ANAKAYUB's Notes

 MCAI OSCE 5th Nov 2019

Station 1 (CPR): You have a patient who is a known case of chronic renal disease, found unresponsive in the ward. You are called to the scene.
- CPR approach as per ALS
- Defibrillator: VF, shocked x 2
- Adrenaline and Amiodarone 300mg 20-60 minutes
- Identifying the 5H 5T
- Organised rhythm, ROSC - post cardiac RESSUSITATION care

Station 2: ECG interpretation x 2
- Morbitz Type 1 heart block?
- Management? Risk factor?

Station 3: Another ECG (5 ECG)
- SVT, Atrial flutter, Sinus tachychadic, Identify area that have MI, hyperkalemia.

Station 4: Patient have just completed a surgery in prone position with head rotated and arms on arm board, now he complained of numbness of upper arm, patchy sensation. Please do complete neurological examination.

Station 5: SimMan simulation. Patient was given atracurium and thiopentone during induction and was also given morphine and maintained with Sevo/O2. You just took over the case.
- Monitor shows hypotension MAP 40, tachycardic (up till 145bpm), capnography reducing trend.
- What’s your differential diagnosis?
- Tell me about Anaphylaxis management (intra - and post operative management)

Station 6: SimMan simulation. You are to interpret Capnography Monitor shows normal capnography and suddenly become flat line.
- What’s your differential diagnosis? PS: HR, BP, Saturation are all NORMAL. ?Disconnection.
- Asked to interpret different capnography waveform.
- For eg. Air trapping/COPD, hypercarbia and hypocarbia.

Station 7: CXR - Pulmonary TB/Lung cancer?
- White patch over the right upper zone, ?consolidation/mass.
- Management based on the CXR.

Station 8: Anatomy - diaphragm
- the orifices at what level it open and the structure it passed through,
- what is congenital diaphragmatic hernia and the clinical sign and the investigation to confirm the diagnosis

Station 9: Identify different ETT Varities.
- LMA, Re-enforced LMA, RAE tube South facing and north facing.
- ETT: Murphy eyes (identify) and what’s the function
- Cuff design: high pressure low volume (or opposite) and when do you use them.

Station 10: Airway assessment in trauma
Patient had an alleged trauma, GCS 5, facial trauma, blood in oral, gargling sound.
- How do you approach this case? ATLS guideline - A+ cervical spine immobilisation and BCDE.
- You were unable to intubate the first time, with BURP? What is your plan? (Gum elastic bougie, change laryngoscopes, videolarygoscope)
- Despite that still fail intubate? Next plan? Fail Plan B also. Next? Plan C then eventually tracheostomy.

Station 11: MRI machine
- What is the principle of MRI Machine
- When do you need an MRI imaging
- What’s Tesla?
- What difficulty you anticipate during when Anaesthetize a patient in MRI suite?

Station 12: Pacemaker
- what does the alphabets on pacemaker signify? VVI, DDV
- Perioperative assesment of a patient with pacemaker?
- What is the five question you would like to ask the patient before anaesthesia.
- During the surgery, what consideration would you have? Especially diathermy use. How do you want to tell surgeon?
- In the case of VF during surgery, what’s your plan?

Station 13: Suxamethonium apnea
Your patient have just done an appendicectomy and was ventilated in ICU for 12 hours. Now she’s extirpated and she’s anxious about her condition, please explain to her what have happened.
- Patient concern: what test to be done? Can i have another surgery? Does she have any complication she would be worry of? Will this sux apnea occur with another drugs?

Station 14 Arterial blood gas monitoring - data interpretation
- Interpret and write down the diagnosis
- Post anaesthesia, hypercarbia and hypoxia. Most likely diagnosis?
- Opioid induced Respi depression/Inadequate reversal
- What’s your management?

Station 15: Epidural procedure and risk, anatomy
- When do you an epidural?
- What are the structure you are going through when doing an epidural
- What are the complications of epidural
- What is inside the epidural?
- Describe how you insert an epidural?
- Where does the spinal cord and dural sac ends?

Station 16: Awareness
Patient is planned for laparoscopic cholecystectomy, she had a bad previous anaesthetic history. Talk to patient regarding general anaesthesia
- Patient have awareness. Explicit memory recall - feeling someone touching the throat, and needed to give more sedative to let her sleep. Was followed up in anaesthetic clinic previously.
- Talk about the strategy to minimise awareness with the patient
- Address concern
- Reassurance.

Special thanks to Yeoh JC