2004, Paper 1 Vivas
| OSCE 11 | Equipment. Examples included anaerobic and aerobic blood culture bottles, a tracheostomy tube with supraglottic suction port, 3 different personal protective respiratory devices, a jejunal (oro- or naso-) enteric feeding tube, and an angle tip tracheal suction catheter. (Equipment and Procedures) - Pass rate ; highest mark . |
| OSCE 12 | CT scans.. Material presented included a head CT with a middle cerebral artery territory cerebral infarction, a chest CT of a man with an aortic coarctation, a chest CT with a chest tube and abnormal collections of fluid and air, and a chest CT of a pulmonary embolus. Fifteen out of twenty-two candidates passed this section. (Radiology) - Pass rate ; highest mark . |
| OSCE 13 | Clinical case .Material presented regarding post-operative management of a patient with multiple injuries included management of coagulopathy and lung injury , CXR and CT chest with chest trauma, complications of disease and management, and multiple invasive devices. Twenty out of twenty-two candidates passed this section. (Trauma, Burns, Drowning) - Pass rate ; highest mark . |
| OSCE 14 | Microbiology: Material presented included questions about gentamicin, Legionella pneumonia, VRE, synergistic drug combinations and Activated Protein C. Twenty-one out of twenty-two candidates passed this section. (Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark . |
| OSCE 2 | ECGs. Examples included electrical alternans, complete heart block, ventricular pacing, QT Twenty out of twenty-two candidates passed this section. (Cardiology) - Pass rate ; highest mark . |
| OSCE 3 | CXRs. Examples included pneumothorax, raised dome of diaphragm, pneumopericardium, fractured, widened mediastinum, subglottic tracheal narrowing, azygos lobe, hyperinflated lung fields. Fifteen out of twenty-two candidates passed this section. (Radiology) - Pass rate ; highest mark . |
| OSCE 4 |
(Equipment and Procedures) - Pass rate ; highest mark . |
| OSCE 5 | Clinical case. Material presented included a head CT scan (with subdural haematoma, local mass effect, contusion and hydrocephalus); a blood gas (with an increased A-a gradient, and a non-anion gap metabolic acidosis); an ECG (with sinus bradycardia, a prolonged QTc, and inverted T waves), a CSF sample (with decreased rbc/wbc ration), and a short synacthen test (with a normal baseline but a blunted rise at 30 min and 60 min). Eighteen out of twenty-two candidates passed this section. (Miscellaneous Topics) - Pass rate ; highest mark . |
| OSCE 7 | Technique of percutaneous tracheostomy (Airway Management) - Pass rate ; highest mark . |
| OSCE 9 | “You are the ICU consultant today after a 2-week break. Your Intensivist colleague yesterday arranged this family meeting with the daughter of your patient Mrs Pearson. Mrs Pearson is a 78 year old lady who has been in ICU for 2 weeks. She has had three bowel resections for recurrent GI bleeding (angio-dysplasia). Her ileostomy continues to bleed and she requires 2-3 units of blood each day, every day. She has a tracheostomy, is ventilated, and occasionally obeys commands. Her blood lactate is 7 mmol/L suggesting ischaemic gut.The Surgeon has decided that another operation is pointless, that angiography has failed, that transfusions should cease and therapy be withdrawn. You have assessed the patient and you and your colleagues agree, but no one has yet spoken with her daughter, Dianne Pearson. The Blood Bank director advised today that no more blood would be provided.” Candidates were expected to discuss these issues with the daughter in a compassionate manner. (Communication and Ethics) - Pass rate ; highest mark . |
| Viva 1 | Gastrointestinal Scenario: Mr CJ is a 45 year old man involved in a motor vehicle accident. He sustained:
He was taken directly from Emergency to theatre for surgery. He now returns to your Intensive Introductory question: Describe your approach to stress ulcer prophylaxis in this patient. Fifteen out of twenty-two candidates passed this section. (Gastroenterology and Hepatology) - Pass rate ; highest mark . |
| Viva 2 | Cardiovascular Scenario: A 65 year old diabetic man returns from theatre after coronary artery bypass grafting with an intra-aortic balloon pump in situ. His pre-op history included diabetes mellitus and hyperlipidemia. Introductory question: Describe your priorities in managing this patient. All twenty-two candidates passed this section. (Cardiothoracic Intensive Care) - Pass rate ; highest mark . |
| Viva 3 | Respiratory/Ventilatory Scenario: The plain Chest X-Ray and CT thorax below are those of a 25 year old man admitted to the Intensive Care Unit after a motorcycle accident in which he suffered bilateral fractured femurs and a ruptured spleen. He required a 15 unit blood transfusion before and during a laparotomy for splenectomy and open reduction and internal fixation of his fractured femurs (6-hour procedure). CXR day 2 post injury
CT scan day 5 post injury
Introductory Question: What are the most likely causes of the CXR appearances? Twenty-one out of twenty-two candidates passed this section. (Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark . |
| Viva 4 | Scenario: A 22 year old girl had chemotherapy and bone marrow transplantation for leukaemia.. While waiting for marrow recovery she develops hypoxic respiratory failure requiring admission to your Intensive Care Unit and non-invasive ventilation by mask with an FiO2 of 1.0. The PaO2 improves initially but she remains dyspnoeic. Over the next 24 hours she becomes progressively more hypoxic and exhausted, and is intubated. She requires an FiO2 of 1.0 and PEEP of 15cm H2O to achieve a PaO2 of 54mm Hg. Her Chest X-Ray shows dense bilateral pulmonary infiltrates. She requires increasing doses of noradrenaline by infusion (to 50mg/min) and progresses to acute renal failure. Your registrar asks you whether you think it is appropriate to continue active management. Introductory question: What are the ethical principles of medical care that must be considered when decisions regarding the withdrawal of active medical treatment are being made? (Communication and Ethics) - Pass rate ; highest mark . |
| Viva 5 | Obstetrics Scenario: A 34 year old Para 1 Gravida 1 primary school teacher presents at 28 weeks gestation with a blood pressure of 170/120. Introductory question: What do you think this patient is suffering from? Nineteen out of twenty-two candidates passed this section. (Pregnancy, Obstetrics and Gynaecology) - Pass rate ; highest mark . |
| Viva 6 | Neurological Scenario: A 26 year old man crashed his motor bike one hour ago. He has been brought in by ambulance to your emergency department. He is unable to move his legs, and has limited movement in his arms. Introductory question: Tell me how you will determine his neurological level? Seventeen out of twenty-two candidates passed this section. (Neurology and Neurosurgery) - Pass rate ; highest mark . |
