Primary OSCE 2

1. Data interpretation  
Following massive transfusion, a patient is found to have deranged clotting. You are asked to interpret the results.

2. History   
Take a full history from an arthritic patient undergoing metacarpophalangeal joint replacement.
3. Equipment  
- Correctly connect an HME filter and sidearm CO₂ analyser to a Bain circuit
- Describe the points of interest on a normal capnograph trace
- Identify a trace showing disconnection and re-breathing
- Why does the sidearm sampler tubing have to have a small diameter?

4. Communication  
A drug addict is about to undergo appendicectomy.
- Talk to him about prescription methadone
- Discuss his concerns about not having received methadone since admission to hospital
- Address his anxiety about becoming re-addicted to opiates given for postoperative analgesia

5. Resuscitation station 
- Perform basic life support on a dummy
- Correctly complete an algorithm to treat the rhythm shown on the cardiac monitor (ventricular fibrillation)

6. Statistics 
- What is the difference between nominal, ordinal and categorical data? (Type 1 and 2 errors)
- What can you do to reduce type 2 error?

7. Examination  
Assess the Glasgow Coma Score of a patient (played by an actor)

8. Chest X-ray
In the lateral view, it appears as though the patient has a hiatus hernia. 
- Would you give antacids and pass a nasogastric tube preoperatively in this patient?

9. History
A 20-year-old female presents for laparoscopic sterilisation. When asked specifically, she mentions that she has recently been jaundiced but this was not investigated. She is a smoker and has a cough.

10. Anatomy
- Name the layers of the heart
- Where are the sinoatrial (SA) and atrioventricular (AV) nodes?
- Where are the origins of the coronary arteries?
- How many cusps have the mitral and aortic valves?
- Where are the sinuses of Valsalva?
- Describe the normal coronary angiogram (i.e. name the major vessels and the territory supplied by the left anterior descending [LAD] coronary artery)

11. Temperature measurement
You are shown photographs of a nasal probe and an axillary probe.
- What are these?
- How do they work?
- Describe resistance temperature curves for each device
- What reference temperature does a thermocouple use?
- What is the triple temperature of H₂O?
- What is the core temperature and how do you measure it?

12. Anatomy
You are shown a model of the vertebral column.
- Identify the pedicles, lamina, facet joints, foramina, ligament denticulatum
- Describe the margins of the epidural space and the upper and lower limits of the cord
- Where is the sacrococcygeal membrane?

13. Electrical hazards
- What current magnitude can cause microshock?
- What techniques are used to safeguard from this common earth?
- Identify four electrical symbols

14. Machine check
In this case, there are no volatile gases; remember to connect the O₂ analyser to the circuit, as well as calibrating it.

15. ECG interpretation
The ECG shows LVH and angina, and the patient is hypertensive.
- Would you postpone carrying out elective surgery on this patient?