| OSCE 1 |
Clinical case.
Candidates were asked to describe the X-ray findings, interpret arterial blood gases and an ECG, and suggest relevant further management. Questions included:“A 64 year old man is referred to the Intensive Care Unit with hypoxaemia 5 days post-lobectomy for lung carcinoma.
This is his Chest X-ray on admission to ICU. List the findings.”
On admission to ICU, he is NOT in respiratory distress, is afebrile with a normal white cell count and is otherwise stable. This is his arterial blood gas:
|
FiO2
|
0.5
|
|
|
|
PaO2
|
66
|
mmHg
|
|
|
PaCO2
|
43
|
mmHg
|
35-45
|
|
HCO3
|
26
|
mmol/l
|
20-30
|
|
pH
|
7.41
(Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark . |
| OSCE 11 |
As for communication stations in general, candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the daughter. Other factors looked for included delineation of next-of-kin, expressed wishes,
clear plan of management etc. The clinical scenario provided was as follows:
“You have been asked to consider admission to the ICU of an 86 year old woman, Flavia Arcadia. She has presented with confusion, fever and hypotension thought to be due to urosepsis as microscopy has shown Gram negative bacilli in her urine. Despite fluids she remains oliguric and her creatinine is now 300 micromol/L with a K+ of 5.4 mmol/L. Her JVP is clearly elevated, and there are basal crackles heard.
The medical team has started to discuss management options, but her daughter wants ‘everything done.’ You have one ICU bed left on Friday evening running into a long weekend. There are two HDU beds available.
You meet the daughter at the bedside as you finish examining the patient.”
(Communication and Ethics) - Pass rate ; highest mark . |
| OSCE 15 |
Procedure station 2.
Candidates were expected to demonstrate that they could safely insert a pulmonary artery catheter. Marks were allocated under headings of “Patient preparation”, “preparation of catheter for insertion”, “insertion of the catheter”, and “confirmation of placement and calibration”.
Introductory material was:
“A 62 year old man has cardiogenic shock. A dobutamine infusion of 7 mcg/kg/min is running. He is intubated and ventilated, on 50% O2 and PEEP 10 cm H2O. He is lightly sedated on morphine and midazolam, but rouses to voice and is interactive. You have decided to insert a continuous cardiac output oximetric pulmonary artery catheter in to the right internal jugular vein. Describe exactly how you will go about this.”
Some candidates had difficulty in reproducing expected pressure waveforms.
(Equipment and Procedures) - Pass rate ; highest mark . |
| OSCE 2 |
Other Xrays. Candidates were asked to describe the X-ray findings, list possible aetiologies, and suggest relevant further investigations or treatment.
Introductory questions included:
"This is an abdominal radiograph of a man with abdominal pain and septic shock. Describe any abnormalities present and list three precipitating life-threatening causes."
"A 50 year old man was admitted to ICU following major surgery. Post operatively, he persistently complains of bilateral ankle pain. Bilateral ankle x-rays are performed Describe the significant radiological abnormality. His pre-operative chest radiograph is found , what obvious abnormality has been missed?"
"This is the CT brain scan of a man who presents with sudden loss of consciousness. Please describe the abnormalities."
"This is the abdominal radiograph of a 30 year old diabetic woman with loin pain and septic shock. Describe any abnormalities present."
Findings to be identified included: air in portal venous system, hypertrophic pulmonary osteoarthropathy, subarachnoid haemorrhage, air in bladder and renal tissue emphysema.
(Radiology) - Pass rate ; highest mark . |
| OSCE 3 |
Clinical case 2.
(Trauma, Burns, Drowning) - Pass rate ; highest mark . |
| OSCE 4 |
Chest Xrays.
Candidates were asked to describe the X-ray findings. Candidates were expected to comment on the presence and position of devices/foreign bodies, even if they were positioned correctly.
Introductory questions included:
"This the chest radiograph of an infant who is desaturating. Please list the abnormalities."
"This child underwent rigid bronchoscopy for inhaled foreign body. He is to be air-lifted to a tertiary hospital for care. Please list findings on this chest radiograph."
"This wheelchair bound woman deteriorated after a procedure. Please list the findings on this chest radiograph."
"This is the routine chest radiograph after cardiac surgery. Please list the findings."
"This patient deteriorated after a procedural intervention. Please list the findings on this chest radiograph."
