MCAI OSCE/ VIVA APRIL 2018
VIVA (Physiology)
1. CARDIOVASCULAR: Define EF , describe its formula , how to calculate EF , what techniques to calculate EF apart from ECHO, volume of EDV and ESV. what is NYHA classification, how to measure EF and pressures, how would you optimise patient with poor EF in preoperative period.
2. CARDIOVASCULAR: Define stroke volume , define and describe it’s formula , how to measure and cardiac output.
3. NERVE ACTION POTENTIAL: define resting membrane potential. It’s value of ion differences intracellular and extracellular, draw and describe nerve action potential. Draw and label, what happen at each point, saltatory conduction.
4. VASOPRESSIN: describe origination and function and regulation, what is it, site of production, mechanism of action, what stimulates/inhibits production, effects. What is osmolality, how does it differ from osmolality, how to calculate, how body detects changes.
5. OXYGEN DISSOCIATION CURVE: oxygen content formula , values, why sigmoid shape, causes of left/right shift, how is O2 transported, double Bohr effect.
6. ABG , how to perform , how to measure PH , precautions
VIVA (Pharmacology)
1. ANTIARRHYTMICS - Draw and label cardiac action potential. What happens at each phase. Vaughn Williams classification of antiarrhythmics and show on the diagram of cardiac AP how they act, which drugs to give at which scenario
2 NEUROMUSCULAR BLOCKING AGENTS - differences in depolarising and non depolarising block at NMJ. MOA of sux and side effects
3. DOSE RESPONSE Curve - Draw and label, why use Log, efficacy, competitive antagonist, superimposed agonist and antagonist at same curve
4. SPINAL & EPIDURAL: which drugs can be given intratechal / epidural, mechanism of action of local anaesthetics, where specifically in the CNS does opioid act after neuraxial administration?, adjuncts, which drugs are contraindicated
5. PHYSICS - Oxygen storage, how its gets connected to ventilator , oxygen critical pressure and temperature.
6. CLINICAL MEASUREMENTS - Describe how u take ABG, how ABG machine/electrodes work (which values are measured or derived).
OSCE
1. Equipment
-Identify HME , function and mechanism of action
-Identify oxygen , helium and nitrous oxide cylinder
-Identify oxygen cylinder valve
-Identify bodok seal
2. Communication and History taking
From an anxious mother who has a 6 years old son going for surgery, to take history and address her concerns. She is concerned over her son’s fear of needle pricking and pain relief.
3. Clinical skill/procedure
Epidural
To describe anatomy and contents of epidural space
Steps of performing epidural
Indications of epidural (more than 3 indications)
Risks and complications of epidural
4. Airway equipment and labeling
Label ETT
2 uses of murphy’s eye
Identify south RAE and north RAE
Identify Classic LMA and flexometallic LMA
Identify and State 2 functions of flexometallic ETT
5.Communication
To explain to the patient who undergone surgery and ventilated post op for 12 hours due to suxamethonium apnoea.
6. ECG
To Identify second degree heart block , list it’s causes and management
Label position of limb leads and chest leads
Explain uni-polar and bipolar limb lead
7.Radiology ,cxr
Pacemaker and precautions during intubation and ventilation
Left aortic region opacity, mediastinal mass, diagnosis , and why it causes hoarseness of voice
8.MRI
Indication and contraindication
Principle of MRI
Problems anticipated in MRI
Difference between T1 and T2
9. CPR
A 50 years old man stabbed in the scene , abdominal stab wound with profuse bleeding. You attended him in the scene. Cardiac monitoring shows VF
10. Physical examination
Respiratory examination
11.Crisis simulation and management
65 years old, male, ESRF , post induction, given LA , post LA given , BP 79/55 HR 45 sats 100
Diagnosis - LA toxicity , discuss management as per AAGBI guideline in detail
12.Crisis simulation
Preoperative AF
65 Years male, ASA III, BP 139/95 mmHg, HR 144 in AF, Sats 95%
Identify causes of AF and likely cause for this pt
What medication you want to give and dosage
Monitor Then shows BP turn 90/55 mmHg
What to do next
What are signs of unstable tachycardia
Post stabilization , will you proceed for op
-No, to stabilize and monitor in ICU.
13. Data interpretation
Turp syndrome
Calculator anion gap , serum osmolality , Why serum osmolality can still be normal in this case
Management of TURP syndrome
14. Airway management
Discuss fail intubation guideline
Landmark for cricothyroidotomy
15. Discuss management of polytrauma pt with cervical collar for op
ABCDE approach
Modes of intubation
16. TAP Block
Label layers
Origin of anterior abdominal wall nerves
Indicated in which surgeries
Complications