The Objective Structured Clinical Examination in Anaesthesia

400 Pages·2007·3.955 MB·English

by  Cyprian Mendonca, Shyam Balasubramanian

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The Objective Structured Clinical Examination (OSCE) is a highly reliable and je
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valid tool for the evaluation of trainees in anaesthesia. It enables examiners tiv The Objective Structured
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and trainers to assess a number of competencies in an organised way. S
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Performance in the OSCE is considered to be a fair reflection of the level of c
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knowledge and skill attained during anaesthesia training. Apart from having a re Clinical Examination in
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wide and deep knowledge on the subject, trainees are expected to have the C
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capacity to demonstrate their competency in a short period of time allotted for ic
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each station. l E
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The authors of this book have a rich experience in successfully conducting tio
OSCE courses in the United Kingdom. The sample OSCE sets in the book closely n in
simulate the style and content of The Royal College of Anaesthetists' A
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examination format. The book contains 100 OSCE stations with answers based e
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on key practical procedures, clinical skills, communication skills, data e
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interpretation, anaesthetic equipment and the management of critical P
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incidents on a simulator. The answers are presented thoroughly and clearly. c
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The tutorial on the relevant topic and additional key points at the end of each e
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station, together with more than 100 illustrations throughout the book, will a
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complement the reader’s overall understanding. The marking system signifies rs
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the relevance of each question, enabling objective assessment of knowledge r te
and practical skills. a
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This book will also help candidates all over the world to pass highly competitive a
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postgraduate examinations in anaesthesia. It is an invaluable educational tra
resource for all anaesthetists. in
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ISBN 978-1-903378-56-4
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Cyprian Mendonca & Shyam Balasubramanian
9 781903 378564
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The Objective Structured
Clinical Examination in
A N A E S T H E S I A
Practice papers for teachers and trainees
Cyprian Mendonca MD FRCA
Shyam Balasubramanian MD FRCA
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The Objective Structured Clinical Examination in Anaesthesia Practice papers for teachers and trainees
tfm Publishing Limited, Castle Hill Barns, Harley, Nr Shrewsbury, SY5
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E-book editions: 2013
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Contents
page
Preface vii
Foreword viii
Acknowledgements ix
Abbreviations x
OSCE set 1
Anaesthetic equipment: circle absorber 1
Station 1.1
Data interpretation: ECG - myocardial infarction 7
Station 1.2
and WPW syndrome
Data interpretation: haemodynamic data 12
Station 1.3
Data interpretation: statistics 15
Station 1.4
Anatomy: internal jugular vein 17
Station 1.5
Communication: awake tracheal intubation 21
Station 1.6
Technical skill: cricothyrotomy 26
Station 1.7
Clinical examination: assessment of a trauma patient 30
Station 1.8
Measuring equipment: pulmonary artery flotation catheter 33
Station 1.9
Resuscitation: paediatric resuscitation 37
Station 1.10
Anatomy: base of the skull 40
Station 1.11
History taking: teeth extraction 46
Station 1.12
Simulation: anaphylaxis 50
Station 1.13
Monitoring equipment: capnography 54
Station 1.14
Clinical safety: diathermy and electrical safety 59
Station 1.15
Radiology: chest X-ray - pneumothorax 63
Station 1.16
History taking: arthroscopy of the knee 67
Station 1.17
Communication: awareness under anaesthesia 69
Station 1.18
Anatomy: intercostal nerve block 72
Station 1.19
Clinical examination: cranial nerves 75
Station 1.20
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The Objective Structured Clinical Examination in Anaesthesia Practice papers for teachers and trainees
OSCE set 2
Anaesthetic equipment: Humphrey ADE breathing system 81
Station 2.1
Data interpretation: ECG - complete heart block 84
Station 2.2
Data interpretation: drug overdose 87
Station 2.3
Data interpretation: neuro-observation chart 90
Station 2.4
Anatomy: stellate ganglion 94
Station 2.5
