Primary FRCA OSCE January 2012

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Primary FRCA OSCE-SOE exam January 2012capnography at the patient end? what are the disadvantages?Communication: Jehovah's witness going to have abdo hysterectomy next week formenhorragia and she has an Hb of 7.2. She refuses to have any blood transfusions.ECG: You are called to see a patient in recovery who is confused post-op.Bradycardia rhythm strip 40bpm. Management.Anatomy 3: cross section of spinal cord: different ascending tracts, tell me about thepain pathway after a pin prick to the finger?Skills: Epidural. How much local to block each segment. how to perform, structuresthat you pass through. complications.OSCE set 21. CXR - large thyroid mass.2. CXR - pulmonary oedema3. Simulation - tension pneumothorax, demonstrate on manikin how to decompress.Describe chest drain insertion. Other differentials.4. Intraosseous needle. Demonstrate on dummy. Exact questions as Coventry course.5. History-taking - elderly man for hemicolectomy. Hx MI, AF (failed cardio versionon warfarin), arthritis. I think main issue was cardiac history.6. O2 measurement - 3 diagrams (Clark electrode, fuel cell, paramagnetic analyser).Asked to indicate which was Clark. Name electrodes & electrolyte. Given list ofequations - which one takes place in Clark. Name other 2 diagrams. What else canClark electrode be used for (not sure what he wanted, he kept saying I had said it inmy previous answer but I had no clue what I'd just said!)7. Spinal cord anatomy - had ascending tracts drawn on right side (unlike mosttextbooks which have them on left) which threw me off initially. Name gracilis &cuneatus. Function. Which tract involved in pain & temperature, point out ondiagram. What is grey matter, what does it contain. Blood supply of spinal cord. Whatis spinal artery syndrome. Specific gravity of CSF. Volume of CSF.8. Equipment - shown epidural kit. Asked if I would be happy to use it. Had a hole init, said no. Gave me an open pack and asked to check it. Asked to demonstrate how Iwould check it (I attached filter to catheter, pretended to flush it etc). Asked if I washappy to use it, said yes but he just snarled. He was not a happy examiner (agreed byall candidates I spoke to!). Filter pore size, function.9. Obstetric resus. Scenario was CT1 had just inserted epidural, now patient isunconscious. Resus officer as your assistant. Wedge. Non-shockable rhythm bothCoventry collection: Many thanks to the candidates from January 2012Course2
Primary FRCA OSCE-SOE exam January 2012times. Asked dose of adrenaline. Asked to demonstrate intubation when I said I wouldintubate (Grade 1 no worries). Differentials (total spinal, AFE, etc). What if continuedresus unsuccessful (C-section within 5 minutes). How to treat total spinal (I saidsupportive treatment etc, but she kept asking for more, not sure what else she wasexpecting). What symptoms/signs of high spinal.10. Cranial nerves. Trigeminal nerve - how many nuclei, where are they situated.What branches. Where does V1, V2, V3 exit and point on skull. What do theyinnervate. What about motor component of V3. How do you test facial nerve. Whatelse does facial nerve innervate (I said taste for ant 2/3 tongue, chorda tympani, but hewanted more). Which nerve innervates posterior 1/3 of tongue (IX).11. History taking. Lady due for some hand surgery. Bad arthritis affecting lung,kidneys. On Methotrexate & Prednisolone. Lots to ask re. various systems affected.12. Electrical safety. Shown diagram of patient on operating table which was earthed.Connected to ECG, which was earthed. Also connected to ?arterial line which wasearthed. Asked re. microshock, and various questions about earth and equipotentialstuff which I had no idea about. Then shown a bunch of pictures of various electricalsymbols. Pick 2 and tell me what they represent. Bad station, most candidates I spoketo had no idea what was going on.13. Capnography. Shown picture of capnograph, what 3 parameters can be derivedfrom this (etCO2, fiCO2, rate). Principle of capnography. What do different phasesrepresent. What if there's upward slope of plateau. Name 3 critical incidents that acapnograph can show.14. Communication skills. Ex-IVDU for appendicectomy. On methadone, concernedre. pain relief and relapse if given morphine. Very short station, gave a lot ofreassurance and found had a lot of time left. I went into history etc. to kill time, wasstopped by examiner who said it was not necessary.15. Shown ECG of fast AF (looked regular but only after drawing those lines onblank piece of paper found that it was not). Name one investigation that will help youdetermine cause. What energy levels and how many shocks will you deliver forDCCV. Contraindications for DCCV. Name drugs to slow rate. How is amiodaronegiven. How else will you manage this patient if he was stable but not responding tochemical cardioversion.16. Questions re. difficult airway. Shown diagram of Grade 3 laryngoscopy - what isit (wanted Grade 3 Cormack-Lehane). What would you do now. Still can't intubate,next step. Now can't ventilate, LMA. Can't ventilate via LMA. Describe differenttechniques of crico (needle vs surgical). Jet ventilator, how do you use it.OSCE set 31) Simulation Station: CT1 just intubated young male with life-threatening acuteasthma, so far given nebulised salbutamol & iv steroids. You as SpR called by CT1for help as pt starts desaturating, tachycardic. DD: tension pneumothorax. Asked toactually do needle thoracocentesis on SimMan, then describe chest drain insertion.Coventry collection: Many thanks to the candidates from January 2012Course3
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