Primary FRCA: OSCEs in Anaesthesia

310 Pages·2013·15.79 MB·English

by  William Simpson

Primary FRCA: OSCEs
in Anaesthesia
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Primary FRCA: OSCEs
in Anaesthesia
William Simpson
SpecialistRegistrarinAnaesthesia,NorthWesternDeanery,Manchester,UK
Peter Frank
SpecialistRegistrarinAnaesthesia,NorthWesternDeanery,Manchester,UK
Andrew Davies
SpecialistRegistrarinAnaesthesia,NorthWesternDeanery,Manchester,UK
Simon Maguire
ConsultantAnaesthetist,UniversityHospitalofSouthManchester,UK
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Firstpublished2013
PrintedandboundintheUnitedKingdombytheMPGBooksGroup
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary
LibraryofCongressCataloguinginPublicationdata
Simpson,William,1983–
PrimaryFRCA:OSCEsinanaesthesia/WilliamSimpson,traineeanaesthetist,NorthWesternDeanery,
Manchester,UK,PeterFrank,traineeanaesthetist,NorthWesternDeanery,Manchester,UK,Andrew
Davies,UniversityHospitalofSouthManchester,SimonMaquire,consultantanaesthetist,NorthWestern
Deanery,Manchester,UK.
pages cm
Includesbibliographicalreferencesandindex.
ISBN978-1-107-65223-1(pbk.)
1. Anesthesiology–Examinations,questions,etc. I. Title.
RD82.3.S485 2013
617.906–dc23
2012040703
ISBN978-1-107-65223-1Paperback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceor
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Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformation,whichisin
accordwithacceptedstandardsandpracticeatthetimeofpublication.Althoughcasehistoriesaredrawn
fromactualcases,everyefforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.
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hereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychangingthrough
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topaycarefulattentiontoinformationprovidedbythemanufacturerofanydrugsorequipmentthatthey
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Contents
Preface pageix
Acknowledgements xi
Section 1. Anatomy Section 3. Communication
1. Trachea 1 Introduction 63
2. Brachialplexus 3 Scenarios 65
3. Greatveinsoftheneck 7 1. Sicklecelltest 65
4. Antecubitalfossa 9 2. Rapidsequenceinduction 67
5. Ankleblock 11 3. Suxamethoniumapnoea 68
6. CircleofWillis 15 4. Cancelledsurgery 70
7. Coronarycirculation 17 5. Toothdamage 71
8. Baseofskull 21 6. Jehovah’sWitness 72
9. Diaphragm 23
Section 4. Equipment
10. Spinalcord 25
1. Diathermy 75
11. Wrist 29
2. Defibrillators 77
12. Larynx 31
3. Laryngoscopes 79
Section 2. History taking 4. Endotrachealtubes 89
Introduction 35 5. Breathingcircuits 95
1. TURPsurgery 43 6. Airways 99
2. Laparoscopiccholecystectomy 45 7. Vaporisers 103
3. Thyroidsurgery 47 8. Scavenging 107
4. Shoulderreplacement 51 9. Medicalgases 109
5. Caesareansection 55 10. Filters 113
6. ENTsurgery 59 11. Ventilators 115
v
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ts Section 5. Anaesthetic 5. Displacedtracheostomy 183
n
e
nt hazards 6. Paediatricemergency 187
o
C
1. Electricity 119 7. Intraoperativedesaturation 191
2. Lasers 123 8. Tachyarrhythmia 195
3. Positioning 127 9. Anaphylaxis 197
4. Bloodtransfusion 131 10. Obstetrichaemorrhage 199
Section 9. Procedures
Section 6. Radiology
1. ChestX-ray 135 1. Lumbarpuncture 203
2. ChestX-ray 137 2. Chestdrain 207
3. CThead 139 3. Epidural 210
4. Cervicalspine 141 4. Surgicalairway 215
5. Angiogram 145 5. Centralvenouscannulation 217
6. Intraosseousaccess 221
Section 7. Physical examination
7. Anaesthesiaoftheeye 223
1. Cardiovascularexamination 147
8. Rapidsequenceinduction 225
2. Respiratoryexamination 151
Section 10. Monitoring and
3. Cranialnerveexamination 155
measurement
4. Obstetricpreoperative
assessment 159 1. Capnography 231
5. Peripheralcirculation 2. Centralvenouspressure
examination 163 trace 235
6. Airwayexamination 167 3. ECG1 239
Section 8. Resuscitation and 4. ECG2 241
