| OSCE 11 |
Other X-rays. Examples included CTs of infarcted basal ganglia, a parasternal mass, aortic dissection and adrenal haemorrhage, and X-rays demonstrating cervical spine subluxation. A list of abnormal findings was requested, as were potential aetiology and complications.
Seven out of twenty-three candidates passed this section.
(Radiology) - Pass rate ; highest mark . |
| OSCE 12 |
Clinical case. Material presented included a CXR showing cardiomegaly, pulmonary oedema, a pneumothorax, and a malpositioned pulmonary artery catheter; an ECG showing a new LBBB; blood abnormalities secondary to beta-adrenergic stimulation and the effects of cardiopulmonary bypass/heparin; evidence of pulsus alternans, tricuspid regurgitation and hypotension; and PAWP > PADP, with a wrongly calculated SVRI. Ten out of twenty-three candidates passed this section
(Radiology) - Pass rate ; highest mark . |
| OSCE 13 |
Biochemistry. Examples included artefact secondary to contamination with potassium EDTA, a hypo-adrenal state, effects of alcohol/malnutrition, and rhabdomyolysis. Nine out of twenty-three candidates passed this section.
(Electrolytes and Fluids) - Pass rate ; highest mark . |
| OSCE 14 |
Interpretation of iron studies and anaemia of chronic disease
(Haematology and Oncology) - Pass rate ; highest mark . |
| OSCE 2 |
ECGs. Examples included AF with rate dependant bundle branch block, R wave in V1, heart block (Wenckebach), widened QRS, atrial flutter, and right axis deviation. Eighteen out of twenty-three candidates passed this section
(Cardiology) - Pass rate ; highest mark . |
| OSCE 3 |
CXRs. Examples included left SVC, shoulder dysplasia, sub-diaphragmatic gas, pleural calcification, and mechanical heart valves. Many tubes/devices were inappropriately positioned.Fifteen out of twenty-three candidates passed this section.
(Radiology) - Pass rate ; highest mark . |
| OSCE 4 |
Equipment. Examples included a McCoy blade, a blood filter, a biphasic defibrillator and an intra-aortic balloon pump.
Sixteen out of twenty-three candidates passed this section
(Equipment and Procedures) - Pass rate ; highest mark . |
| OSCE 5 |
Microbiology. Material presented included central venous catheters (some with anti- bacterial impregnation), anti-bacterial and anti-fungal therapeutic agents, and activated protein C.
(Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark . |
| OSCE 7 |
Procedure station. Candidates were expected to provide a systematic approach to a patient with a tension pneumothorax. The scenario provided was as follows:
“A twenty-two (22) year old male has been brought to your Emergency Department following a motor vehicle accident. He was the unrestrained driver of a car that collided head-on with a truck. The ambulance officers report that he has been dyspnoeic, tachycardic and shocked en route to the hospital. You are the only doctor available to attend to him.”
Thirteen out of twenty-three candidates passed this section.
(Trauma, Burns, Drowning) - Pass rate ; highest mark . |
| OSCE 9 |
“A twenty-three (23) year old woman (Jane Bland) was admitted to your Intensive Care
Unit last night with a right lower lobe pneumonia, hypoxaemia and hypotension. Her blood pressure is now stable but she is breathless and has a pulse oximeter saturation of 85% while breathing humidified 90% oxygen at a flow of 50L/min. The pulse oximeter values have been consistent with a recent arterial blood gas:
|
pH
|
7.30
|
|
7.35 – 7.45
|
|
PaCO2
|
61
|
mmHg
|
35 -40
|
|
PaO2
|
51
|
mmHg
(Communication and Ethics) - Pass rate ; highest mark . |
| Viva 1 |
Literature evaluation
Scenario: Consider the following abstract as an example – NEJM 2003, 349: 949 – 58 “Treatment of opiate addiction with sublingual buprenorphine and naloxone has been proposed, but its efficacy and safety have not been studied.
