OSCE Guide for the ABA Applied Examination

261 Pages·2017·19.431 MB·English

by  Sean Neill, William Simpson, Andrew Davies

OSCE Guide for the ABA
Applied Examination
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OSCE Guide for the ABA
Applied Examination
Milo Engoren
Professor
DepartmentofAnesthesiology,UniversityofMichigan,USA
Sean Neill
AssistantProfessor
DepartmentofAnesthesiology,Pharmacology&Therapeutics
UniversityofBritishColumbia,Canada
William Simpson
Consultant,DepartmentofCardiothoracicAnaesthesia,LancashireCardiacCentre,UK
Andrew Davies
ConsultantinCardiothoracicAnaesthesiaandCriticalCare,UniversityHospitalofSouthManchesterNHS
FoundationTrust,UK
Peter Frank
ConsultantinAnaesthesiaandIntensiveCareMedicine,LancashireTeachingHospitalsNHSFoundation
Trust,UK
Simon Maguire
ConsultantinAnaesthesia,UniversityHospitalofSouthManchesterNHSFoundationTrust,UK
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Informationonthistitle:www.cambridge.org/9781107594999
DOI:10.1017/9781316476864
©SeanNeill,WilliamSimpson,AndrewDavies,PeterFrank,SimonMaguireandMiloEngoren2017
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LibraryofCongressCataloging-in-PublicationData
Names:Engoren,Milo,author.|Neill,Sean.|Simpson,William.
Title:OSCEguidefortheABAappliedexamination/MiloEngoren,Professor,Department
ofAnesthesiology,UniversityofMichigan,USA,SeanNeillandWilliamSimpson.
Description:Cambridge,UnitedKingdom;NewYork,NY:CambridgeUniversityPress,2017.|
Includesbibliographicalreferencesandindex.
Identifiers:LCCN2017022456|ISBN9781107594999(paperback)
Subjects:LCSH:Anesthesiology–Examinations,questions,etc.
Classification:LCCRD82.3.E542017|DDC617.9/6–dc23
LCrecordavailableathttps://lccn.loc.gov/2017022456
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Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationthat
isinaccordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesare
drawnfromactualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.
Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthattheinformation
containedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychanging
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Contents
Preface pagevii
Acknowledgements viii
Section 1. Anatomy Section 4. Equipment
1. Trachea 1 1. Electrocautery 63
2. BrachialPlexus 3 2. Defibrillators 65
3. GreatVeinsofthe 3. Laryngoscopes 67
Neck 6 4. EndotrachealTubes 75
4. AntecubitalFossa 8 5. BreathingCircuits 80
5. AnkleBlock 10 6. Airways 83
6. CircleofWillis 12 7. Vaporizers 86
7. CoronaryCirculation 14 8. Scavenging 89
8. BaseofSkull 17 9. MedicalGases 91
9. Diaphragm 19 10. Filters 95
10. SpinalCord 21 11. Ventilators 97
11. Wrist 24
12. Larynx 26
Section 5. Anesthetic Hazards
Section 2. History Taking 1. Electricity 101
2. Lasers 104
Introduction 29 3. Positioning 107
1. TURPSurgery 36 4. BloodTransfusion 110
2. LaparoscopicCholecystectomy 39
3. ThyroidSurgery 41
Section 6. Radiology
4. ShoulderReplacement 44
5. CesareanSection 47
1. ChestX-Ray1 113
6. ENTSurgery 50
2. ChestX-Ray2 115
3. CTHead 117
Section 3. Communication 4. CervicalSpine 119
5. Angiogram 122
Introduction 53
1. SickleCellTest 54
Section 7. Physical Examination
2. RapidSequenceInduction 56
3. SuccinylcholineApnea 57
1. CardiovascularExamination 125
4. CancelledSurgery 59
2. RespiratoryExamination 128
5. DentalDamage 60
3. CranialNerveExamination 131
6. Jehovah’sWitness 61
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ts 4. ObstetricPreoperative 7. AnesthesiaoftheEye 190
n
e Assessment 135 8. RapidSequenceInduction 192
t
n
o 5. PeripheralCirculation 9. TransversusAbdominisPlane
C
Examination 138 Block 195
6. AirwayExamination 141
Section 10. Monitoring and
Section 8. Resuscitation and
Measurement
Simulation
1. Capnography 199
1. Bradyarrhythmia 145 2. CentralVenousPressureTrace 202
2. CollapsedObstetricPatient 147 3. Electrocardiogram1 205
3. MalignantHyperthermia 150 4. Electrocardiogram2 207
4. FailedIntubation 153 5. Humidity 210
5. DisplacedTracheostomy 156 6. InvasiveBloodPressure 214
6. PediatricEmergency 159 7. Respiratory1 217
7. IntraoperativeDesaturation 162 8. Respiratory2 220
8. Tachyarrhythmia 165 9. NoninvasiveBloodPressure 224
9. Anaphylaxis 167 10. OxygenMeasurement1 227
10. ObstetricHemorrhage 169 11. OxygenMeasurement2 229
12. PulmonaryArteryCatheter 231