simulation 5. Humidity 245
1. Bradyarrhythmia 171 6. Invasivebloodpressure 249
2. Collapsedobstetricpatient 173 7. Respiratory1 253
3. Malignanthyperthermia 175 8. Respiratory2 257
4. Failedintubation 179 9. Noninvasivebloodpressure 261
vi
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10. Oxygenmeasurement1 265 15. Rotameters 281 C
o
n
11. Oxygenmeasurement2 267 16. Temperature 285 te
n
t
s
12. Pulmonaryarterycatheter 269
13. Nervestimulators 273
14. Pulseoximetry 277 Index 290
vii
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Preface
The Primary FRCA is a formidable examination and not all trainees will leave the Royal
College with the sweet taste of success. The syllabus is wide and deep while the three
examinationareasandtechniquesarealsovaried:
(cid:2) Amultiplechoicequestions(MCQ)paperincorporating60multipletrue/false(MTF)as
wellas30single-bestanswer(SBA)questions
(cid:2) TheStructuralOralExamination(SOE).Thisisdividedintotwoparts:
SOE1–concernedwithphysiologyandpharmacology
SOE 2 – examines knowledge of clinical anaesthesia, physics, clinical measurement,
equipmentandsafety
(cid:2) TheObjectiveStructuredClinicalExamination(OSCE)
The aim of the OSCE examination is to test procedural and cognitive skills, which are
underpinned by knowledge. The OSCE is composed of up to 18 stations, of which 16 are
liveandmarkedforthepurposesofthatsittingoftheexamination.Theotherstationsareon
trialandbothexaminersandexamineesareunawareofwhichtheyare.
Thestationshavegeneralthemes,whichare:
(cid:2) Resuscitation
(cid:2) Technicalskills
(cid:2) Anatomy
(cid:2) Historytaking
(cid:2) Communicationskills
(cid:2) Anaesthetichazards
(cid:2) InterpretationofX-rays
(cid:2) Simulation(usuallyacriticalincident)
(cid:2) Equipment(anaesthetic,monitoring,measurement)
(cid:2) Physicalexamination
Eachstationismarkedoutof20butthepassmarkforeachstationmaybedifferentandis
assignedbytheAngoffmethodbytheexaminers.ThepassmarkfortheOSCEexamination
isthesumofthepassmarksfortheindividualstations.
TheMCQmustbetackledandpassedbeforeapplyingfortheSOE/OSCE.Thesemustbe
takentogetheratthefirstattempt.Ifonesectionisfailed,thenthatsectiononlyneedstobe
retaken. There has been a general feeling among trainees that the SOE was the ‘difficult’
section while the OSCE would generally sort itself out with the knowledge gained from
studyingfortheMCQandSOE.Ithasbecomeincreasinglyclearoverthelastfewyearsthat
the OSCE section demands more respect and consideration. There are many trainees who
have been successful in both the MCQ and SOE sections but failed the OSCE by some
margin.
ix
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e The OSCE provides most trainees/departments/regions with a logistical headache.
c
a
ef OrganisingacourseforMCQrevisionorSOEpracticerequirestime,personnel,determin-
r
P ation and planning. Any OSCE course demands all of that plus equipment and therefore
revisionfor,orexposureto,arealisticOSCEenvironmentpriortotherealexaminationcan
bedifficultandpatchy.
Thisbookisaimedatprovidingtraineeswithamorestructuredapproachtorevisionfor
the OSCE. It has been written by three trainees in the North Western Deanery who have
passedtheirexaminationsinrecentyearsand,therefore,theirknowledgeisfreshandup-to-
date. It includes questions that have appeared in the RCOA examination. It covers all the
maincomponentswithsamplequestionsandanswerstoeach.Italsoprovidessuggestions
abouthowtoapproachsomeofthesections,suchashistorytaking.
Itwillnotprovideyouwiththeexperienceofatimed,noisy,bell-ringingOSCEandwe
wouldcounselyoutotryandsupplementthisbookwiththatexperience.
Thebookwillbeusedasarevisionguidebyindividualsbutwouldalsobebeneficialfor
groupsoftraineeswhoarerevisingtogetherfortheOSCEexamination.
WewishyoutheverybestofluckandtoquoteBenjaminFranklin:
‘Diligenceisthemotherofgoodluck’.
WS
AD
PF
SM
x
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