Primary FRCA OSCE SOE -October 2011 · PDF filePrimary FRCA OSCE-SOE exam October 2011...

Primary FRCA OSCE-SOE exam October 2011

Coventry collection: Many thanks to the candidates from September 2011 Course

1

OSCE set1

1. CXR of coarction of aorta

2. X-ray neck: ankylosing spondylitis

3. Simuation: Light plane of Anaesthesia

4. Caudal block with sacral bone for landmarks

5. Methods of measuring humidity and applications

6. Cross section of C6 level

7. Anaesthetic instrument: iv giving sets with 2 drip chambers and a white ball in the

2nd

chamber

8. Anatomy of trigeminal nerve

9. Simulation: VT with demonstration of DC cardioversion

10. Anaesthetic instrument: precordial stethoscope

11. Simulation: cardiac arrest in the ward

11. History taking station: lady for lap surgery with family history of malignant

hyperthermia

12. History taking station: 36 weeks pregnant lady for epidural analgesia with

pervious failed intubation

13. Communication: talk with relative for her father admitted for AAA rupture and

repair

OSCE set 2

1. Examination - Respiratory system

2. Examination - take a manual BP and discussion regarding korotkoff sounds

3. Radiology - RUL collapse in recovery & management questions

4. Radiology - labelling facial bones

5. Anatomy - vagus nerve (which are the nuclei, point out exit on skull)

6. Anatomy - epidural space questions plus cross section of spine and asked to

name segments

7. Monitoring - oesophegeal temperature probe - questions on thermistors

8. Monitoring - hot water bath, questions about how they work, advantages and

disadvantages

9. Equipment - ECG trace and questions on standardisation of frequency and

amplitude

10. History - lady for tympanoplasty with suxamethonium apnea

11. History - Hernia repair with crecendo angina

12. Communication - discuss epidural vs spinal anaesthesia

13. Resuscitation - picture of VF management

14. Sim man - head injury and cushings reflex

15. Sim man - VF and defibrillation

16. Positioning - picture of brachial plexus and positions on operating table with

quesitons relating to nerve damage



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OSCE set 3

1. Anatomy - path and function of vagus nerve

2. Anatomy - spinal cord, tracts and functions

3. Radiology - Facial fracture in CT reconstruction image

4. Radiology - CXR post bowel surgery (RUL pneumonia), questions related to

bowel disease (does zinc deficiency occur? Are people who are allergic to

sulphonamides also likely to be allergic to sulphasalazines?

5. Equipment - LMA demonstrate insertion and questions on use

6. Equipment - Humidifiers (different types)

7. Equipment - ECG monitoring

8. History - Inguinal hernia and angina

9. History - Rhinoplasty in patient with history of sux apnoea

10. Communication - Epidural vs PCA

11. Examination - Respiratory examination

12. Examination - BP measurement

13. Resuscitation - Bradycardia and then pulsed VT

14. Resuscitation - Bradycardia and dilated pupils in head injury patient

15. Resuscitation - Confirm arrest and reasons for arrest (basic ALS)

OSCE set 4 1. Critical incident:light anaesthesia

2. Sacral anatomy and caudal

3. Equipment venflon and iv infusion

4. Cross sectional anatomy c6

5. History taking from preg female for labour analgesia

6. Explain emergency AAA to relative of a patient


8. Stethoscope for detecting millwheel murmurs

9. Hypovolaemic arrest

10. Pulsed vt after induction

11. X-rays coarctation and c spine in ankylosing spondolysis patient.

OSCE set 5 1. Critical incident light anaesthesia

2. Sacral anatomy and caudal

3. Equipment venflon and iv infusion

4. Cross sectional anatomy C6 spine

5. History taking from pregnant female for labour analgesia

6. Explain AAA to relative


8. Stethoscope for detecting millwheel murmurs

9. Hypovolaemic arrest

10. Pulsed vt after induction

11. X-rays coarctation and c spine in ank spond



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OSCE set 6

1. Axillary block: how to perform, positioning etc demonstrate on an actor. and

then some questions about brachial plexus and innervation

(dermatomes/myotomes)

2. Resus: 16 yr old drowned in an lake (ice cold) asked about how many times

you could shock, also asked why defibrillation wouldn't work

3. Needle stick injury: immediate management, transmission rates, also asked

who my employers would need to inform if I got infected..

4. Airways assessment in pt with poor neck movement and parasthesia. then

showed a c-spine xray and asked about gaps etc.

5. Hx: Lap chole, reflux, ?FH (cousin with ?MH)

6. Counseling: cancelling an elective op due to addition of an emergency case to

the list.

7. Anatomy of the larynx: wasn't easy prob worst station. asked about

innervation to label a diagram and about blood supply, despite giving what I'm

sure was the right answer examiner seemed unhappy..not sure

8. Resus: Rx of VT, stable and unstable

9. CXR - Goiter asked whether it is beneficial to have cannula in the foot for

such a patient....

10. 3D reconstruction of lumbar spine

11. Simulator: Malignant Hyperthermia

12. Equipment: asked about nerve stimulator and placement where would you put

it on a foot.

13. HX: knee arthroscopy- actor looked afrocarribean, had his spleen out due to

trauma but wasn't on any prophylactic abx...no other significant hx thatI could

elicit..was a bit confused...

14. Anatomy of the ANS- another name for the stellate ganglion

15. Entonox: demand valve, safety features, asked what kind of analgesia entonox



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was (thought about it afterwards is it Patient Controlled Analgesia?

16. Equipment: cylinders and safety features

OSCE set 7

Technical Skills

• Axillary nerve block

• Boundaries

• Volume to block

• Other methods

Anatomy

• Larynx

• Photo and cross section diagram

Communication skills

• Breaking news to elective patient they have been cancelled for the day

Anaesthetic Hazards

• Needle stick injuries

Physical Exam

• Airway assessment

• Xray also of neck

•

Monitoring Equipment

• Vapourisers

History

• 54 year old for lap chole

• Hx of cousin going to ITU - ?sux apnoea

Resuscitations Skills

• Post op patient with VT and pulse

• Rx of VT and other Mx

• Pt not responding

X-ray – Thyroid

• tracheal deviation due to thymus

• difficulty with induction

X-ray – 3D CT of lumbar spine

• are they all visible

• is the cord compressed

• is there danger of paralysis if log rolled



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•

Simulation

• Malignant hyperthermia

Technical Skills

• Peripheral nerve stimulator

• Where place for ulnar nerve

• Where for ankle

• TOF/DB

Measuring Equipment

• Entonox cylinder

• Type anaesthesia get – dissociative

• What in casing at the top

• Valve types

History

• 22 year old for knee arthroscopy

• Hx not Ex

Anatomy

• ANS

• SNS roots

• PNS roots

Anaesthetic Equipment

• Bodok seal and function

• How pipe line pressure gets to CGO

OSCE set 8

1. Assessment of head injury. GCS and C-spine stabilisation.

2. Arterial line assembly. Find faults, asked questions on damping, etc.

3. History taking for varicose veins- Asthmatic with anaphylaxis from

propanolol

4. ECG strip- Asystole

5. C-spine X-ray(C1-2 fracture)

6. Pulmonary venogram. Rt artery embolus

7. Resus- tension pneumothorax

8. Tracheostomy replacement

9. DINAMAP

10. Anatomy of heart - Asking very extensively on anatomy of heart.

11. Anaesthesia machine check

12. Sub- arachnoid block- How to position, communication, anatomy,

complications.



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13. Resus of a pregnant mother collapsed after intra-thecal injection of LA.

14. Explain Malignant Hyperthermia to a trainee ODP

15. Chest drain. Single bottle.CE set 9

OSCE set 9

1. C spine x ray, fracture C2

2. Arteriogram - pulmonary art - CXR, patient signs PE

3. Simman- tension pneumothorax

4. BP – DINAMAP looks like diathermy, questions on measurements, pressure,

pulsation graph

5. History station - man OSA, nasal surg

6. Check anaesthetic machine, ? Leak, not attatched to circuit no gas monitors

7. Cardiac anatomy - where do coronary arteries arise, where is SA & AV node,

what does LAD supply

8. Spinal anaesthesia - method, needle, positioning on actor

9. Arterial line - patient implications of problems, how do you high & low

pressure standardise it

10. Chest drain - problems

11. History - asthmatic, prev anaphylaxis beta blocker (propanolol)

12. Ankle block - the course of the saphenous nerve, only asked about deep

peroneal & post tibial

13. Resuscitate- pregnant, intrathecal injection of epidural or iv injection of la,

asystole, bradycardia no pulse

14. Minimal level spinal would have to reach to knock out sympathetics ? T1?

15. Malignant hyperpyrexia - explain to theatre staff what this is ?

16. Head injury patient forTracheostomy change

OSCE set 10

1. CXR: showing right upper lobe collapse and series of questions

This is an x-ray taken of patient in recovery of a patient with low oxygen

saturations

-Problem likely to be caused by foreign body T/F

-Patient needs a rigid bronchoscopy immediately T/F

-This patient’s saturations would have been low intraop T/F

-The mainstay of treatment is antibiotics T/F

2. Simulation station: Called to ITU, as patients 2 day old trachy has fallen out,

saturations falling. 100% oxygen and call for help. Asked nurse to cover stoma

and attempted to bag mask ventilate. Unable to. So adjusted position and used

OP airway. Unable to. Placed LMA and could ventilate patient. On attempting

to intubate when sats increased grade 3 view. Went through algorithm –

optimise, mccoy, bougie etc.

3. Technical skills: Asked to demonstrate technique of US guided internal

jugular vein cannulation. Why is patient head down? Where should the tip be

seen on x-ray? Also asked to name 4 immediate complications.



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4. Measurement: pH electrode – asked to name various parts labelled on pH

electrode. Same picture that appeared on eLH learning module, althought the

examiner didn’t seem to know his way around the picture. Got confused as to

which was the reference and which was the measuring electrode!

5. History: Gentleman for hernia repair. Has had permanent pacemaker fitted in

the past for “blackouts” Hyoertension and bronchitis.