13. NerveStimulators 234
Section 9. Procedures
14. PulseOximetry 237
15. Rotameters 240
1. LumbarPuncture 173
16. Temperature 243
2. ChestTube 176
3. Epidural 179
4. SurgicalAirway 183
5. CentralVenousCannulation 185
6. IntraosseousAccess 188 Index 248
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Preface
The Objective Structured Clinical Examination (OSCE) is designed to measure if the
examineecandothings.Usingwrittenandoralexaminations,theexamineeshavealready
shown that they know things, have sufficient knowledge to be anesthesiologists, but are
they just “book smart?” When I started in medical school, certifying examinations were
mostlywrittenbutsomehadanoralcomponentwhereexamineesneededtoshowthatthey
couldthinkand actlikea consultant.Criticscomplainedthattheseexaminations didnot
showhowtheexamineewouldperforminarealsituation.Somespecialtiesandprograms,
mostly outside the United States, developed clinical examinations using real patients.
Typically, the examinees would rotate amongst several patients and they would either be
observedor,moreusually,questionedafterwardstomeasurewhathistorytheyhadelicited
and what physical findings they had noticed. These examinations suffered from the vari-
ability in the patients. While real, some patients gave better histories, some had better
(easier)physicalexaminations.(Palpatingsplenomegalyinanobesepatientischallenging.)
Theyalsosufferedfromtheunstructuredquestionstheexaminersusedontheexaminees.
Differentexaminersaskeddifferentquestionswithadifferentdegreeofthoroughness.
When Iwas aresident, I wasanexaminer fora physician assistants’physical examin-
ation test. Students came in, I read with them the clinical scenario, and they performed
afocusedphysicalexamination.Ihadachecklistandforeachitemonthelistthattheydid,
Icheckeditoff.Theycoulddosuperfluousitems.Therewasnocreditforthese,butalsono
penalty.Thetotalnumberofcorrectlyperformeditemstranslatedintoascoreandapassor
fail. I wondered why physician assistants but not physicians needed to show clinical
competence. Over the succeeding years, I have worked with a few physicians who were
very smart, had top scores on all the written examinations. They could cite the 20 most
commoncausesofchestpain,butdidn’tknowwhattodowhenfaced witharealpatient
withchestpain.
In the succeeding decades, the calls for an examination that tests clinical skills have
increased. Fortunately, the science of the OSCE has advanced. Tests are carefully con-
structed for validity. Examiners are trained. Clinical patients are trained. This minimizes
othervariabilityasmuchaspossible,leavingtheexamineeasthemajorsourceofvariation
inperformance.Patientswillgivethesameanswerstothesamequestions–ifaskedbythe
examinee.
During medical school and residency, few students and residents get many (or any)
opportunities to do and practice the OSCE. Much as auscultating a chest or reading an
X-ray,practicebuildsskills.WeofferthisbookasahelpfulguidetoyoutobuildyourOSCE
skills.Itpresentsanumberofclinicalscenariosandshowshowtoapproacheachone.
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.001
Acknowledgements
Many thanks to Dr. Andreas Erdmann for permitting the reproduction of the anatomy
imagestakenfromhisConciseAnatomyforAnaesthesia.Withouthishelpandsupport,the
taskofconstructingtheanatomysectionwouldhavebeenalmostimpossible.Wewouldalso
liketothankDr.JamesHoward,RadiologyRegistrar,NorthWesternDeanery,forhishelp
withtheX-rayfilmsandDr.JamesMitchell,CardiologyRegistrar,NorthWesternDeanery,
for his help with the ECGs. We would also like to extend our sincerest thanks to the
CambridgeUniversityPressandDr.WilliamSimpsonforallowingustoreusetheimages
fromthePrimaryFRCA:OSCEsinAnaesthesiabook.
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Section 1 Anatomy
1 Trachea
’
Candidate s Instructions
Lookatthiscross-sectiontakenatthelevelofC5.Answerthefollowingquestions.
Pretracheal fascia
1
2
5
3
4
Questions
1. Labelthestructures1–5.
2. Whataretheproximalanddistalbordersofthetrachea?
3. Whatformsthewallofthetrachea?
4. Whichtypeofmucosalinesthetrachea?
5. Whatliesimmediatelyposteriortothetrachea?
6. Whichmajorvascularstructurestraversethetracheaanteriorly?
7. Whatisthebloodsupplytothetrachea?
8. Whatisthenervesupplyofthetrachea?
1
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