Primary FRCA OSCE January 2012

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Primary FRCA OSCE-SOE exam January 20122) Intraosseous needle insertion - indications, sites, demonstrate on mannikin,complications, etc3) Hx-taking: 70ish yo male for elective hemicolectomy. Hb 7.0. PMH: IHD,previous MI. On further questioning, started telling me about previous angiogram,failed pace-maker insertion, chronic AF, also currently on some 'blue' tablet, onlyconfirmed it warfarin when I suggested to him.4) Diagrams & questions on 02 measurement: paramagnetic, fuel cell, polarographic5) Transverse section of spinal cord: describe ascending & descending tracts, bloodsupply, anterior spinal artery syndrome6) Epidural kit: components, whether would use set given (I said no as there was atear at the plastic covering), then asked to check epidural set (?possibly assemble),function of filter, size of filter material, why saline is preferable for LOR compared toair, state major complications of epidural (started off with PDPH, examiner didn'tlook too happy, he reiterated 'MAJOR complications' of epidural insertion, so talkedabout nerve damage/paraplegia, haematoma, high block/total spinal). Should've beenstraightforward but examiner looked unhappy throughout.7) DAS guidelines of difficult intubation, CICV.8) Simulation Station: 38/40 pregnant lady just had epidural inserted, on injection ofLA, started feeling drowsy & began losing consciousness. Assess & manage. Call forhelp, o2. Pt eventually went into cardiac arrest, asystole & non-shockable algorithm.No help but paramedic who didn't do chest compressions correctly so had to quicklyshow. Intubated mannikin. Then long list of questions on total spinal.9) ECG rhythm strip. Irregular narrow complex tachycardia - fast AF. Asked for otherdifferentials. List signs of instability; if so, what would you do? If pt is stable, howwould you manage? How would you rate control? When would you not use DCcardioversion? (initially confusing, but all he wanted was post-48hrs after onset)Energy of DC cardioversion (biphasic/monophasic). Dose of amiodarone used.10) Communication. 20-yo lady previous IVDU, currently on methadone, in forappendicectomy, very concerned about pain issues & use of morphine post-op.Ascertain her concerns & reassure her.11) Hx-taking. 80-ish yo female for elective hand procedure. Hx of RA, previous TB& right pneumonectomy (only mentioned when asked about previous ops). Couldn'tremember her medications, but will produce prescription list when asked (onprednisolone 60mg!)(also on various others inc methotrexate).12) Anatomy of basal skull.13) Radiology: CXR of lady booked for thyroidectomy. Huge retrosternal goitre seenwith tracheal deviation. Would you anticipate difficult intubation? etcCoventry collection: Many thanks to the candidates from January 2012Course4
Primary FRCA OSCE-SOE exam January 201214) Radiology: CXR of male admitted with SOB. Looked like atypical pneumonia,with bilateral shadowing, with questions whether you would use macrolide to treat pt,whether CCF is a possibility, etc.15) Electrical safety: very confusing station. Given different diagrams of electricalsymbols, supposed to describe each. Also questions on micro shock.OSCE set 41. History taking: Elderly + DM + IHD for cataract2. History taking : Asian lady with dry cough, night sweats and Hb: 7.2 forhysterectomy (thalassemic)3. Communication : Jehovah’s witness for hysterectomy4. Bains circuit: was asked to assemble with filter and EtCO2 tubing. There wasan additional IV set extension tubing kept and was asked why it cant be usedfor capnography. Then was shown three capnography traces a)rebreathing b)Disconnection c) Blocked tube5. Clinical Skills: Insertion of lumbar epidural. Was asked to demonstrate on theactor how to locate correct spaces. Very detailed step by step description ofthe procedure was required.6. Oxygen CD cylinder with transport ventilator. a) Identify the equipment b).What is the volume of CD cylinder c) Uses d) This was followed by 3questions on calculations7. Larynx anatomy: shown a lateral cross section and identify various labelledstructures. Sensory and motor nerve supply. Abductors and adductors of cords.Elevators and depressors of larynx.8. Anatomy of spine question in the college guide, word to word9. Carbon dioxide measurement question from college guide, again word toword.10. Examination of a trauma patient with triage. Then went on to management ofpneumothorax11. Safety: Photo of a patient with hyperabducted arm. Which nerve likely to bedamaged. Nerve roots. If damaged, which part of the hand affected . Anotherphoto with a patient under GA with open eyes. What harm caused to eyes.How will you prevent.12. Photo of grade 3 Cormack Lehan view . How will you improve. Threemethods to identify esophageal intubation.Coventry collection: Many thanks to the candidates from January 2012Course5
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