MCAI OSCE 16th Nov 2022
1. ACLS pulseless VT
Mr Smith, who has his TPN accidentally disconnected in the ward earlier, became unconscious, please attend to him.
No respond, no pulse. Attach monitoring, pulseless VT.
Chest compression to ppv ratio.
Defibrillation, iv adrenaline and amiodarone dosage.
2. Ecg (unmanned)
4 ecg.
SVT, non pharmacological management
Sr. Comment on axis and explain
AF. Concern bout cardioversion
Tall tented t wave. Management of hyperK
3. Upper limb neurological exam
30 year old girl, post op complaint of Upper limb numbness. Perform neurological examination.
How do you grade power strength.
4. Hypotension tachycardia (anaphylaxis)
Scenario: a patient is just anaesthesised, with iv propofol, fentanyl and atracurium. Currently is on maintainence o2/sevoflurane/Air and received iv morphine. You took over the patient. He has underlying hypertension on ace inhibitor, and he just took it this morning. He required boluses of phenylephrine. Please proceed.
-what were in your mind?
- what is the possible cause?
Then saturation going down in monitor, bp 60/20, etco2 getting lower
- what is the management of anaphylaxis
5. A patient is arranged for a spine surgery. Induction was uneventful and he is now in prone position. You took over the case. Please proceed.
Normal Etco2 waveform suddenly read 0
- what is your immediate respond?
- differential?
- describe a normal capnography?
- comment on different type of capnogram shown
6. A pregnant lady mallampati ii is in theatre for emergency caesarean for severe fetal bradycardia. You did an RSI with cricoid pressure, CL3. Please proceed
7. Dermatome
Label the diagram
8. Spinal cord
Label diagram
What is in grey matter
What is in white matter
Describe sensory pathway (spinothalamic and dorsal column)
What is the normal csf volume
Where does spinal cord start and end
9. Communication
Awake fibre optic (communication)
60 year old lady with pshx of jaw fixation, having a limited mouth opening. She is scheduled for gynaecology laproscopic surgery. Explain to her how you going to intubate her.
10. Awareness (communication)
40 years old lady is scheduled for laproscopic cholecystectomy. She is anxious because she had history of awareness during her previous surgery many years back. Explain how you going to perform GA on her.
11. Nerve stimulator
Describe the principal, interpretation and usage of nerve stimulator
12. Cxr (left lung collapse)
Unmanned
Shown a picture of hyperinflated right lung with homogenous opaques left lung, with shifted tracheal and mediastinum to the left. Differential, possible causes, investigation, procedure.
13. Turp syndrome (data interpretation) unmanned
- anion gap and osmolarity
- outline Turp syndrome management
14. Anaesthetic machine and diathermy (unmanned)
Label the parts
Content of soda lime.
Diathermy mode, principle of diathermy., different between monopolar and bipolar. Usage of diathermy
15. Hypothermia definition
Mechanism of heat lost
Percentage of increase in oxygen consumption
Effect of hypothermia on various organ, including the eyes.
Special thanks to C.A et. al.