6. Anatomy: Asked to name various parts of vertebral anatomy. Joints, foramina

etc. Upper and lower borders of epidural space, what is the dura continuous

with superiorly/inferiorly? What is it anchored to laterally? Where does the

spinal cord end in children and adults? Asked to identify atlas and axis and

point out odontoid peg.

7. Anaesthetic equipment: Asked to test Mapleson F cicuit. Was a tear in bag,

had to state that I wasn’t happy to use this piece of equipment. Then asked

series of questions on circuit, dimensions, FGF etc.

8. Resuscitation: Fine ventricular fibrillation, was asked questions on the

shockable side of the ALS algo

• Dose of adrenaline, ideally when will u give (after 3rd

shock)

• Which other drug would you consider along with adrenaline

• Dose of amiodarone and when would you give (after 3rd

shock)

• Name other drug in case if you do not have amiodarone (lignocaiune 1mg/kg)

• List the eight reversible causes. (4 Hs and 4Ts)

• What energy levels do you use and do you escalate these?

1. Communication: Asked to see mother and explain that her young son has

suxamethonium apnoea following an appendicectomy.

2. Hazards: Asked to identify various electrical symbols from a table. Then asked

to pick 2 of my choice and name them as well.

3. Physical signs: Asked to demonstrate how I would examine each of the nerves

of the hand on an actor. Also asked how each nerve might get injured during

anaesthesia.

4. Monitoring: Y connecter from PCA. Asked to name piece of equipment. It had

fluids and PCA connected to it. Asked to point out non-return valve. Why is

this here? What about this valve (Valve on arm from PCA) what type of valve

is this???

5. History: Seemingly fit and well gentleman (I forget what he was having done)

must not have been fit and well as I only got 11/20 for this station!

6. Resuscitation : Asked to demonstrate safe defibrilation of a patient with pulsed

ventricular tachycardia. Followed by various questions on tachycardia

algorithm.

7. Radiology: Lateral CXR of a patient with large hiatus hernia. Various

questions on anaesthetic management. Do they need an RSI etc.

OSCE set 12

1. RESUSCITATION STATION- asked what you will do If you do if the nurse

called you to the ward for a pt who had a witnessed collapse on the ward. Tell



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ALS algorithm . shows ECG- asystole how you will manage. When will

pacing be suitable in this scenario?

2. X-ray- shows Cervical spine with some C2 vertebral changes following #rta

and now complains of paraesthesia of the hands. Which sensory dermatome is

affected? Needs urgent neuro Surgery intervention? Needs intubation?

3. X-ray 2- CVP line insitu(very deep) ot had hip THR 2 days ago . now

BP80/40 hr120 sweaty and SOB. Needs urgent cardio thoracic referral? Passes

dye through the CVP –called pulmonary venogram?

4. DINAMAP- principle involved, is MAP measured or calculated, shows the

ocilotonomerty graph and interpret SBP, DBP, MAP on it, when not reliable?

Which nerve damaged? Why recheck BP only after 2 minutes?

5. History taking – pt for nasal septal surgery- has sleep apnoea, prev

appendicectomy no problems. Stopped smoking 5 yrs ago

6. Resus 2- explain to a novice about an asthmatic intubated and ventilated why

SOB and high airway pressures. Tension pneumothorax- could here breath

sounds clearly in the rt side but then said chest isn’t rising and trachea

deviated. Asked to puncture- the values didn’t improve!! Explained insertion

if a chest drain. Stopped me there

7. Showed coronary angiogram – really tricky as it had only 1 coronory they had

marked A at the root of it and asked identify – I think it was left and asked

what B was said LAD, blood supply of the SA aV node and position

8. Arterial cannulae- identify the errors- no pressure bag, fluid out of date, air

bubble, not attached , venous cannulae- why cant u use it? Drug error, show

how u calibrate the arterial line? How is high calibration done? Why is the

300mmhg not shown on the trace?

9. Communication station- explain to the ODP about malignant hyperthermia

10. Resus- pregnant woman collapsed after epidural top- manage – ALS , why

collapsed?2 reasons . what drugs ? what management? What signs would she

have had prior to collapse?

11. Ankle block show on the foot each nerve dermatome and how you will

position the foot and how much you will ive for each nerve. Course of

saphenous and tibial of the nerves from groin to end.

12. Spinal block – anatomy how you will perform,position the patient and do what

you will feel ?why l34 , what level for TURP nd how will you test it

13. Another history taking- varicose veins. Asthmatic admitted to ITU following

b blocker- why b blocker- GP said one single episode of palpitations after that

never had them or doesn’t need anymore treatment it was a one off. Said he

had excema around the site and the bell rang!

14. Tracheostomy change- show on dummy, change complications what you

would do if you cant get it in

15. Machine check – no circuit. I forgot to take off the vapouriser though I said I

would check for leak, but couldn’t test for the leak as there was no circuit.

Vapouriser was empty and machine said not for clinical use, and had 2 dates

oflast check and so the examiner said I will correct and give you marks as he

didn’t know that!! Couldn’t turn the emergency cylinder and he tried and it

was stuck-so said assume its full

OSCE set 13



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1. Humidifier-why do we need to humidify in theatre(impaired ciliary

function, increased susceptibility to infection, loss of heat due to latent

heat of vaporization, buildup of static charge), identify picture of water

bath humidifier, other methods of humidification, disadvantages of

nebulizers (water in alveoli), what relative humidity can be achieved with

water bath and HME

2. BP measurement-define which Korotkoff sounds used, is 120/80 in a

young fit male expected in this environment?did i take the wrong value?,

how do you estimate size of cuff, what does the wrong size cuff cause, i

guess marks for correctly identifying cuff size and doing the procedure

3. Cardiac defibrillation- called to ward, nurses already started cpr, asked

what do you confirm? (pulse and breathing), run through station by

switching on defibrillator (demonstrate on machine), talk through drug

doses

4. History taking from young healthy female with history of sux apnea

5. Temp probe-what is in the bead, which graph matches the resistance

properties

6. 3D reconstruction of facial fracture

7. Chest X-ray possible aspiration

8. Simman trauma head injury with cushing’s reflex, same as in the course

9. ECG –calibration, difference between a trace with interference and another

trace

10. Brachial plexus injury, position and testing ulnar nerve injury-asked to

match pictures of people in positions where the nerves are in

traction/pressure points and point to a picture of the brachial plexus and

match numbers, how to test ulnar nerve damage

11. History taking-old man with angina going for hernia operation in a pre-op

clinic

12. Resus-what to do with vf

13. Spinal cord anatomy-identify tracts and which tracts supply what

14. Vagus nerve anatomy

15. Communication-pca vs epidural, same question as on the course

16. Resp system examination, including doing pefr

17. LMA insertion

OSCE set 14

1. Trigeminal nerve station with a skull – foramina, divisions, number of nuclei,

innervation, tests, supply to the mouth. Where does the ganglion sit? What

else comes out of the SOF?

2. Station with a photo of 4 ETT (nasal, reinforced, RAE, MLT). Name them.

What are they used for. What would you use for someone having 4 wisdom

teeth out. Why? Problems? Would you use a throat pack? (And then VERY

many questions on throat packs)

3. History station: radical mastectomy. Breast cancer. Nausea. Fhx of MH.



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4. Communication station: Tell this man's daughter her father had a ruptured

AAA and is being operated on.

5. History station: Obstetric patient. 30 something weeks along. Ank spond with

previous failed spinal and difficult intubation. IUGR.

6. Sacral anatomy and caudal epidural. Dose of bupivacaine.

7. PEA in post lap chole patient on the ward. Go through the guidelines (just talk

through it). What would you do after the pulse returns?

8. Humidity. Recognise the instruments. Definitions.

9. Resuscitation – patient on table in VT. Had to shock (paramedic there to

prevent harm). Then talk through treatment of VT, number of shocks,

chemical treatment.

10. Simulator. HTN, tachycardia – Sats ok, CO2 ok, temperature ok, but sevo on

0.25%. Turned this up, said would give propofol, gave alfentanil and fentanil;

was asked what I would give if this didn't work. Pt had asthma but only on

salbutamol. How would I check for awareness?

11. Question from previous entries in Coventry 'database' – pink and grey

cannulae, differences between the two, flow rates, check this drip. How would

you make it run faster? What TWO reasons are there for having the ball in the

chamber?

12. CXR – systolic murmur. No left atrial enlargement, and I didn't see any

obvious rib notching. Some upper lobe diversion perhaps.

13. C spine XR – most probably ankylosing spondylitis.

14. Examine this man's JVP. Then questions about it.

15. Airway stuff – demonstrate bag valve mask ventilation on this (VERY stiff)

dummy. Then a discussion about nasopharyngeal airways.

16. Monaural stethoscope – what is it used for, what murmurs do you hear with

gas embolism, what surgeries predispose towards this? Treatment?

17. C6 transection. What are these bits (pointing to diagram). What happens in

successful stellate ganglion block.

OSCE set 15

Station 1: AF, and treatment ran through usual treatment and post event risks.

Station 2: Xray of a chest with history of blood stained sputum in a smoker, acutely

unwell. Looked like millary TB to me. Questions like “oral fluclox indicated ?F”,

Viral pneumonitis ?F. Likely to deteriorate, bronch will improve.



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Station 3: Parangeal Pouch same as on the course

Station 4: Hypotension intra op in an intubated patient, management etc.

Station 5: Airway assessment – patient in room. Show surface anatomy.

Station 6: History pre op assessment.

Station 7: Practical Defib station

Station 8: O2 gas analysers – really annoying examiner, knew the subject but nothing

seemed to be right.

Station 9: Another history

Station 10: Pulse Oximetry

Station 11: Cardiac examination

Station 12: Practical demo CVP line insertion – landmarks on dummy

Station 13: Pre op in drug abuser.

Station 14: O2 cylinders

Station 15: Needle stick on HCW, talk to them about what to do and risks.

OSCE set 16

1. CXR – 30 yo with colitis, post resection, desaturates – RUL collapse, qus

about ?aspiration and whether to give antibiotics, is bronchoscopy indicated?,

whether sulphasalazine is contraindicated if allergic to sulphonamides,

2. Resus: Trache tube (new) has fallen out of patient on ITU, difficult intubation.

Sats climbed when LMA inserted.