Communication: brain stem test 98
Station 2.6
Technical skill: lumbar puncture for spinal anaesthesia 102
Station 2.7
Clinical examination: cardiovascular system 106
Station 2.8
Measuring equipment: Wright respirometer 109
Station 2.9
Resuscitation: basic life support of a pregnant mother 112
Station 2.10
Anatomy: vagus nerve 115
Station 2.11
History taking: laparoscopic cholecystectomy 118
Station 2.12
Simulation: failed intubation 121
Station 2.13
Monitoring equipment: peripheral nerve stimulator 124
Station 2.14
Clinical safety: defibrillator 129
Station 2.15
Radiology: chest X-ray - basal atelectasis 132
Station 2.16
History taking: varicose veins 136
Station 2.17
Communication: suxamethonium apnoea 138
Station 2.18
Anatomy: cubital fossa 142
Station 2.19
Technical skill: ankle block 148
Station 2.20
OSCE set 3
Anaesthetic equipment: anaesthesia machine check 153
Station 3.1
Data interpretation: biochemistry 158
Station 3.2
Data interpretation: ECG - pacing rhythm 162
Station 3.3
Data interpretation: coagulation studies 165
Station 3.4
Anatomy: neck and thorax 167
Station 3.5
Communication: postponed surgery 171
Station 3.6
Technical skill: tracheostomy tube exchange 173
Station 3.7
Clinical examination: respiratory system 176
Station 3.8
Measuring equipment: temperature measurement 178
Station 3.9
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Contents
Resuscitation: atrial fibrillation 182
Station 3.10
Anatomy: trigeminal nerve 186
Station 3.11
History taking: mastectomy 190
Station 3.12
Simulation: ST depression 192
Station 3.13
Monitoring equipment: pulse oximeter 199
Station 3.14
Clinical safety: administration of blood to a patient 203
Station 3.15
Radiology: CT scan of the head 206
Station 3.16
History taking: hernia repair 210
Station 3.17
Anaesthetic equipment: entonox valve 212
Station 3.18
Technical skill: intra-osseous infusion 216
Station 3.19
Technical skill: intravenous regional anaesthesia 219
Station 3.20
OSCE set 4
Anaesthetic equipment: Bain breathing system 223
Station 4.1
Data interpretation: lung function tests 227
Station 4.2
Data interpretation: ECG - first degree heart block 233
Station 4.3
Data interpretation: vital parameters 239
Station 4.4
Anatomy: the orbit and ophthalmic anaesthesia 244
Station 4.5
Communication: Jehovah’s Witness 252
Station 4.6
Technical skill: laryngeal mask airway (LMA) insertion 255
Station 4.7
Clinical examination: airway examination 258
Station 4.8
Measuring equipment: Bourdon gauge 261
Station 4.9
Resuscitation: broad complex tachycardia 264
Station 4.10
Anatomy: larynx 267
Station 4.11
History taking: tympanoplasty 274
Station 4.12
Simulation: post-induction hypotension 278
Station 4.13
Monitoring equipment: oxygen analyser 281
Station 4.14
Clinical safety: peripheral nerve injury 287
Station 4.15
Radiology: chest X-ray - hiatus hernia 292
Station 4.16
History taking: total hip replacement 295
Station 4.17
Communication: labour analgesia 297
Station 4.18
Clinical skill: cricoid pressure 300
Station 4.19
Anatomy: caudal block 304
Station 4.20
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The Objective Structured Clinical Examination in Anaesthesia Practice papers for teachers and trainees
OSCE set 5
Anaesthetic equipment: airway equipment 309
Station 5.1
Data interpretation: lung function tests 312
Station 5.2
Data interpretation: statistics 316
Station 5.3
Data interpretation: arterial blood gas result 321
Station 5.4
Anatomy: sciatic nerve block 324
Station 5.5
Communication: dental injury 328
Station 5.6
Technical skill: chest drain insertion 330
Station 5.7
Clinical examination: arterial and venous pulses, and pressures 335
Station 5.8
Measuring equipment: Severinghaus carbon dioxide electrode 338
Station 5.9
Resuscitation: pulseless electrical activity 341
Station 5.10
Anatomy: arterial system of the hand 344
Station 5.11
History taking: septoplasty 347
Station 5.12
Simulation: bronchospasm 350
Station 5.13
Monitoring equipment: invasive blood pressure monitoring 353
Station 5.14
Clinical safety: patient positioning 358
Station 5.15
Radiology: cervical spine X-ray 365
Station 5.16
History taking: abdominal hysterectomy 369
Station 5.17
Communication: abdominal aortic aneurysm repair 371
Station 5.18
Anatomy: spine and vertebrae 374
Station 5.19
Technical skill: supraclavicular brachial plexus block 380
Station 5.20
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Preface
The aim of this book is to help trainees sitting the primary fellowship
examination of The Royal College of Anaesthetists. This book consists of
five complete sets of OSCE papers that closely simulate the OSCE format
of the primary FRCA. To help both teachers and trainees in an objective
assessment of their knowledge and skills, marks have been allocated to
each OSCE. The tutorial following each OSCE station will provide a depth
and breadth of knowledge for candidates and will assist trainers in setting
up additional OSCEs on the related subject. Alongside the authors’
previously published book The Structured Oral Examination in Anaesthesia
- Practice Papers for Teachers and Trainees (ISBN 9780521680509), this
book supplements the essential study material for the oral part of the
primary FRCA examination.
