

Answer 86

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

Answer 87

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?

Answer 88

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

Answer 89

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?

Answer 90

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

Answer 91

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

Answer 92

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

Answer 93

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)