3. Talk through RIJ cannulation – preparation, complications (easy - I think this

was the test, sadly!)

4. History – 71, ex smoker and drinks 1-2/day, PPM for syncope, for resection of

mole on back – scored low on this and not sure what I missed, having spoken

to others on the day and covering lots of the PPM hx. Maybe more about his

EtOH?

5. Equipment – pH electrode – nice examiner, label parts

6. Equipment – Jackson Rees check circuit and answer qus – bit more searching

than the usual qu’s

7. Anatomy – Spine – levels of termination, what’s the dura continuous with,

name the denticulate lig, conus medullaris, id pedicle, lamina on a model of

the spine

8. Equipment – PCA line, ID 2 valves, safety features of PCA

9. Resus – show how you’d give synch shock for AF, qu’s about AF

10. Equipment – diagram with electrical equipment, qu’s about microshock,

equipotential earth, ID two symbols from page



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11. Anatomy – ribs, models provided– first rib and attachments, show where to

put chest drain on actor, bifurcation of trachea and other surface anatomy

12. History – young guy, first op, wisdom teeth, needle phobia (seemed a bit more

about communication)

13. Communication – mother of young son, sux apnoea – I didn’t elicit how much

she knew first! But otherwise, fine

14. Equipment – art line – only spotted one or two defects (there really weren’t as

many as there usually are!), asked about calibration –including at high

pressure, shown over damped trace

15. Radiology – CXR of smoker for pan endoscopy – lateral – fluid level – really

didn’t know if it was a malignant effusion or massive hiatus hernia! Qus

relating to HH really. Scored ok on this

16. Neuro – qus about ulnar and radial nerve, demonstrate on an actor how you

would test function, sensory and motor

17. Resus – chat with examiner – shockable algorithm – what other drugs can you

give?

OSCE set 17

1. Insertion of right subclavian line. Anatomy, practical aspects, risks.

2. Hypotension in theatre secondary to fast AF. Safe cardioversion. What to do

if cardioversion fails.

3. Anatomy of the hearts blood supply including to nodes. Position of nodes.

4. Shown picture of RAE, armoured and nasal tubes. What are they? Discussion

of 10 year old for tonsillectomy. What kind of tube? Size? Post op

complications?

5. Examine this mans pulse and praecordium.

6. SaO2 probe. Graphs, wavelengths, sources of error. Frequency of light

flashes.

7. Anaesthetic history. For lap steri. Hidden agenda appeared to be past IVDU

with symptoms of what could have been HIV/Hep C/PCP.

8. Rhythm strip with SVT on. How would you treat? Amiodarone doses.

9. X Ray. Diffuse fluffy shadowing with symptoms of pneumonia. ?ARDS.

?Viral pneumonia.



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10. X-Ray. What appeared what appeared to be a barium swallow with

pharyngeal pouch. Blurry film (difficult to even tell if it was AP or lateral).

Questions regarding airway management. Is LMA ok? Should you use

cricoid?

11. Resus sim. Post induction for fixation of fracture femur secondary to car crash.

Hypotension and reducing pCO2. Didn’t improve until inotropes/vasopressors

mentioned. May have been too deep.

12. Technical skills. Airway assessment including exactly where is thyro-mental

distance is measured to and from. Explain sensitivity and specificity with

regard to airway assessment.

13. Equipment. Clarke electrode, fuel cell and paramagnetic analyser. How do

they work. Which is which. What is paramagnetism? What do you call a gas

repelled by magnetic field?

14. History. Young patient for resiting of hickman for chemo – had leaukaemia.

Needle phobic, appeared satisfied when pre-med discussed, initially wanted a

gas induction.

15. Anatomy of trachea on person. Where would you place a mini-trach? Where

would a surgical trach go? Complications of cannula cricothyroid membrane

puncture.

16. Gas cylinders. Light weight CD canister and E canister. List differences?

Calculate o2 stored. Pressures.

17. Communication (tester station). While placing a block the patient moves and

you stab your very junior assistant with the used needle. Discuss this with her:

questions re: risk of BBV, management, who she needs to see, forms to do.

OSCE set 18

1. Machine check – had a leak behind the vapouriser.

2. DINAMAP – was shown a picture. What is the principle behind this machine,

What does it measure and what does it calculate, uff size calculations

3. Simulation – called to an emergency C-section, has had an epidural up now

low GCS continue…

a. PEA arrest

4. Regional anaesthesia: Ankle block – actor present asked to talk through where

you would block which nerves and how much LA used. Asked origin of

nerves.

5. Communication – explain to a new OPD about MH

6. Arterial line set up – asked about which things were set up incorrectly. How to

calibrate high and low pressures.



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7. Simulation – shown ECG asystole, asked to run through what you would do

next, what are the reversible causes.

8. Regional anaesthesia: Spinal – asked to demonstrate on a model the landmarks

for the spinal. How much and which LA used, which space and why, Shown

two different needles, what are the differences and which one would you use.

9. X-ray station : C-spine (marked on optical paper), at what level is the problem.

Should the patient be in a soft or hard collar, ? need for urgent intubation.

10. X-ray station: CXR with contrast in pulmonary arteries. Pt had low BP and

raised HR, low GCS. Any filling defects, any need to transfer to

cardiothoracic unit.

11. Assessment: called to A+E to a patient with a head injury. Actor present

sitting in chair but bed present. Assess GCS. Patient was able to talk,

following commands had good power but complained of tingling in both hand.

Eyes opening to voice. Had to say would put in collar. Had to say all parts to

how you would calculate a GCS.

12. Simulation- asked to attend ITU where a patient intubated due to severe

asthma has become unstable. Had tension pneumothorax, had to perform

needle decompression on the model and talk through chest drain, wanted a

large bore chest drain.

13. Simulation – Called to ITU patient’s trachy has fallen out which is 2 weeks

old. Demonstrate what you do next. What would you do differently if the

trachy was new. What are the possible complications. What to do if you fail to

re-insert.

14. Coronary angiogram – 3 layers of the heart. What are sinus of valsalva, where

do the right and left coronary arteries originate. Asked to identify the vessels

shown.

15. History – patient having nasal surgery. Had history of OSA, had a sleep study.

allergy to penicillin

16. History – bilateral varicose vein surgery. History of asthma, unable to take

NSAIDS and beta blockers, on antibiotics.

17. Chest drain – shown two underwater drains, one was filled to the top with

water and the other was underfilled. Asked to say where you would attach the

patient and what the other port can be used for ie suction. Where should it be

positioned in relation to patient. What happens if the drain in clamped, placed

on a drip stand above the patient, if the tube is full of fluid.

OSCE set 19

1. Simman- cannot intubate and cannot ventilate—needle crico thyroidectomy

2. Simman- young lady ectopic collapsed in a and e……use the protocol

+massive haem protocol,osb/gynae surgn,laparotomy

3. Resuscitation—post lap chole patient collapsed in the ward---- shown a ecg +

examiner says no pulse---- pea in ecg….what u will do …again

protocol.surgeons,laparotomy

4. History taking --- carotid entarterectomy….follow usual protocol ( had strokes

in the past,has claudication now)



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5. History taking for an elderly lady for hip replacement with heart murmur and

and medications for arthritis and reduced ex tolerance

6. Communication--- difficult intubation in the past with sore throat now we are

planning awake fibro optic……address her concerns and explain about the

procedure…make sure that u tell her that the anaesthetic consultant will be

around for the case…she is very anxious

7. Xray---- pericardial effusion with enlarged pulmonary arteries? And carina

slightly deviated to right…all questions related to that

8. Reconstructed ct scan image of vertebrae—T 12 to L 3 I think……t 12 has

moved backward from its position (misalignment)… all related clinical

question like which nerve segment is damaged and whether his femoral nerve

is intact,will he have spinal shock on turning him to the side.etc

9. Capnograph trace and related question

10. Nerve injury during surgery---- this was a photo showing supine position of a

patient with head turned to the opposite side and arm abducted more than 90

degree plus forearm supinated……all related nerve injury questions …shown

a picture eyes not protected and some questions related to that ….straight

forward I think

11. Anaesthetic machine check----- date mentioned on the service card april 2011

so it was due for servicing I think…….blanking plug behind the machine was

missing on 2 places,oxygen cylinder was already on,vapourizer was not fixed

properly,pressure test failed on the system--- no bobbin drps….so there was a

leak.

12. Demonstrate nerve block on the foot on a patient …..asked every possible

questions including how to block each nerve and volumes and area supplied

course of saphanous ,,etc etc….

13. Nerve stimulator---- on a manikin hand…..everything possible including show

how to attach the leads,lot of graphs of different stimules ,asked about -

hz,duration,current ,,,,everything u can think of.

14. Spinal cord cross section diagram--- all questions related to the various tracts

and all also asked about how many mls required to block each segment during

spinal.

15. Change tracheostomy tube in a ventilated patient in itu--- on manikin—

16. Examination----- on actor… trauma patient --- examin( atls ) ….this patient

had haemothorax and gcs was 14 …..

17. Photos of oxygen analysers ..----- asked about all of them….also equations….



16

OSCE set 20

1. CPR – 2010 Guidelines.

2. ECG – Related questions

a. Sinus Arrhythmias

b. Antero – Inferior MI

3. Pacemaker related questions (examiner will ask questions)

� What does DDD & VVI mean to you?

� What are the indications of pacemaker insertion?

� What pacemaker types do you know?

� What are preop concerns and what preop assessment needs to be done?

� What are the contraindications?

� Surgeon adamant about using a mono polar diathermy what would you do?

4. Examination of Precordium (Actor lying on trolley)

� Remember WIPE (Wash your hands, Inform patients what you are going to

do, permission, exposure)

� Inspection, Percussion, Palpation, Auscultation

� Demonstrate areas auscultation

� What is bell of stethoscope used for?

5. Critical Incident 1

RSI related questions, pretty simple (Imagine what you do on a regular basis and how

you do it)

6. Critical incident 2 (repeated from previous exam)

Air Embolism questions

� Symptoms in anaesthetized patients

� When does this occur?

� How much air is required to cause air embolism?

� What is the treatment?

