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Flashcards in OSCE Deck (120)
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1

EQUIPMENT:
Anaesthetic equipment: circle absorber
(B1P1)

- 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

2

DATA INTERPRETATION:
ECG
(B1P7)

- WPW syndrome

3

DATA INTERPRETATION:
Haemodynamic data
(B1P12)

- 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

4

DATA INTERPRETATION:
Statistics
(B1P15)

.

5

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

- 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?

6

COMMUNICATION:
Awake tracheal intubation
(B1P21)

.

7

TECHNICAL SKILL:
Cricothyrotomy
(B1P26)

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

8

CLINICAL EXAMINATION:
Assessment of Trauma patient
(B1P30)

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

9

MEASUREMENT AND MONITORING:
Pulmonary artery flotation catheter
(B1P33)

- 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

10

RESUS & SIMULATION:
Paediatric resuscitation
(B1P37)

- 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?

11

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

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

12

HISTORY TAKING:
Teeth extraction
(B1P46)

.

13

RESUS & SIMULATION:
Anaphylaxis
(B1P50)

- Know management (Primary/Secondary/Investigations)

14

MEASUREMENT AND MONITORING:
Capnography
(B1P54)

- 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

15

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

- 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?

16

RADIOLOGY:
Chest X-Ray
(B1P63)

- Borders of a heart in a CXR

17

HISTORY TAKING:
Arthroscopy of the knee
(B1P67)

.

18

COMMUNICATION:
Awareness under anaesthesia
(B1P69)

.

19

ANATOMY:
Intercostal nerve block
(B1P72)

- 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

20

CLINICAL EXAMINATION:
Cranial nerves
(B1P75)

- Signs of complete paralysis of 3rd cranial nerve

21

EQUIPMENT:
Humphrey ADE breathing system
(B1P81)

- 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

22

DATA INTERPRETATION:
Drug overdose (salicylate)
(B1P87)

-

23

DATA INTERPRETATION:
Neuro-obs chart
(B1P90)

-

24

ANATOMY:
Stellate ganglion
(B1P94)

- 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?

25

COMMUNICATION:
Brain Stem Test
(B1P98)

-

26

TECHNICAL SKILL:
Lumbar puncture for spinal anaesthesia
(B1P103)

- 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

27

CLINICAL EXAMINATION:
Cardiovascular system
(B1P106)

-

28

MEASUREMENT AND MONITORING:
Wright respirometer
(B1P109)

- 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?

29

RESUS & SIMULATION:
Basic Life Support of a pregnant mother

-

30

ANATOMY:
Vagus nerve
(B1P115)

- 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?

31

HISTORY TAKING:
Laparoscopic cholecystectomy
(B1P118)

-

32

RESUS & SIMULATION:
Failed intubation
(B1P121)

-

33

MEASUREMENT AND MONITORING:
Peripheral Nerve Stimulator
(B1P124)

- 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?

34

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

- 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?

35

RADIOLOGY:
Chest X-Ray
(B1P132)

-

36

HISTORY TAKING:
Varicose veins
(B1P137)

-

37

COMMUNICATION:
Sux Apnea
(B1P138)

-

38

ANATOMY:
Cubital fossa
(B1P142)

- 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

39

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

- 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?

40

EQUIPMENT:
Anaesthetic equipment: anaesthesia machine check
(B1P153)

- 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?

41

DATA INTERPRETATION:
Biochemistry
(B1P158)

-

42

DATA INTERPRETATION:
ECG
(B1P162)

- 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

43

DATA INTERPRETATION:
Coagulation studies
(B1P165)

- 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

44

ANATOMY:
Neck and Thorax
(B1P167)

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

45

COMMUNICATION:
Postponed surgery
(B1P171)

-

46

TECHNICAL SKILL:
Tracheostomy tube exchange
(B1P173)

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

47

CLINICAL EXAMINATION:
Respiratory system
(B1P176)

- Position
- Inspection
- Palpation
- Percussion
- Auscultation

48

MEASUREMENT AND MONITORING:
Temperature measurement
(B1P178)

- 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

49

RESUS & SIMULATION:
Atrial Fibrillation
(B1P182)

- 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

ANATOMY:
Trigeminal nerve
(B1P186)

- 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

HISTORY TAKING:
Mastectomy
(B1P190)

- order of pre-anaesthetic Hx taking
- if pts on meds, ask about side effects

52

RESUS & SIMULATION:
ST depression
(B1P192)

- 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

MEASUREMENT AND MONITORING:
Pulse oximeter
(B1P199)

- 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

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

- 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

RADIOLOGY:
CT scan of the head
(B1P206)

- Know different types of hematomas and CT scans observations

56

HISTORY TAKING:
Hernia Repair
(B1P210)

-

57

EQUIPMENT:
Anaesthetic equipment: entonox valve
(B1P1)

- 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

TECHNICAL SKILL:
IO infusion
(B1P216)

