ANAKAYUB's Notes

 MCAI OSCE 6th Nov 2019

Station 1: CPR. A&E Department, patient experienced chest pain and was found unconscious and slump on the floor. Assess the patient.
- CPR As per ALS guideline
- VF, unsynchronised cardioverted x 2
- IV Adrenaline during RESSUSITATION
- Identify the 5H 5T

Station 2: Please Measure pulse, JVP, BP
- How to choose the correct cuff size
- Explain in detail how you measure the BP
- What are the korokoff sound?
- What happen if you pick a cuff that’s too big/too small
- How to measure JVP? Triangle neck, characteristic, the hepatojugular reflex, waveform of JVP
- Site of pulse, rhythm

Station 3: you just induced a ENT case, and the nose was packed with patty of co-phenylcaine. Initially vital sign normal and subsequently noted Intra operative hypertension. 200/90.
- Cause of intraoperative HTN
- Drugs to be considered in managing HTN intraoperative
- Investigation you will send post op? - thinking of pheochromocytoma/thyroid storm.

Station 4: ASA 1,you just induced a case for laparascopic cholecystectomy, Noted hypotensive and bradychadia suddenly.
- Cause of hypotensive and Bradychadia
- (Not responsive to ephedrine and adrenaline and atropine)
- Subsequent steps and management
- Complication of laparoscopic surgery

Station 5: You have a patient who’s just undergone coronary bypass graft surgery, intubated with direct laryngoscopes was impossible and was subsequently intubated with video laryngoscopy . Post op transfer to ICU, You are now about to walk in, approach from there
- How would you asses if this patient is suitable for extubation
- What precaution will you take?
- What blood Ix will aid you in decision making of extubation.
- If this patient is not fit for extubation, what subsequently management you will do?
- How do you manage a difficult airway patient post op - DAS

Station 6: Electrical symbols
- electrical safety (type BF, CF, B, double insulator or with defibrillator safe)
- defibrillator - symbols in defibrillator circuit, what is effect of applying force of the pedals,
- define power and state it’s unit,
- define energy and its unit,
- define charge and its unit.
- Define work, and its unit

Station 7: Peripheral nerve stimulator
- Method of monitor neuromuscular blockade
- Explain about double burst, TOF, single twitch
- Site of application
- Explain different between peripheral and percutaneous nerve stimulator
- What is the current use in peripheral and percutaneous NS

Station 8: Counselling
- You are attending a lady who is planning for a Total Hip Replacement and was noted to have a murmur. ECG and CXR have been send but is pending. How would you approach this patient (further history and examination is not needed)

Station 9: Counselling
Susan Jones, 35 years old, planned for total hysterectomy tomorrow, her Hb was noted to be 9.5g/dL. She is a Jehovah witness and refused transfusion of ALL blood product. Please speak to her of the management of anaesthesia.

Station 10: Spinal needle (attached a needle, LA heavy macaine, and introducer)
- Identify the needle and describe the characteristic and it’s use
- Significant of the needle displayed
- Shown another needle - introducer
- What does “heavy” means?
- What affect the spread, risk of using spinal needle, significant of pencan

Station 11: ECG
- 4 diff ECG (broad complex tachyarrythmia, heart block?, WPW)
- Diagnosis and investigation for each of the ecg.

Station 12: ECG
- Atrial fibrillation, medication to serve and it’s dosage.
- PR interval, QRS interval, QT interval

Station 13: CT brain.
- SAH ?hydrocephalus.
- Risk factor and presenting symptoms?
- What are the cause of hydrocephalus?
- What's the role of lumbar puncture? Diagnosis to be diagnosed
- What impact on the ECG and in terms of hemodynamic changes
- CSF in spinal cord? Volume?

Station 14: Anatomy
- Cross sectional of spinal cord, pain pathway
- Total CSF volume
- Identify Fasciculis Gracilis and cunateos and what fibre passed through here
- What’s in the dorsal root ganglion?
- What’s in the grey matter and white matter?
- What modalities are detected by the anterior spinal thalamic tract

Station 15: Vitalograph and arterial line waveform
- What is the FEV1, FVC, then the FEV/FVC
- What’s the normal ratio?
- What the likely diagnosis from here.
- Obstructive pattern
- Artline waveform, identify the ventricular contraction, aortic valve opening and closing.
- Identify the under-damp waveform, causes of damping, what’s the changes to the MAP.

Station 16: Trauma - patient planning for laparotomy.
- airway assessment in trauma
- How to secure airway in trauma with cervical spine immobilisation
- What are the feature of patient with cervical spinal cord injury?
- What’s the anatomy of cervical vertebrae?
- What intraoperative difficulty you anticipate intra-operative beside the airway?

Special thanks to Benedict. Ng BJ and Olivia