7. Instruments (lots of related questions)

a) Electrical symbols b) Diathermy c) Defibrillator circuit

8. Clinical scenario: Grade 4 View how would you proceed. Question related to peads

ETT

9. Anatomy of thoracic vertebra and spinal cord section diagram label the parts

10. Simulation: Many scenarios. (Could be Pilot)

11. HME filter, related question like what is AH/RH, Units, how is it measured, RH in

trachea, best form humidification?

12. Lady with Hx of DVT on OCP pills needs laparoscopic surgery. Do your

assessment

13. IVDA with Hx smoking coming to abscess drainage. Examiner will ask questions

related to anaesthetic Management

14. CXR

a. Pleural Effusion

b. Boot shaped heart

15. Communication skills: lady in pain after surgery already on PCA.

16. Rest



17

17. Arterial Line, Related question eg. Indication, components, damping, critical

damping, causes, complication, why do you pressurize, how much pressure? Why is

heparin not used anymore?

OSCE 21

1. CPR – 2010 Guidelines.

2. ECG – Related questionsSinus Arrhythmias Antero – Inferior MI

3. Permanent Pacemaker: What does DDD & VVI mean to you?What are the

indications of pacemaker insertion?What pacemaker types do you know?What

are preop concerns and what preop assessment needs to be done?What are the

contraindications?Surgeon adamant about using a mono polar diathermy what

would you do?

4. Examination of Precordium (Actor lying on trolley) Remember WIPE (Wash

your hands, Inform patients what you are going to do, permission,

exposure)Inspection, Percussion, Palpation, AuscultationDemonstrate areas

auscultation ,What is bell of stethoscope used for?

5. Critical Incident 1

RSI related questions, pretty simple (Imagine what you do on a regular basis and how

you do it)

6. Critical incident 2 (repeated from previous exam)

Air Embolism questions,Symptoms in anaesthetized patients,When does this occur?

How much air is required to cause air embolism?What is the treatment?

7. Instruments (lots of related questions)

a) Electrical symbols b) Diathermy c) Defibrillator circuit

8. Clinical scenario: Grade 4 View how would you proceed. Question related to

peads ETT

9. Anatomy of thoracic vertebra and spinal cord section diagram label the parts

10. Simulation: Many scenarios. (Could be Pilot)

11. HME filter, related question like what is AH/RH, Units, how is it measured,

RH in trachea, best form humidification?

12. Lady with Hx of DVT on OCP pills needs laparoscopic surgery. Do your

assessment

13. IVDA with Hx smoking coming to abscess drainage. Examiner will ask

questions related to anaesthetic Management

14. CXR : Pleural Effusion,Boot shaped heart

15. Communication skills: lady in pain after surgery already on PCA.

16. Arterial Line, Related question eg. Indication, components, damping, critical

damping, causes, complication, why do you pressurize, how much pressure?

Why is heparin not used anymore?

OSCE set 22

1) Airway management – manikin. How would you manage this patient’s

airway? Can you demonstrate by giving 5 breaths with the ambubag? What

would you change if this was an 8kg child? What is this (NPA)? What’s it

used for? What are the complications of its use?



18

2) Defibrillation – manikin attached to monitor. You are asked to help an ST1. Pt

has just been induced. On entering station, VT on monitor. What is this

rhythm? What will you do about it? What energy will you shock at? Safely

defibrillate. If this shock doesn’t work, what will you do next? How many

further shocks would you give? What would you do if a rhythm disturbance

persisted after the patient was stabilised?

3) Anatomy – Base of scull

4) Anaesthetic risks – pt attending for dental extraction in all 4-quadrants. How

would you anaesthetise? Name these tubes (nasal, microlaryngeal, armoured,

RAE). How would you size a NETT (diameter and length)? How else would

you protect the airway from surgical soiling? Name 3 risks associated with the

use of a throat pack. What safety measures would you take to ensure safe

removal of the throat pack? What 2 safeguards to removal of throat pack do

the NPSA advise? Which 2 items of documentation aim to ensure safe

removal of a throat pack? What 2 visual aids can be used to ensure removal of

throat pack?

5) Communication – speak to this relative, whose elderly father was admitted

with a ruptured AAA.

6) Examination of JVP on actor. How can you distinguish between carotid

pulsation? How can you measure the JVP? What causes a raised JVP? What

causes a large a wave? What is the significance of an absent a wave?

7) Monoaural stethoscope – what is this? What can you use it for? Where would

you place it exactly? What might you be able to diagnose with its aid? What

are the 2 conditions required for a venous air embolism to occur? What is the

name of the murmur? How would you treat it?

8) History – pt attending for mastectomy. Withdrawn patient, hx of ponv

9) Resus – Discussion: you’ve been called to an arrest on the ward, CPR in

progress when you arrive. Pt 2 hours post cholecystectomy. What do you do?

What is this rhythm? How would you proceed – standard ALS algorithm etc.

Post-resuscitation care, blood transfusion – practical aspects of arranging

blood.

10) X-ray – Chest ?coarc

11) X-ray – c-spine, pt with ank spond

12) Simman – asked to help ST1 just after surgery has started. Pt known

hypertensive, very tachycardic + hypertensive on table, MAC 0.3, improves

with deepening and analgesia. Then asked what I would do if tachy and

hypertension persisted despite adequate anaesthesia.

13) Caudal analgesia: Name parts of sacrum on model. Demonstrate technique.

How many mls of 0.25% bupivacaine would you give in a 20kg child for an



19

orchidopexy? What’s the max dose? What 3 things must you ensure before

discharge?

14) Humidity measurement – pictures of hair, wet + dry bulb + regnault’s

hygrometers. Define absolute/relative humidity. Picture of humidity graphs.

How much water would you have to add achieve 100% amount of humidity at

body temperature?

15) History – pregnant lady, ankylosing spondylitis, prev failed central neuraxial

block, difficult intubation

16) Anatomy – C6 transverse section – name different structures, effects of

sympathetic block at this level

17) Cannulae, different flow rates, measures to increase flow. What’s the white

ball in the giving set for (2 things)?

OSCE set 23

1. BP measurement:Take BP in this patient using stethoscope and

sphygmomanometer. Fit correct cuff, which Korotkoff sounds to listen for etc

2. Bradycardia: SimMan station, called by CT1 to help with laparoscopic

procedure and bradycardia Given Atropin up to 3mg, no response. Which

other drugs could you try? Finally told me to give Adrenaline, patient

develops VT with output -> synchronised shock. Back into sinus rhythm

3. Vagus nerve – this was a test station,Where does it originate, where does it go,

which foramen does it pass through, which organs in thorax innervated,

response in the heart through vagus, problems in different surgeries

4. Patient, explain PCA/ epidural,Advantage/ disadvantage of PCA or epidural

explained to patient, like the station we had on the course. Was brilliant, as I

knew how to not to go into too much detail and still cover everything

5. Patient positioning and brachial plexus problems Pictures of different

positions and which nerve in brachial plexus could be damaged (not necessary

to name nerve, just point out on diagram of plexus)

6. Respiratory system: Examine respiratory system in actor incl peakflow

7. ECG: Shown ECG monitor, which frequency does it work with, what is

differential amplifier, what is the difference between diagnostic and monitor

mode. What is speed etc. Shown picture of CM5, where does which lead go, is

it unipolar or bipolar

8. Female patient for procedure I don't remember, had RTA in past, ITU

admission due to suxamethonium apnoea

9. Defibrillation theory,Prompt says walking in on CPR, what to do next. Just

asked as theory. After I got to attaching the defibrillator, I was shown fine VF

-> I said treat as asystole, but think VF would have been what they wanted.

Talk through VF algorithm, 4Hs and 4Ts, what can be tried in refractory VF

10. CXR in patient after bowel resection for Crohn’s ,Low SatO2 in recovery.

CXR showed ?right upper lobe collapse Some questions about Crohn’s like do

you need to replace steroids if been on steroid enemas, can patients with

sulphonamide reaction in past have sulfasalazine



20

11. CT reconstruction of facial bones Obvious fracture of right orbit. Text said

increasing drowsiness and swelling of face. Early intubation needed? Can sux

be used? Which side is fracture on (CT said right over fracture!), arrow

pointing to infraorbital foramen ?is this the supraorbital foramen etc.

12. Head injury on ITU. Promt says you walk to patient and explain findings to

CT1,Patient had high BP and low HR. Explain to CT1 what this is. What else

do you want to know? (ABCDE, don’t forget pupils like me) What can you

do? Who to call? Prognosis? What induction agent would help in this situation

13. LMA insertion:Which LMA to pick for 70kg male? How to insert? What are

the indications? Contraindications for using LMA

14. Temperature measurement:Identify temperature probe (oesophageal probe),

where should it be placed, how is it measured. Point out thermistor in set of

four resistance against temperature graphs

15. Patient with angina for hernia repair,Daycase for hernia repair. Turned out he

had angina at rest. He was on full angina medication and had MI in past.

Nothing else in his history as far as I can remember

16. Spinal tracts

Picture of spinal tracts, mix of some ascending and descending tracts all on one side.

Identify tracts and function. Explain perfusion of spine. What happens in thrombosis

of anterior spinal artery?

OSCE set 24

1. Manual BP measurement. Measure it. How do you choose the cuff size? How does

bp change with age?

2. There was a picture of a chest with three electrodes on it (red, yellow, green).

Asked to show where each one would move to for CM5 configuration. What is is

useful for? What is a differential amplifier? How do you prevent interference?

3. History station for a hernia repair - patient with unstable angina

4. Communication station - PCA vs epidural for analgesia for laparotomy

5. Insert a LMA into manikin. What are the contraindications for using an LMA apart

from reflux? What size would use for a 2 year old? What do you do with a non

disposable LMA after use? How many times can you use it?

6. Anatomy of vagus nerve. Point to foramen in skull base where vagus nerve exits.

what is it called? What else passes through this foramen? name 3structures in the

thorax does the vagus nerve innervate?

7. Cross section of spinal cord. What is in the grey matter. Examiner pointed at

different tracts and had to name them. What is the volume of csf? What is the specific

gravity of csf? Blood supply. What neurology do you get with anterior cord

syndrome?