- 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

TECHNICAL SKILL:
Intravenous regional anaesthesia
(B1P219)

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

60

EQUIPMENT:
Anaesthetic equipment: Bain breathing system
(B1P223)

- 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

DATA INTERPRETATION:
Lung Function Tests
(B1P227)

- what is a vitalograph
- know vitalograph and different types of pathologies observed

62

DATA INTERPRETATION:
ECG
(B1P234)

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

63

DATA INTERPRETATION:
Vital parameters
(B1P239)

-

64

ANATOMY:
The orbit and ophthalmic anaesthesia
(B1P1244)

- 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

COMMUNICATION:
Jehova's Witness
(B1P253)

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

66

TECHNICAL SKILL:
LMA insertion
(B1P255)

- 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

CLINICAL EXAMINATION:
Airway examination
(B1P258)

- 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

MEASUREMENT AND MONITORING:
Bourdon gauge
(B1P261)

- 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

RESUS & SIMULATION:
Broad complex tachycardia
(B1P264)

- 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

ANATOMY:
Larynx
(B1P267)
(B2P31)

- 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

HISTORY TAKING:
Tympanoplasty
(B1P274)

- 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

RESUS & SIMULATION:
Post-induction hypotension
(B1P278)

- 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

MEASUREMENT AND MONITORING:
Oxygen analyser
(B1P281)

- 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

CLINICAL SAFETY / HAZARDS:
Peripheral nerve injury
(B1P287)

- 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

RADIOLOGY:
Chest X-Ray
(B1P292)

- hiatus hernia

76

HISTORY TAKING:
THR
(B1P295)

-

77

COMMUNICATION:
Labour analgesia
(B1P297)

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

78

TECHNICAL SKILL:
Cricoid pressure
(B1P)

- 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

ANATOMY:
Caudal block
(B1P305)

- 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

EQUIPMENT:
Anaesthetic equipment: airway equipment
(B1P309)

- 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

DATA INTERPRETATION:
Lung Function Tests
(B1P312)

- FEV1, FEV1/FVC/ TLC...

82

DATA INTERPRETATION:
Statistics
(B1P316)

-

83

DATA INTERPRETATION:
Arterial blood gas result
(B1P321)

-

84

ANATOMY:
Sciatic nerve block
(B1P324)

- 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

COMMUNICATION:
Dental injury
(B1P328)

-

86

TECHNICAL SKILL:
Chest drain insertion
(B1P330)

- 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

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

- 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

MEASUREMENT AND MONITORING:
Severinghaus CO2 electrode
(B1P338)

- 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

RESUS & SIMULATION:
Pulseless electrical activity
(B1P341)

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

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

- 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

HISTORY TAKING:
Septoplasty
(B1P347)

- Specifically about OSA

92

RESUS & SIMULATION:
Bronchospasm
(B1P350)

- 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

MEASUREMENT AND MONITORING:
Invasive BP monitoring
(B1P353)

- 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

CLINICAL SAFETY / HAZARDS:
Patient positioning
(B1P358)

- 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

RADIOLOGY:
Cervical spine X-Ray
(B1P365)

-

96

HISTORY TAKING:
Abdominal hysterectomy
(B1P369)

-

97

COMMUNICATION:
Abdominal aortic aneurysm
(B1P371)

-

98

ANATOMY:
Spine and vertebrae
(B1P375)

- 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

TECHNICAL SKILL:
Supraclavicular brachial plexus block
(B1P380)

- 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

ANATOMY:
Trachea
(B2P1)

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

ANATOMY:
Brachial plexus
(B2P3)

- 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

ANATOMY:
Circle of Willis
(B2P15)

- 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

ANATOMY:
Coronary circulation
(B2P17)

- 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

ANATOMY:
Diaphragm
(B2P23)

- 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

ANATOMY:
Spinal cord
(B2P25)

- 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

EQUIPMENT:
Laryngoscopes
(B2P79) + See youtube

- 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

EQUIPMENT:
Endotracheal tubes
(B2P89)

- 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

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

- 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

EQUIPMENT:
Airways
(B2P99)

- 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

EQUIPMENT:
Vaporisers
(B2P103)

- 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

EQUIPMENT:
Scavenging
(B2P107)

- 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

EQUIPMENT:
Medical gases
(B2P109)

- 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

EQUIPMENT:
Filters
(B2P113)

- 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

EQUIPMENT:
Ventilators
(B2P115)

- 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

CLINICAL SAFETY / HAZARDS:
Electricity
(B2P119)

- 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

CLINICAL SAFETY / HAZARDS:
Lasers
(B2P123)

- 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

CLINICAL SAFETY / HAZARDS:
Positioning
(B2P127)

- 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

CLINICAL SAFETY / HAZARDS:
Blood transfusion
(B2P131)

- 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

RADIOLOGY:
Angiogram
(B2P145)

-

120

HISTORY TAKING:
Obstetric preoperative assessment
(B2P159)

- 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)