Methods – we conducted a multi-centre, randomised, placebo-controlled trial involving 326 opiate- addicted persons who were assigned to sublingual buprenorphine and naloxone, buprenorphine alone or placebo…….
Results – The trial was terminated early because both active treatments were found to have a greater efficacy than placebo…….
Conclusions – Buprenorphine/naloxone and buprenorphine are safe and efficacious in reducing opiate craving…….”
Introductory question: What do you understand by the term “evidence-based medicine”?
Nineteen out of twenty-three candidates passed this section.
(Statistics and Interpretation of Evidence) - Pass rate ; highest mark . |
| Viva 2 |
Musculo-skeletal
Scenario: A thirty (30) year old male driver has a high speed collision with a tree. He has a GCS of 8, multiple right sided injuries and fractures, and had been intubated and resuscitated by the trauma team in your Emergency Department. Orthopaedic surgery is planned and you are asked whether you have an ICU bed. You review in the Emergency Department and are told that he was a difficult intubation with a grade 3-4 larynx. He is nasally intubated, on a transport ventilator with 100% FiO2, VT 900ml and respiratory rate of 10. His SBP is 100 mmHg, pulse rate is 130/min. His abdomen is soft. He has one 14 G IV line with Hartmann’s running.
X-rays: # ribs (R 2-3), # pelvis, # R femur, # R tibia (complex)
Chest: diffuse opacities both lungs consistent with ARDS
Cervical: (AP and lateral) normal to C6
Thoracic: # T4
CT head scan: # base of skull
Introductory question: What is your immediate management?
Sixteen out of twenty-three candidates passed this section.
(Trauma, Burns, Drowning) - Pass rate ; highest mark . |
| Viva 3 |
Cardiac surgery
Scenario: A seventy-two (72) year old ex-heavy smoker underwent “on-pump” coronary artery bypass grafting (LIMA to LAD, RIMA to RCA, free radial to Circumflex). His preoperative left ventricular function was normal. It was not possible to achieve satisfactory retrograde cardioplegia so anterograde cardioplegia was employed.
He received a total intravenous anaesthetic technique with propofol and remifentanil. There were no specific problems separating from cardiopulmonary bypass but a new Right Bundle Branch Block was noted on his ECG.
In transit to the ICU he was noted to be awake and obeying commands.
Soon after arrival in ICU, he became agitated, dysynchronous with the ventilator and developed marked systemic hypotension.
Here are his first haemodynamic measurements in ICU.
|
Heart rate
|
100 reg
|
|
|
|
Systolic blood pressure
(Cardiothoracic Intensive Care) - Pass rate ; highest mark . |
| Viva 4 |
Haematology-oncology
Scenario: A 45 year old male has been referred to you from the oncologists. He was recently diagnosed with non-Hodgkin’s lymphoma and commenced chemotherapy three (3) days ago. He has been admitted to intensive care with a convulsion, acute renal failure and ventricular arrhythmias.
Introductory question: What is your initial management?
(Haematology and Oncology) - Pass rate ; highest mark . |
| Viva 5 |
Nutrition
Scenario: A fifteen (15) year old female is admitted to your Intensive Care Unit following a laparotomy for perforated appendix and drainage of pelvic abscess. She has developed septic shock necessitating mechanical ventilation and inotropic support.
She has an intercurrent history of anorexia nervosa, for which she was attending counselling and was poorly compliant to follow up.
Her weight is 34 kg, she is 165 cm tall.
Introductory question: Describe how you will manage this patient in the acute stage of her intensive care stay?
Fourteen out of twenty-three candidates passed this section.
(Endocrinology Metabolism and Nutrition) - Pass rate ; highest mark . |
| Viva 6 |
Scenario: A forty-three (43) year old man, previously fit and well is brought into the Emergency Department having been found at home unconscious by his wife. He had last been seen six (6) hours previously. Pupils are reactive, GCS 8, breathing spontaneously, no focal signs.
Introductory question: What is the differential diagnosis?
Fifteen out of twenty-three candidates passed this section.
(Neurology and Neurosurgery) - Pass rate ; highest mark . |
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