8. Simulation station. Head injury. Tubed in ICU. Tachycardia and hypotension. I said

most likely to be Cushing�s response. What would you do? I said neurosurgeon, head

up, hyperventilate, mannitol, no tube tie etc. How many degrees? How does putting

patient head up help? I said it reduces ICP. They wanted more than that. What dose of

mannitol? What is the prognosis?

9. Shown a temperature probe and asked to name it. How does it work? Shown graphs

of resistance vs temp and asked to point to graph that represented the most common

thermistor. What is a Kelvin?



21

10. Humidity. Shown a picture of a hot water humidifier. Asked advantages,

disadvantages, dangerous features. Asked what other humidifiers are there? What is

the problem with the ultrasonic nebuliser

11. CXR. It looked like RUL collapse but all the questions were about aspiration.

Scenario was CXR in recovery post colectomy for UC. Antibiotics is immediate

management T/F, Zn deficiency causes colitis T/F, steroids should be given T/F.

12. CT facial bones reconstruction. Left Zygoma fracture T/F, other eye will develop

immunological problems ?!?!?! T/F, metronidazole is indicated T/F.

13. Shown an ECG of VF. What is it? Management. What do you do if shocks aren�t

treating the problem?

14. Defib scenario. Manikin with hypotension and HR around 40. What do you do?

After a while rhythm changed to VT with pulse. Had to perform syncronised

cardiversion. There was a safety officer present so there were 3 people and you in the

cubicle.

15. History for a patient for rhinoplasty with history of sux apneoa.

16. Picture of a brachial plexus and of patients in different surgical positions. Had to

point to which nerve and part of plexus that is at risk for each position. What nerve is

at risk with bp cuff. How would you examine for ulnar and radial nerve injury.

17. Can�t remember the last one. Sorry. Possibly another history.

OSCE set 25

1. Technical skills: Caudal block in 5 year old child for orchidoplexy

Anatomy of sacrum

• Performance of caudal

• Calculation of volume and dose of 0.25% bupivacaine for 20 kg child

2. Humidity:

- Measurement, units, absolute and relative definitions

- diagrams of hygrometers: hair, wet and dry bulb and regnaults

- two gas samples with relative humidity of 50 % in 30 and 37 degrees- which

has more water in it

- humidity graph: if 50 % rh at 37 degrees how much water needs to be added to

fully saturate the ample(in grams)

3. Patient history taking

- You are going to take history from a patient who will want epidural for labour

- Patient has bilateral hips replacement for arthritis, back problem

- Previously on steroids

- Patient had Gas for hip replacement cause they couldn’t do spinal

4. Comparison of 20 and 16 G venflons

- What fluid rates, what are the differences apart from colour, can any of these 2

be used as arterial cannula, if now why not

- If you presssurise bag to 300 mmhg what other factors will improve the flow

(reducing viscosity, warming, using large bore cannula, short and reducing

length of tubing)

- If you connect 20 ml syringe and aspirate fluid through 3 way tap- can you

entrain air into syringe

5. Monoaural sthetoscope

- Where do you place it

- When do you use it



22

- What cardiac and respiratory complications can you detect with it

- How can you recognise venous air embolism, what heart sounds are there

- 2 ways of treating venous air embolism

6. Resuscitation:

- VTach with pulse, unstable hypotensive, use of defibrillator

7. Resuscitation: verbal discussion of PEA arrest: 2 hours post cholecystectomy,

2010 guidelines

8. Simman: light plane of anaesthesia, patient hypertensive, tachycardia, ma cow,

increase vapouriser of sevoflurane, differential diagnoses and treatment if

increasing plane not enough, treatment of perioperative ischaemia

9. Technical skills: ambu bag and mask ventilation on a manikin, adult vs child

10. Equipment: nasal intubation for dental extraction

- How will you manage airway for extraction of wisdom teeth, picture of

different ET tubes,

- Complications of nasal intubation, how do you decide on size and length

ofnasal tube, throat pack- complications, how do you prevent dislodgment(

NPSA guidelines), 2 thinkgs you document regarding throat pack

1. Examination of patient: examine jugular venous pulse, questions on

cvp trace

2. Communication: discuss with daughter of a patient who had rupture

AAA and is on operating table. Inform her about AAA and situation

3. History taking: patient for mastectomy, post chemo, radiotherapy,

ponv,

4. Trigeminal nerve: skull, where is trigeminal ganglion, foramen

rotundum, infraorbital foramen, superior orbital fissure, what signs will

a patient with ophthalmic herpes zoster have

5. Cross section of neck- C6 level

6. Xray- CXR, coarctation of aorta

7. Neck xray- ankylosing spondilitis

OSCE set 26

1. CXR: bilateral pulmonary patchy shadowing likely military TB

2. Barium swallow: pharyngeal pouch

3. SimMan: management of hypotension in a trauma victim having just been

anaesthetised

4. Airway assessment: Mallampati explain the classification, define specificity

and sensitivity

5. History station: GA for Hickman line insertion in a leukaemia patient, needle

phobic. Recent illness requiring hospital admission-neutropenic sepsis

6. Anatomy of larynx-show land marks on patient (with difficult neck) cricoid

cartilage, hyoid bone, thyroid cartilage. Position of a surgical tracheostomy

and mini tracheostomy. Immediate complications of mini trach insertion

7. Picture of 2x oxygen cylinders: Size E and CD cylinders. What size are they?

List 4 differences between the cylinders. What are they made out of?

Calculations of amount of oxygen. Oxylog ventilator how much is the %

oxygen in air/oxygen mix?



23

8. Insertion of subclavian line: explain insertion technique and landmarks,

complications of insertion

9. SimMan: resuscitation station. Tachyarrhythmia: AF in patient under general

anaesthesia. Management in compensated and decompensated. Use of the

defibrillator.

10. Communication station: Needle stick injury in a health care support worker-

give information to her about management and be empathic

11. History station: 35 year old female for laparoscopic sterilisation, IVDU,

alcoholic

12. Pulse oximetry: oxygen dissociation curve partial pressure of oxygen at 90%

saturation, p50 what does it mean, why useful. Shown a picture of a

myoglobin curve-what does this show? Isobestic point-what is it, what does it

signify. Wavelengths of pulse oximetry diodes, how does it differ to a co-

oximeter.

13. SVT management of in a patient in A&E who is not compromised.

14. Pictures of Fuel Cell, Polarographic electrode and Paramagnetic oxygen

analyser. Name them explain who they work

15. Anatomy of the heart-blood supply arterial and venous drainage

16. Cardiovascular examination on an actor- pulses and praecordium

OSCE set 27

1. Hx from pregnant patient who had had airway trouble before and a previous

difficult spinal due to ank spond

2. Ca patient for mastectomy, sister had MH, she had been tested and was

negative.

3. JVP examination and questions about cvp trace

4. Airway – show bag and mask ventilation, how differ for infant?

5. Trigeminal nerve anatomy, skull foramens, where is the trigeminal ganglion?

What does the nerve supply? What are the branches of the nerve?

6. X ray – chest – I think it was co-arctation – there was rib notching. What

valvular abnormalities? More common in females? Need abx prophylaxis?

7. X ray – c spine – think it was ank spond as there were calcified ligaments.

Difficult airway anticipated? Difficult spinal? Are there osteophytes? (there

was not).

8. Demonstrate a caudal block (imagine ptn already asleep and consented etc)

had to show anatomy on skeleton, what layers do you go through? Where is

the sacral hiatus?

9. Humidification questions, pictures or humidification equip – wet and dry,

regnaults, hair. Which does each measure. Graph of humidification lines –

how much more water can be held in air at a certain temp vs another temp?

10. Equip – one eared stethoscope thing, how do you use it? Which groups of

ptns? What information does it give you?



24

11. Equip – cannulas, physical differences flow rates, how increase flow through

this cannula? Can aspirating through a three way tap entrain air? What is the

ball for in the drip chamber?

12. Simultation – awareness

13. Simulation – VT with low BP, shock, one examiner kept moving back to

touch the trolley.

14. Cardiac arrest talk through PEA

15. Another history station that I cannot remember

OSCE set 28

1. Tracheostomy tube change, what precautions, what follow up, complications

other than failing to place it? Can you demonstrate on this manikin with the

equipment provided (syringe and new trache tube).

2. DINAMAP. What is the principle behind this measuring device? What cardiac

abnormalities and patient factors can lead to inaccurate measurement? What

can happen if 1 min intervals are used to the patient? Can you show on the

trace which points correspond to systole, MAP and diastole?

3. History station. Patient with obstructive sleep apnoea, hypertension and

alcoholism for a septoplasty.

4. Cardiac anatomy, diagram of cardiac angiogram.

5. Machine check using a new Drager machine

6. Spinal anatomy. What level block do you need for a TURP? Can you show on

the patient? Can you position the patient for a spinal? What do you do to

perform a spinal? What layers do you go through?

7. Resus station. Simman post insertion of epidural top up with bradycardia/PEA

and loss of output.

8. Chest drain hazard station.

9. Ankle block station.

10. History station. Asthmatic for varicose vein surgery.

11. ALS algorithm station.

12. Simman station, ventilated asthmatic with tension pneumothorax

13. C spine X ray with C2 fracture and subsequent management.

14. Pulmonary angiogram in patient one day post op TKR with dyspnoea and

hypoxia.

15. Check an arterial line.

16. Clinical examination of a patient with a head injury.



25

SOE set1

Pharmacology

1. What are the cardiovascular effects of Isoflurane? How does that compare to

Sevoflurane? How does it compare to Desflurane and Halothane? Are there

any specific MAC values above which theses effects are seen more? What

this the mechanism of action of coronary steal?

2. What is an Isomer? What are the different types of Isomers? Give examples

of the different types of isomers.

3. What medication can be used to treat Diabetes? Discussion of the mechanism

of action and contraindication / complications of different hypoglycaemic

agents. Would have gone on to talk about insulin but didn’t have time.

Physiology

1. What is the valsalva manoeuvre? How is it done and what does it achieve?

What are the effects on the BP and HR? What is the mechanism of action of

these effects? (key word: baroreceptors) How might it differ in a patient with

diabetes?

