MCAI OSCE 15th November 2022
1. Critical incident 1
Simulation hypotension pneumothorax
70 year old guy undergoing laparotomy for I/O, central line was inserted at right IJV
Normal vitals, then spo2 suddenly drop
HR high, BP low, CO2 increasing, temp normal
Whats your action? Call for help, highflow o2, check circuit,
auscultate, communicate with surgeon
What's your differential diagnosis?
How do you diagnose a pneumothorax?
What are the causes of pneumothorax?
What is your immediate action? How do you do emergency thoracotomy, what
level? Where would you then insert the chest tube? What is safety triangle?
2. Critical incident 2
Symptomatic bradycardia
40 year old lady undergoing laparoscopic hysterectomy
Initial vitals normal, then bradycardic and hypotensive BP 70/40, HR 38 sinus rhythm
What is your immediate action?
What is your differential diagnosis?
What medication would u give? (answered atropine and ephedrine)
How much of atropine would u give? How much of ephedrine would u give?
3. Rest station
4. Clinical skills- Airway (1 examiner)
DAS algorithm, FONA (front of neck access)
40 years old guy for Emergency exlap with I/O, you’ve given fentanyl, propofol and suxamethonium, you are still unable to intubate
What doyou do next? How many attempts? How would u attempt them?
after LMA, how many attempts?
If failed with bag mask ventilation, what next?
Demonstrate how you would identify cricoid
What equipment do you need for FONA?
Describe how you would perform an open cricothyrodotomy
5. Anatomy (unmanned)
Brachial plexus
Label structures A to G
Side effects of interscalene block
Risks with supraclavicular block
Max dose of lignocaine, lignocaine plus adrenaline, bupivacaine, ropivacaine
6. Communication (2 examiners)
40 year old lady had an appendicectomy. She was ventilated for 12 hours post op in ICU. You think it might have been suxamethonium apnoea.
She wants an explanation of what happened. She's really anxious, kept asking about if it will happen again, if she should get tested and if her family has to.
Was there a mistake, did they give me the wrong drug, is it common for this to happen etc
7. Radiology (1 examiner)
MRI
What is MRI?
What is it used for?
What is the difference between Type 1 weighted and Type 2 weighted MRI?
What are risks involved with patient undergoing MRI imaging?
What is Tesla? What is the normal Gaussian unit for MRI/earth?
8. Ultrasound (unmanned)
What is the range of sound waves humans hear?
What is range for linear probe
What is range for curvilinear probe
Ultrasound will not reflect waves more than how many nm
Clinical uses for ultrasound
9. Xray (unmanned)
Lady who underwent chemo/mastectomy, consolidation of left mid zone to lower zone
What is the diagnosis
What is your differential
What is your management
What drug would be beneficial in the treatment of this condition?
10. Data interpretation- Capnography / pulmonary function test (unmanned)
Vitalograph FVC read 3L, FEV1 reads 1.2L
What is the FEV1/FVC ratio
What is the diagnosis
What are 2 medications that would be useful
Why would beta agonists help
11. Equipment - Mapleson (1 examiner)
4 real life pictures of Mapleson A,B,D,F
What is this part, points to 1 by 1, name, what is it used for
What is FGF needed for these circuits
What’s the advantage of Mapleson F
12. Resuscitation-VF (2 examiners)
40 year old man with chest pain, collapse, you found patient on the
floor. Approach pt
How do you approach pt? - DRABCD
What rhythm is this?
How do you attach monitor to defibrillator
How do you perform CPR correctly
What is the ratio of CPR to breath if 2 rescuer and 1 rescuer
How much would you charge the biphasic and monophasic defibrilator for VF
What drugs would u give
What do you think is the cause
Post resus care
13. Communication-Mask phobia (2 examiners)
40 years old lady undergoing ex-lap for perforated colon post scope. You are required to see her for pre-op assessment.
Asked her proper history, ASA 1, no allergy, no previous surgeries,
no major issues detected, so candidate was unsure what the station for until candidate asked do you have any concerns about the surgery.
She then reveals she was scared of wearing masks since COVID, even tho if it’s RSI. she refuses mask. Only barely touched flavoured masks and HFNC, kept talking about her anxiety, a lot of reassuring was needed
14. ECG anterolateral STEMI (unmanned)
What is the diagnosis?
What is the cause?
15. Equipment- One lung ventilation (unmanned)
Cartoon picture with double lumen ett
Label anatomy
What surgery is this used for?
How is it used?