The objective structured clinical examination is a valid tool for evaluating
postgraduate clinical performance. We sincerely hope that the information
in this book will be beneficial to trainees in their preparation for the FRCA
examination and also for other equivalent postgraduate examinations and
competency assessments. We wish you good luck with your revision and
the exam.
Dr. Cyprian Mendonca MD FRCA
Consultant Anaesthetist
University Hospitals Coventry and Warwickshire
Coventry
UK
Dr. Shyam Balasubramanian MD FRCA
Consultant Anaesthetist
University Hospitals Coventry and Warwickshire
Coventry
UK
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Foreword
Anaesthesia is not a career for the faint hearted. Progression through
training requires passing the primary FRCA, accepted as being one of the
most difficult postgraduate medical examinations. There are several
hurdles: firstly, the MCQs, covering the three areas of physiology,
pharmacology, and physics and clinical measurement; once successful,
the lucky doctor has the challenge of tackling the structured oral
examinations on the same day as the OSCEs.
Until recently, The Royal College of Anaesthetists was based in a
beautiful, but relatively small building, in Russell Square. The burgeoning
numbers of candidates could not be contained there for both parts of the
exam. This resulted in added anxiety for the candidates, having to navigate
around Bloomsbury to the various venues which accommodated the
‘vivas’, as they were known. Fortunately, the magnificent building now
housing the College, in Red Lion Square, is able to host the whole exam.
The OSCEs instil terror in the minds of candidates. The sheer number
of stations and brevity of each one demands a profound level of knowledge
coupled with continual practice. This book is an invaluable aide to trainees
sitting the exam. The stations are authentic, and the explanatory notes are
so detailed that they are a valuable supplement to the standard textbooks.
College tutors and other trainers will also find it helpful, not only as a source
of revision, but also to assist them in setting up new practice stations.
The book is a perfect partner to the earlier published book, The
Structured Oral Examination in Anaesthesia - Practice Papers for Teachers
and Trainees; you will not be disappointed.
Jo James FRCA
Consultant Anaesthetist
Heart of England Foundation Trust &
Programme Director, Warwickshire School of Anaesthesia
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Acknowledgements
We are grateful for the feedback and suggestions provided by trainees
who attended the primary FRCA preparation courses at Coventry. Much
of the material within has been used on the courses.
We are indebted to Dr. Jo James FRCA, Consultant Anaesthetist, Heart
of England Foundation Trust and Programme Director, Warwickshire
School of Anaesthesia, who critically reviewed the entire manuscript and
made suggestions for the improvement of this book.
Our thanks are extended to Dr. Raja Lakshmanan FRCA, Specialist
Registrar, Warwickshire School of Anaesthesia and Mr. Jason McAllister,
Graphic Designer, University Hospitals Coventry and Warwickshire for
their help with the illustrations, and also to Nikki Bramhill, Director, tfm
publishing, for critically reviewing the manuscript.
We thank Dr. Jenny Layton-Henry, General Practitioner, Coventry, for
her help with the case scenarios. We gratefully acknowledge the support
and help received from our colleagues.