2. What happens in starvation to metabolism? How much glycogen stores are

there in the body? How are proteins utilised? How are fats utilised? What

happens in the stress response? What hormones are involved?

3. How are the body fluid compartments divided up? What divides the ECF and

ICF compartments? What divides the intravascular and extravascular

compartments? What happens when N saline is given, compared to 5%

dextrose? Which is therefore the better resuscitation fluid? What happens

when 2L of saline is given stat?

Clinical

60 year old man with possible IHD, has had a recent angiogram, on the list for a right

hemicholectomy for a ceacal Ca. Hb 7.0

1. Pre-op assessment and optimisation

2. Plan for anaesthetic

3. Post op he becomes hypertensive BP 200/120. What are the possible causes?

How would you manage it?

Physics

1. Defibrillators: recognise a diagram of a defib. What are the parts. How does it

work. What does the inductor do? How does it work clinically? What is the

difference between monopolar and bipolar?



26

2. Circle systems: Recognise diagram. What are the parts? How does it work

and what flow rates can be used. What happens if the sodaline is used up.

How does soda lime work (said that did not need to write done the reaction but

I did as found it easier to explain). What happens if the unidirectional valves

get stuck / break?

3. pH electrode: recognise a diagram. What are the different parts? How does it

work? How does the CO2 electrode differ?

SOE set 2

1. Physiology – Action potentials of ventricular contractile muscle and

pacemaker cells, ion channels associated with both, effect of adrenaline on the

curves.

2. Pharmacology: SUX apnoea, dibucaine number, genetic changes for SUX

apnoea, management of SUX apnoea, classification of antihypertensives,

mech of action of ACE inhibitors, rennin-angiotensin-aldosterone system

3. Physics: venturi and applications, methods of temp measurement

4. Clinical: 36 yr lady for lap cholecystectomy, nausea and vomiting with

previous gynaecological surgery, mouth opening 2 fingers

SOE set 3

PHYSIOLOGY

1. Asked about the physiological response to blood loss - 20% circulating

volume

2. Asked to discuss the difference types of immunity and the different types of

lymphocytes and myelocytes on the white blood count differential

3. Asked about normal values for HR, BP, CVP then given a blood gas and asked

to comment on values, normal values and explain the relationship between pH

and hydrogen ion concentration, plus asked to write the Henderson-

Hasselbach equation.

PHYSICS

1. Asked about dead space, given a graph of Fowlers method and asked to

explain it. Asked about ways to measure flow.

2. Shown electrical symbols, asked about inductors and capacitors, questions on

ohms law and power

3. Blood warmers - how they work, different types and the ideal blood warmer

PHARMACOLOGY

1. Local anaesthetics and factors determining speed of onset

2. Asked to give examples of adverse drug reactions

3. Asked to explain the different types of drugs which influence gastric acid



27

production

CLINICAL

1. 24 year old man - dialysis dependant renal failure. Anaesthetising for wisdom

teeth extraction.

- Asked about the different factors you would consider when planning your

anaesthetic,Critical incident was VF

2. Questions on scoring systems wanted to know the particulars of the ASA

scoring system.

SOE set 4

Pharmacology

3. Local anaesthetics, lipid solubility, Pka

4. Drugs and the GI tract, formation of HCl, how different drugs act

5. Adverse drug reactions (type A and B)

Physiology

1. Henderson-hasselbach equation and acid-base

2. White blood cells and immune response

3. Normal values HR, BP, CVP, CO, what happens if you loose 1000ml blood

Clinical

1. Wisdom tooth extraction in dialysis patient

2. Multiple ectopics

Physics

1. Electrical symbols, capacitor, defibrillator, inductor

2. Blood warming devices, principles behind these

3. Dead space, fowlers method and bohr equation (not sure why this was in

physics!!)

SOE set 5

Pharmacology

1. Local anaesthetics, lipid solubility, Pka

2. Drugs and the GI tract, formation of HCl, how different drugs act

3. Adverse drug reactions (type A and B)

Physiology

1. Henderson-hasselbach equation and acid-base



28

2. White blood cells and immune response

3. Normal values HR, BP, CVP, CO, what happens if you loose 1000ml blood

Clinical

1. Wisdom tooth extraction in dialysis patient

2. Multiple ectopics

Physics

1. Electrical symbols, capacitor, defibrillator, inductor

2. Blood warming devices, principles behind these

3. Dead space, fowlers method and bohr equation (not sure why this was in

physic

SOE set6 Pharmacology

1. s/e NMDR:Compare cisatrac with atrac, Use roc, Dose for rsi

2. Corticosteroids

- Where do they act

- How immuno suppress

- Other actions

- Steroid replacement

- Stress response

- S/e of steroids especially immediate perioperative concerns

Drug interactions

- Physical/ pharmacokinetic/ pharmacodynamic

- Wanted a graph for synergism but wasnt sure!

Physiology

1. Haemoglobin

- How produced

- Structure

- Hba/f/s

- Thaessemia

- Production epo-when/where/why produced and how does it act

- Role iron,b12, folate in hb production

- Other exocrine functions of the kidney

2. Lungs

- V/q, graph, west zones, pvr, shunt

3. Pacemaker cells

- How increase hr

- Effect parasymp and symp- how does it alter hr- which channels does it affect



29

- Compare with muscle ap

- Where else has pacemaker activity

Clinical

68 yr old man collapsed in street, low bp, tachycardic, unconcious, bought to a&e

- Differential diagnosis

- Initial mx and ix

- Abg ph 7.2, pco2 3.4, po2 11, bic 10, gluc 30

- What is the diagnosis

- What treatment

- What electrlyte disturbance would u expect

- Precipitants of dka

Pt aspirates- how manage - intubation drugs, why did u chose roc rather than sux?

What would u prepare for transfer to itu

Physics:

4. Pressure reducing valves.how it works, Draw it (others given a pic and asked

what it was)

- Pressure in cylinder

- Pressure at common gas outlet, how achieved

- when does pressure in cylinder fall - think we talked about nitrous

- O2 failure alarm- how work, ideal characteristics

5. Preload

- How measure-clinical and invasive

- Cvp- static or dynamic?

- Brief mention pa catheters

- Oeso doppler

- Response to fluid challenge- what give, what expect to see, %improvement

- Stroke vilume variation- what is it, how change with preload, how would u

fluid challenge against it?

6. Ultrasound

- Uses

- How it works

- Also wanted you to say it included a transducer and what a transfucer is

- Range of frequencies

- Probe sizes

- How improve picture

- Some people talked more on doppler

- Instead i got asked about different tissue attenuations, speed sound in air and

in tissues!

SOE set 7



30

Clinical

7. Hemicolectomy in anaemic man with ischaemic heart disease

Physics

8. ph electrode, pH calc, inductors,

Physiology

9. Metabolism in starvation, valsalva

Pharm

10. volatiles on cardiovascular system, isomers

SOE set 7

Pharmacology:

11. Depolarising/non-depolarising muscle relaxants- MOA, phase 1/2 bocks

12. STATS!!! asked about power of study alpha and beta errors false positive and

negatives, clinical trials , difference between statistical and clinical

significance

13. Anti emetics - site of action , Vd of ondansetron !

Physiology:

1. LV pressure wave , aortic , coronary perfusion

2. Nutrition!!!! assessment etc- talked about muscle vs fat proportions nitrogen

balance etc ..

3. Monro kellie doctrine

Physics:

1. SVP, freezing/boiling points etc .

2. Biological potentials

Clinical:

1. 65yr old for vaginal hysterectomy with RBS of 15mmol/l

- management of diabetes, complications, assessment asked would you cancel

op because of high BM

- Discussion about anaesthetic options - GA vs regional with sedation

- critical incident- high spinal - asked if once stabilised if would continue with

op....



31

- discussion about regional anaesthesia- contraindications , problems

SOE set 8

Pharmacology

2. Classify NSAID's and describe Diclofenac. Describe Aspirin its structure,

kinetics, dynamics,etc

3. Classify antiepileptics. Describe their mechanism of actions. Describe

Phenytoin.

4. Describe drug passage through cell membrane. Henderson Hasselbach's

equation, pKa, etc.

Physiology

1. Draw and compare cardiac and AV nodal action potential.

2. Describe the process of glomerular filteration, concentration through the

kidneys,etc

3. Showed a blood gas with respiratory alkalosis and asked what components are

directly measured and which components are derived.

SOE2:

Clinical Scenario

1. 26yrs old female arrived in casualty with rt inguinal tenderness for 8

hours. She is 16 weeks pregnant. Observations made are: HR-110/min,

BP-85/54 T, Temp 39 celcius.

- The examiner started with Differential diagnosis. Asked about the problems

with GA to mother and the foetus. Asked about the difficulties with GA in

mother. CVP line was inserted and she suddenly developed sudden

hypotension. D/D Air embolism and tension pneumothorax. Wanted to hear

about management of tension pneumothorax and the precautions taken to

prevent it(use of USG in siting the line and avoidance of nitrous).

- Discussed about the categories of C-section, indications for elective C-section

under GA.

Physics:

2. Showed pictures of a) MacIntosh, b) Millar and c) McCoy laryngoscope

3. Asked about electrical current and safety in theatre. Asked about

electrical impedance.

4. Asked about spirometry, He dilution method, Body plethysmography.



32

SOE set 9

Pharmacology

1. Ketamine, use, se, what is dissociative anaesthesia

2. Diuretics - tell me about them, loop diuretics more detail

3. Phenotypic variations & what other f influence differences in drug action

Physiology:

1. Cardiac cycle LV pressure trace, changes in AS & AR, aortic pressure trace,

why does aortic rise above ventricular before aortic valve closes

2. Cacium homeostasis

3. Nerve - nerst equation, what determines membrane potential, explain nerve

action potential

Physics:

1. Cardiac output, thermodilution, equation, fick principle in alot of detail

2. Scavenging components, what valves present, safety pollution what national

standards, why is halothane at lower concentrations, why are they set

3. Pressure in a cylinder nitrous versus o2 as used

4. N2O isotherms, describe them

Clinical:

1. Woman heavy smoker & kyphoscoliosis for vaginal hysterectomy

- HIstory

- Examinations

- GA versus regional

- High airway pressures differential

SOE set 10

Physiology

2. Pituitary gland- anatomy histology?what it secretes from where action of each-

couldn’t remember aquaporin2 but said water channels said was ok. what

stimulates secretion relation with hypothalamus

3. Co2 transport, % of each type in arterial and venous blood

4. Coronary blood supply factors affecting it-and rt draw a graph showing the

flow in each coronary during the systolic and diastolic phase.

