MCAI OSCE 9th March 2022
OSCE Paper 1
1. Patient post laparoscopic cholecystectomy deteriorate in ward
a. describe in detail what are the steps to do according to BLS if u are single person responder (5 marks)
b. List 2 shockable and 2 non shockable rhythm (4 marks)
c. What are the 4H and 4T?
d. 2 medications and dose to give if this is pulseless VT
e. What to do if this is VT with pulse but patient stable
f. What to do if patient is VT with pulse but unstable
g. How often u can give shock to patient if this is pulseless VT
h. What are the most likely causes for this uncle to have collapsed? List 3
i. Clinical signs to determine patient unstable
2. Atrial flutter (exactly same ECG, taken from LITFL)
a. Identify the rhythm and diagnosis. What degree is this?
b. 3 causes of this ECG
c. Medical management
d. Management if unstable
3. Patient underlying hypertension. Intra-op BP 150/90. HR 120. No fever, no desaturation
a. Cardiac monitor showing ST depression - To identify the ST depression
b. How do you control BP
c. Repeated ECG - ST elevation
d. Immediate management before definitive treatment
e. What single drug is the most effective?
4. Coronary circulation anatomy
a. Label the blood vessels [6m]
b. Where does LCA and RCA arise from?
c. Where does the cardiac veins drain into? 2 sites.
d. Cardiac autonomic supply.
5. CVS examination
a. First thing to do when approach patient
b. Photo of pectus excavatum [1m]
c. Photo of pectus carinatum [1m]
d. Where is the apex beat?
e. What are the characteristics of abnormal apex beat? [2m]
f. What is a thrill?
g. What does parasternal heave signify? Where and how do you check for parasternal heave?
h. What is the location to auscultate for aortic valve? [1m]
i. What is the location to auscultate for pulmonary valve? [1m]
j. What is the location to auscultate for tricuspid valve? [1m]
k. What is the location to auscultate for mitral valve? [1m]
l. What is the difference between auscultating using the diaphragm and the bell of the stethoscope? [2m]
6. Bradycardia in laparoscopic surgery
a. How does laparoscopic surgery cause bradycardia
b. 3 side effects of trendelenburg position
c. 3 side effects of reverse trendelenburg position
d. What other complications of laparoscopic surgery?
e. How to manage if patient develops bradycardia during laparoscopy surgery
7. Old lady develops fast AF - Count the rate from ECG, list causes, management
a. Arterial line waveform. Label starting of ventricular contraction, aortic valve opening, aortic valve closure. [3m]
b. Artline waveform showing overdamping - to identify
c. Factors that caused damping [5m]
d. What would the MAP be if the factors causing damping is rectified? [1m]
8. Iiioinguinal and iliohypogastric block
a. Nerve root?
b. Muscles of the anterior abdominal wall? [4m]
c. Which layer to block on ultrasound?
d. Name another 2 nerves that arise from lumbar plexus
e. Indications for ilioinguinal block? [2m]
f. LA volume and doses?
OSCE Paper 2
1. Chest tube
a. Label parts of an underwater seal chamber. [3m]
b. What will happen to the fluid level in normal condition? [1m]
c. Device factor causing chest tube not oscillating? [2m]
d. Patient factor causing chest tube not oscillating? [2m]
e. What causes persistent bubbling? [2m]
f. What precaution when transferring a patient from one bed to another bed?
g. 2 common insertion sites for chest tube? [2m] h. What are the indications for chest tube insertion? [2m]
2. A lot of CT brain films (basically to be able to describe the CT brain is more important than knowing the diagnosis) - ? cerebral infarct with hemorrhagic transformation - Intracerebral haemorrhage - SDH -> why you say so? (crescent shape) - Some intracranial tumour causing obstructive hydrocephalus - Given some brief clinical scenario - to be able to identify the GCS (3 marks)
3. Clinical interpretation ABG: pH 7.15, pCO2 2.8kPa, PO2 12kPa, HCO3 16, BE-20
a. What abnormalities in the ABG [3m]
b. Interpretation of the ABG (uncompensated metabolic acidosis)
c. List 2 diagnosis that could manifest the above ABG
4. Electrical safety
a. Box with human - what is it?
b. What is BF
c. Box with human with 2 lines at the side
d. Circuit diagram for defibrillator. Label
e. Define power in electrical terms. SI unit. [2m]
f. Define capacitance
5. Cat 2 Ceasarean section
a. What are your preparation for difficult airway pre-op [3m]
b. What is Mallampati score? How to assess [5m]
c. What is your preparation for RSI [3m]
d. How do you actually perform RSI in this patient [4m]
e. Difficult airway in this woman, managed to oxygenate and ventilate with LMA. what is the 1 risk factor that will make you decide to wake the patient up and perform another approach? [1m]
6. Ms Jon. 37 years old. ASA I, planned for TKR. Had history of MVA many years ago.
a. What is the first thing that you do when you meet her? [2m]
b. Patient express concern about being awake during the surgery and feeling pain. How do you approach? [2m]
c. Patient scared of needle. What do you tell her? [2m]
d. Patient ask about post-operative analgesia. Give 3 method. [3m]
e. Patient worry about PCA morphine side effect. What are the safety precautions to prevent the side effects? Give 3. [3m]
f. Patient opted for GA as well as regional anaesthesia. What are the options that you would offer her? [2m]
7. Someone had epidural anaesthesia for Ceasarean section. Accidentally punctured dura. Complain of headache.
a. What is the first thing you do when you enter the room to meet her?
b. What further history u want to ask about the nature of presenting complains? At least 3
c. What further specific symptoms that you would like to ask? [3]
d. How do you explain to the patient about the complication that she is suffering?
e. Patient asks what are the management plans? [3]
f. What definite treatment can be given if the above management plan failed? Success rate?
g. How is the intervention carried out
h. Risk of the intervention
Special thanks to Lim WY et. al.