Findings to be identified included: endobronchial intubation and right upper lobe collapse, pneumothorax and intercostal catheter, kypho-scoliosis and misplaced nasogastric tube, and misplaced pulmonary artery and pigtail catheters. Fifteen out of sixteen candidates passed this station.
(Radiology) - Pass rate ; highest mark . |
| OSCE 5 |
Equipment station.
Candidates were expected to describe or discuss advantages or problems with devices presented. Examples included a closed suction device, a “Flexitip” laryngoscope, a metered dose inhaler & a nebuliser, and a chest drainage bottle. Introductory questions included:
“What is this device? What are the proposed advantages of this system?”
“What is this piece of equipment? What is its purpose?”
“What are these 2 pieces of equipment? Compare and contrast these 2 devices.”
“What is this device? Describe the 3 different compartments and their functions.”
Fourteen out of sixteen candidates passed this station.
(Equipment and Procedures) - Pass rate ; highest mark . |
| OSCE 7 |
Procedure station 1.
Candidates were expected to demonstrate that they could safely direct management of a cardiac arrest, including defibrillation.
Introductory material was:
"You have been called to a cardiac arrest on a general medical ward of your hospital. A 55 year old lady was admitted with chest pain and subsequently had a sudden loss of consciousness. The anaesthetic resident and coronary care nurse are at the bedside when you arrive. You will be running her cardiac arrest management."
Fourteen out of sixteen candidates passed this station.
(Cardiac Arrest and Resuscitation) - Pass rate ; highest mark . |
| Viva 1 |
Evidence Based Medicine
“The SAFE study was recently published in the New England Journal of Medicine. SAFE was a large clinical trial comparing albumin and saline for resuscitation of intensive care patients in Australia and New Zealand. SAFE found no difference in mortality between the two groups.
The SAFE study had many features which caused readers to consider it of high quality and for clinicians to believe that the findings were likely correct.
What features must you look for in the DESIGN of ANY clinical trial to determine whether you should accept the results as correct and apply them to your patients?”
Areas covered poorly included concealment, blinding, baseline risk for sample size calculation, and adjustment for baseline variables.
Thirteen out of sixteen candidates passed this section.
(Statistics and Interpretation of Evidence) - Pass rate ; highest mark . |
| Viva 2 |
Paediatrics
“A 14 year old girl presents with a history of chronic renal failure due to Haemolytic Uraemic Syndrome 6 years ago.
She had a failed renal transplant and is currently managed on nightly peritoneal dialysis.
Recently she developed shortness of breath and underwent echocardiography which demonstrated a fractional shortening of 12% and evidence of clots in her atrium and required admission to PICU
for management.
Discuss the management of Haemolytic Uraemic Syndrome in children.”
“Discuss the potential complications of PD in children/ weigh up the relative risks of PD vs
CVHDF”.
Nine out of sixteen candidates passed this section.
(Neonatal and Paediatric Problems) - Pass rate ; highest mark . |
| Viva 3 |
“A 62 year old male patient, with a past history of recently diagnosed ischaemic heart disease,
treated with aspirin and simvastatin, was admitted for overnight ventilation to the intensive care unit after total cystectomy and formation of ileal conduit for extensive TCC of the bladder.
20 hrs after admission your resident shows you his blood results, which demonstrate the following:
|
Na
|
135 mmol/l
|
(137-145)
|
|
K
|
6.2 mmol/l
|
(3.8-4.9 serum)
|
|
Cl
|
103 mmol/l
|
(98-106)
|
|
Bicarb
|
16 mmol/l
|
(22-32)
|
|
Urea
|
5.6 mmol/l
|
(3-8)
|
|
Creatinine
|
0.212 mmol/l
|
(0.05-0.12)
|
|
Urate
(Renal Failure and Dialysis) - Pass rate ; highest mark . |
| Viva 4 |
Respiratory/ventilation
“You receive a young patient involved in a high-speed motor vehicle accident. He has fractures of his femur and humerus. He has returned from the operating theatre following a negative, exploratory laparotomy. He has had a hypoxaemic arrest in the operating theatre. Bilateral intercostal catheters were inserted and he returns to ICU intubated, hand ventilated with SaO2 75% on FIO2 1.0, pulse 100 bpm and SBP 108 mmHg on an adrenaline infusion. His first arterial blood gas demonstrates:
Normal Range
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