Pharmacology

1. Affect of liver disease on drugs

2. Vancomycin

3. Factors affecting the offset of inhalational anaesthetics.

Physics



33

1. Picture of 3 ETT- where each was used and why

- patient N ETT, RAE and paediatric tube,

- Whats the number ?ID, why cut tubes,?paed formulae for #ett? Why

use uncuffed in paed tubes? Problems with #ett? Why not use the

smallest diameter?

Clinical

2. Before we went into the hall we all got a clinical scenario- 82yr

BP190/110 in preassement for /turp. PMH of CHF.

- Will you anaesthetise? Will you use sedation why yes why

not?concerns? what history ?what investigations?

- Incident TURP syndrome- DD as he is hypoxic and confused-

management.

SOE set 11

Pharmacology

3. Antimuscarinics, non anaesthetic uses, side effects of hyoscine,

compare atropine and glycopyrrolate-

4. opioids-how do they work, what other receptors apart from MOP,

where are receptors located in spinal cord,

- drug-receptor interactions

Physiology

1. Haemoglobin

2. Cardiac cycle

3. Action potentials

Clinical-

1. 55 year old man developing chest pain for elective hernia repair, discuss

anaesthetic workup, day surgery criteria, critical incident: sinus tachycardia

Physics

1. Resus bag

2. Lasers

3. Arterial blood pressure measurement-damping and interference

SOE set 13

Physiology

1. Coronary circulation – pressures within the heart. Myocardial oxygen supply.



34

2. CO2 transport, buffers

Pharmacology

1. Gaseous induction agents (onset factors, graphs)

2. Hepatic metabolism of drugs, what happens in hepatic failure with regards to

drug metabolism.

3. Tell me about vancomycin...

Clinical

1. Elderly man for TURP (typical).

- What are your concerns.

- How would you anaesthetise? How?

- Would you sedate? What would you use? Why?

- They desaturate in recovery. What do you do?

- Tell me more about TURP syndrome. What is it, how do you treat it?

- Where do they go afterwards?

Physics

2. Pressure (syringes, equivalents, what is it, how is atmospheric pressure

measured, how does it change with altitude how does it affect vapourisers?)

3. Tracheal tubes

4. Flowmeters/ rotameters

SOE set 12

Pharmacology

1. Vapours. Iso and Sevo.

- Not a direct comparison table, which would have been easy but

discussion about effects on heart rate/CO. Asked to draw a curve to

show change in BP with increasing concentration. Never seen this

curve in any books. Why Des increases heart rate.

2. Isomers, pretty standard talk through the types of isomers and some examples

of each. I used the classification in Peck and Hill not the green book.

3. Diabetic drugs (DMII), biguanides, sulphonyurea. Asked about new drugs

which I was less clear on. Then onto insulin.

Physiology:



35

1. Valsalva, standard really, but difficult to explain in depth as various books

differ. So stumbled a little.

2. Starvation – overview then into depth about production of Ketone bodies,

amounts of reserve such as how much Glycogen stores in i.e 500mg. Then

how much amino acid/protein stores – several kg. Into a fair bit of depth,

source of Ketones and various cycles which I could only vaguely remember.

3. Fluid compartments and distribution to compartments - effect of saline, effect

of dextrose. How much percent or what fraction etc. How does body respond

to changes and maintain homeostasis.

Clinical:

1. Given scenario before entering SOE station. Five minutes whilst in pre room

so had plenty of time to formulate a plan. 65yo male with IHD having an

elective hemicolectomy with Ca bowel. Just prior to operation Hb 7. Proceed.

Started with what other info, so went through history, examination and other

investigations etc.

- Same case, anaesthetic plan, pre peri and post op. What monitoring

required, ie ART line, CVP line, oesophageal doppler, when would

you insert and why and what shown. What analgesia options. Talked

about epidural and PCA. Post op recovery options ?HDU. Prevention

of DVT.

- Critical incident, hypertension of 220/150. Forgot to say call for help

a, but stuck to the ABCD approach. They were looking for causes:

pain, incomplete reversal, failure to take reg meds. Brief discussion

about routes of administering so iv Beta Blockers, SL ISMN.

Physics:

2. Defibrillators. Gave a circuit diagram and asked to explain components. How

capacitors work, what improves their efficiency. Gave the equations for

F=C/V. Inductors briefly mentioned. Why biphasic waveform better than

monophasic. Tried to relate this to normal myocardial depolarisation. How to

improve effectiveness of shocks.

3. Circle system. Explain components. Asked to draw soda lime equation.

Muddled through a little but mentioned key points and they seemed OK with

that. Asked about low flow anaesthesia and why we use it and what defines

it.

SOE set 13

Pharmacology:

1. Compare and contrast fentanyl and alfentanil

2. Drug receptors (lovely!)

3. Vancomycin – didn’t seem like they wanted a lot of knowledge, just basic

MOA, that you need to check levels (what should they be? Didn’t know,

didn’t seem to matter), SE, other glycopeptides, indications, is there

resistance? How does this develop and how is it transmitted?)



36

Physiology

1. Buffers

2. CO2 carriage

3. Genetic polymorphism in the RBC – ie chatted about sickle cell, G6PD and

antigens

4. ODC for normal, sickle and fetal Hb

Physics

1. Pressure – how can you work out what the pressure is at 10m depth?

DefineCO – arterial waveform, Lidco, Picco

2. Vapourisers – characteristics of ideal, plenum vs drawover, diagram of des

vap

Clinical:

1. Afrocarribean child, ?torsion – no investigations, obs indicated in pain with no

analgesia given – probing whether I would proceed if Hb normal and no time

for sickle testing

- Critical incident – laryngospasm – wanted definite answer re re-intubation (I

said I would, bearing in mind may go into spasm again, and got full marks

here)

- Post-operative management.

SOE set 14

Pharmacology

2. Cardiovascular effects of isoflurane. Draw a graph of BP change with iso

concentration. Compare with other vapours.

3. Isomers. What are, discuss them, explain tautomerism, examples of use

moving into atracurium.

4. Oral hypoglycaemics. Side effects of metformin.

Physics

1. Valsalva manoeuvre. Draw graph. What clinical situation is similar?

2. Metabolic changes in starvation. Gluconeogenesis explored.

CLINICAL

1. Symptomatic anaemia and proven IHD on echo for colectomy for Ca. What is

critical stenosis on angio? Discussion of anaemia causes and how to

differentiate them.



37

- How to manage case. Epidural or not? Which lines? How does and

oesophageal dopler work?

- Critical incident was hypertension, appeared to be due to inadequate reversal.

How do you assess neuromuscular block? Receptor occupancy at various

TOF responses.

PHYSICS

1: pH. Discussion. How do you work it out. How does a pH electrode work.

2: Defibrillator and capacitance.

3: Can’t remember.

SOE set 15

VIVA

Pharmacology

1. Acetylcholine, where is it found how is it metabolised. Suxamethonium, how

is it metabolised what effects it and Sux apnoea incl genetic variations

2. Anti-hypertensives, classify, concerns of each group with anaesthetics

3. Receptors, draw g-protein and second messenger pathways, examples of

tyrosine, ligand gated, steroid. Where do the steroids acts, which receptors are

the quickest.

Physiology

1. Heat loss, types, mechanisms to prevent eg vasoconstriction

2. oxygen disassociation curve, draw, oxygen content equation, values for

arterial and venous blood. What happens when you are at altitude.

Clinical

1. 55 yr female for lap chole. Has mouth opening of 2cm. Explain Wilson’s

scoring system, what options are there for anaesthetic eg awake fibre-optic,

gas induction. What happens what you inflate the abdomen.

Physics

1. How can we measure cardiac output. Doppler – principle behind eg doppler

shift, what is the Doppler equation.

2. How do we measure temperature.

3. shown pics of venture masks. What is the principle behind this, what effect is

this. Clinical uses other than oxygen masks. Eg ventilator and nebs.

SOE set 18

Pharmacology

1. Could you list Non Anaesthetics effects of Inhalational agents?



38

2. How would you prolong drug action, tell me by what methods?

3. Classify Anti- Arrhythmic drugs? Draw action potential and explain where

each class of drug works. Any other group of drugs which does not fit in this

classification?

4. What is antibiotic Resistance and how do they develop this and how would

you deal with this?

5. Mechanism of drug action?

Physics:

1. Tell about closed circuit and how does this differ from other systems.

2. ABG machine: chemical reaction at each electrode and how?

Physiology

1. Non Shivering Thermo genesis, mechanism and how would you treat

this?

2. Cardiac output and factors affecting CO, Frank Starlings Law?

3. Define Osmolality vs Osmalarity, how is it measured?

- How is concentrated urine made?

4. What is the difference between micro, macro and normocytic anaemia?

- How would you treat each of these?

SOE 16

Pharmacology Viva

1. Cholinesterase deficiency

- What are the causes of failure to breathe after giving sux? Tell me

more about the genetic causes.

- What tests do you know of?

- What is the management of sux apnoea?

- Is there any specific drug/product that you can give?

2. Receptors

- What types of receptors do you know? Can you give examples of ligands for

each?

- How do GPCRs work? Are there 3rd

or 4th

messengers?

- What about adrenoceptors?

3. Antihypertensives

- What type of antihypertensives do you know of?

- What perioperative problems can be caused by these?

- Which agents would you stop/continue perioperatively and why?

- Name specific side effects of these groups.

Physiology Viva



39

4. Cardiac AP

- Can you draw the cardiac pacemaker + myocyte action potential?

- Explain the phases. Which types of calcium channels in which phase?

- What are the important differences between these 2 action potentials and why

is this important physiologically?

5. Temperature control

- Name the modes of heat loss in a patient.

- What is the physiological response to a fall in core body temperature of 1C?

- How does this change under anaesthesia? What is the role of the

hypothalamus?

- Where are the thermoreceptors located? What is the role of the thyroid gland

in temperature control?

6. O2

- Draw the ODC and label the important points.

- How can we work out o2 content and delivery?

- Can you calculate the content of arterial blood/venous blood if Hb 15 and

SpO2 100%. Calculate the DO2.

- Why is the PaO2 multiplied by 0.0225? How does this change at altitude and

during diving?

Clinical Viva

7. 52 year-old female on an elective list for laparoscopic cholecystectomy. Past

history of severe PONV and on assessing her, mouth opening is only 2 finger

breadths.

- How would you assess this patient’s airway? Tell me more about the Wilson

score. What other tests could you do? How would you anaesthetise her?

Would you do a gas induction? Tell me how you would do an awake

fibreoptic intubation.

- What patient factors increase the chance of PONV? Surgical factors? What

measures would you take to minimise her PONV? How can you avoid giving

an opioid to this patient?

- What are the effects of laparoscopic surgery?

Physics Viva

8. How can you measure a patient’s temperature + tell me how they work? What

are the problems with mercury/platinum wire thermometers? What other

metals can you use? What method do you normally use in theatres? What else

do you need to obtain a reading? What materials are thermistors and

thermocouples made from?



40

9. What’s the Bernouilli principle? How is this used clinically? What is the

coanda effect? How is this important clinically? What equipment uses the

principle?

10. What’s the Doppler Effect? How exactly does the oesophageal Doppler work?

Why is this particular angle important? Where else do we use ultrasound?

What about duplex Doppler? How else can we measure cardiac output? What

is the Fick principle?

SOE set 17

Pharmacology

1. Benzodiazepines

- Talked about GABA receptor, what receptors are they? What goes through?

What else acts on them. Then details about Midazolam, when to give it, how

to give it. Pharmacokinetics of Midazolam

2. IV dose to time curve, can you draw it?

- What would a log transformation of this look like? 2 and 3 compartment

models? What is the mathematical formula for this?

3. Heparin and LMWH

- What is heparin? Where does it exist? How exactly does it work? When is it

used? Side effects? What to watch out for? Advantage of LMWH? Dosing

Physiology

4. Where would you encounter laminar and turbulent flow in body? Hagen-

Poiseuille formula, write it down. What happens if you double radius, increase

length etc

5. Oxygen transport in blood

- How is it carried in blood? Formula? How can I increase oxygen carrying

capacity and why does it have upper limit.

1. Neonatal physiology:Physiology by system, a bit more detail about surfactant

Physics

2. VIE

- Shown a schematic drawing of a VIE, what is this? How does it work? What is

critical temperature of oxygen, what is vapour? What happens if demand is

low? What are components on drawing? What is the backup? Pressure in

different components? What else is piped into theatre

3. Resonance and damping

Clinical

4. Young man with fractured femur. IDDM, taken Insulin and had food 2 hours

before injury

- What are the problems in this patient? How would you assess him in A+E,

does he need to go to theatre right away? What investigations are needed?

How to prepare for theatre?



41

- In theatre he gets incompatible blood because of mistake. How to deal with

this? Where does he go from here? What systems are effected? What treatment

can you give? How to follow this incident up? What is SHOT

- How to deal with his diabetes after theatre? Said sliding scale. Why? How to

set up sliding scale, what are the risks.

SOE set 18 Physiology viva

1. Physiological response to acute blood loss. What is a normal bp, HR,

cardiac output. Why would my CO and examiners CO be different?

Wanted me to mention cardiac index.

2. Shown a blood gas: pa02 15, pco2 8, pH 7.3. Talked about respiratory

acidosis. Asked about compensation. Wanted exact mechanism of

renal compensation (where in kidney, which ion channels etc).

3. Tell me everything you know about the immune system!!!!!

Pharmacology viva

1. Local anaesthetics.

- How do they work? Differences between lignocaine and

bupivicaine.

- What would I use in a Bier�s block? why? Toxic effects.

Management of toxicity.

- Write down the Henderson Hasselbach equation. What is pka.

what is pH?

2. Drug reactions.

- How would i manage a physiological drug reaction. Give

examples of idiosyncratic reactions.

- Asked about mechanism of Halothane hepatitis. Asked about

MH and sux apneoa briefly.

- Asked about Type 1-4 hypersensitivity reactions.

3. Drugs affecting stomach acidity.

- How is acid produced?

- Mentioned Na citrate at some point. Asked how it worked.

They wanted more than that it is an antacid.

- When do anaesthetists use PPIs.

Physics viva

2. Shown lots of symbols to identify (capacitor, inductor, resistor, amplifier,

diode).

- What is a capacitor.

- What is the insulator made of? Uses of inductors.

- Turned down my offer of drawing the defib circuit!

- What is a diode?

3. Blood warmers –



42

- Different types. Non electrical types.

- What temperature is blood warmed to?

- How does a thermistor work? What makes a good blood warmer.

4. What is dead space.

- Talked about Fowler�s method and drew graph. Asked to write down

Bohr equation.

- What is another way of measuring physiological dead space - wanted

me to mention Douglas bag?

SOE set 19

Clinical: 1. 47 year old female, for cholecystectomy. BMI 40, smokes 20 cigarettes a day:

- Focus on Obstructive sleep apnoea, changes in smoking, BMI, obesity and day

case surgery

- Would you prefer this patient to stop smoking and loose weight before surgery

- Incident: intraoperative st depression, management, differential diagnoses,

causes of ischaemia,

Pharmacology:

1. Inotropes, classification, which increase cAMP, how do they

work,

2. Protein binding: why is it happening, how does it happen,

displacement from proteins, what drugs, what

proteins they bind to

Physics:

1. Neuromuscular blockade- TOF, Tetanic stimulation, post titanic count

- Depolarising and non depolarising block

- Position of electrodes

2. Humidifiers:- types, how act, humidity and measurement

3. Pressure: - units, how do you measure and principles of gauges

Physiology:

1. Influence of breathing in 5 % CO2: control of breathing, influence of CO2 and

hypoxia on MV, changes in COPD

2. Cerebral blood flow, what is it and how much grey vs white matter, regulation,

all graphs of CO2, MAP, CMRO2, and Hypoxia, when is CMRO2 increased(

MH- increased Oxygen demand)

3. Anatomy and physiology of adrenal glands: cortex and medulla, hormones,

regulation of corticosteroids and mineralocorticosteroids,

SOE set 20 Pharmacology:



43

1. NSAIDS: name some example,

- tell me about Diclofenac – how can it be given, what are its

pharmacokinetics.

- Tell me about Aspirin, how is it different to diclofenac, what

are its pharmacokinetics

- Name some selective COX-2 inhibitors, what are the possible

complications of these

- What are the side effects of NSAIDS and why do they cause

these effects.

2. How are drugs transported across membranes

Diffusion – Graham’s and Fick’s laws of diffusion and an example

Facilitated Diffusion – what is this and how do we use it to our

advantage in disease (eg Cholera)

2. Antiepileptics: Tell me about different types and name some examples

Tell me more about Phenytoin – what is it? How does it work? How is

it metabolised,

Physiology:

1. Cardiac Action Potential:

- Can you draw a ventricular AP and a pacemaker AP and then

tell me how they differ

- Excitation contraction coupling for cardiac muscle

- Compare the structure of cardiac muscle with skeletal muscle

2. How does the kidney concentrate urine

- Start off by drawing me a nephron

- Do capillaries at the Bowmans’ Capsule differ from other

capillaries and how

- What happens at the Proximal Convoluted Tubule

- Tell me about the loop of Henle and why that is important

- Explain the countercurrent mechanisam

- What happens at the collecting ducts

- How is the release of ADH governed

- How does ADH affect the concentration of urine at the

collecting duct

3. Shown an ABG:

- pH 7.55 PaO2 18 PaCO2 3.3 BE +1 sBi 26

- Tell me which are the abnormal results

- What is pH

- What is sBi – is it different from normal bicarb

- Could someone breathing air have a PaO2 of 18? Why not?

- Can you write the Alveolar Gas Equation

- In what conditions might you find this blood gas

Clinical:

4. A 26yo female who is 12 weeks pregnant is in A&E. She has had an

8hour history of abdominal pain which is generalised but worse in the

RIF. Temp 39C, BP 85/50, HR100.

- What are your differential diagnoses

- How would you assess this patient for anaesthesia



44

- What could the causes of her hypotension be

- What anaesthetic technique would you perform

- After induction the BP remains low so you insert a CVP line. She

subsequently develops cardiovascular collapse – what could the causes

be?

How would you manage a tension pneumothorax in this patient?

Would you continue the operation in this patient?

- Would you continue the operation in a different patient?

- After induction of a patient using RSI you perform a laryngoscopy and

you can’t see anything, what would you do? – this did not proceed to

can’t intubate can’t ventilate

Would you wake the patient up?

When would you perform a GA C-section for a full-term pregnancy

What are the risks associated with GA in a patient with full term

pregnancy

Physics:

5. Shown a picture of Macintosh, Miller and McCoy blades and asked to

describe the salient features.

- On which type of patient do we use Macintosh

- On which type of patient do we use Miller

- What is different about the McCoy and when/why do we use it

- Where is the light source found on these instruments.

Can you draw a cross-section half-way down the blade of the

3. Electrical Safety:

- What determines the amount of damage to a person who sustain

electric shock

- What magnitude of current causes damage

- What do we do in theatre to reduce possibility of electric shock

- Tell me about the different types of equipment we use (ClassI-

III & Type B,BF,CF)

What is current leakage

- What is the difference between a shock from a battery and a

shock from the mains

- What else other than current affects the severity of the shock

- Can you draw a graph of how body sensitivity varies with

changing frequency of current

- What other measures can we take in theatre to reduce the risk

of electric shock

4. Measurement:

- What volumes cannot be measured using spirometry

- How do we measure FRC

- Tell me about Helium dilution technique

- Tell me about body plethysmography

- What else can body plethysmography be used to measure

Primary FRCA OSCE SOE -October 2011 · PDF filePrimary FRCA OSCE-SOE exam October 2011...

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