MCAI OSCE PAPER 2 NOV 2021

1. Picture of transverse section of 6th vertebrae.
a) Label A-F. 6m
b) 8 complications of IJC cannulation.
c) Numbness over shoulder post IJC cannulation, what nerve is damaged? 2m
d) Honer syndrome is cause by disruption to what nerve? 1m List down Honer Triad 3m

2. CXR of diaphragmatic hernia
a) What is the most obvious abnormality and what is the cause? 2m (bowel in thorax)
b) What is the second abnormality relating to airway? 1m (trachea deviated to right)
c) 2 features of symptomatology which is significant in assessing the severity of this condition. 2m
d) What is the anaesthetic risk? 1m
e) 3 respiratory complications if this happens. 3m
f) 2 factors determining the morbidity of such event. 2m
g) Fasting guideline for elective surgery. 1m
h) 2 objectives in premedication to avoid complication. 2m
i) 4 drugs to prescribe, dose and MOA. 4m
j) How will you manage induction? 1m
k) What to make sure during emergence and extubation? 1m

3. pH 7.20 pco2 60 p02 60 Bicarb 25 BE +1
a) State 3 abnormalities 1m and what is this condition called? 2m
b) Is there any metabolic compensation? 1m
c) 2 conditions that cause this. 2m
d) 3 management that may be beneficial. 3m
e) is sodium Bicarbonate indicated? 1m
f) What is this? 2m (battery symbol in electrical circuit)g) What is this? 2m (earth symbol in electrical circuit)
h) What is this? 2m (transformer symbol in electrical circuit)
i) What is this? 2m (switch symbol in electrical circuit)
j) Function of capacitor in defibrilator. 2m

4.
a) What is the innervation of anterolateral abdominal wall? 4m
b) Label 1-5 (ultrasound image of layer of abdomen). 5m
c) Where you aim to deposit the LA? 2m
d) Where is the best place to put ultrasound probe? 2m
e) 3 surgical procedures where TAP is useful. 3m
f) 3 complications. 3m
g) 2 contraindications. 1m

5.
a) What is this? (Picture of VIE) 1m
b) It's function. 1m
c) It's temp and pressure. 2m

Picture of E size cylinder
d) What material it is made of? 1m
e) Pressure at 15 degree Celsius if full? 1m
f) Pressure at 150 degree Celsius if half full? 1m
g) What volume of nitrous oxide will be delivered if full? 1m

Picture of flowmeter
h) At position A (high), what is the flow and depends on what physical properties of the gas? 1m
i) At position B (low), what is the flow and depends on what physical properties of the gas? 1m

Picture of head of gas cylinder with engravement.
j) What is A? (Serial number) 1m
k) What is B? (TP 220 bar) 1m
l) What is plastic ring C and function? 2m
m) 4 ways to ensure safe storage of medical gas cylinder. 4m

6. 6 years old child planned for elective orchiopexy for retractile testis. Mother and child are anxious. You are seeing the mother for premedication.
a) First thing you do when you meet the mother. 2m
b) What history do you want to elicit? 4m
c) 2 premedications that you can give. 2m
d) Mother claims child is scared of needle, she is concerned how the child will be asleep. What options will you give? 2m
e) Mother claims the child's elder brother has had previous surgery, and when he wakes up for anaesthesia, he wake up like a demon, anxious. She wants to know why this happened, will this happen again this time, and how it may be prevented. What do you tell her. 3m
f) What will you tell her about common and serious side effects for general anesthesia in children? 3m
g) What regional technique is suitable in this case? 1m What other types of analgesia you will give? 1m
h) 2 complication of this technique that you will tell her. 2m
i) She is asking if the child’s dad or she can accompany to OT. What will you say? 1m

7. 30yo female ASA I planned for emergency op for knee surgery under general anaesthesia. She said her relative has some serious reaction from anaesthesia previously.
a) What questions do you want to ask about the relative regarding her previous anesthesia? 4m
b) According to the relative, she had high temperature and was admitted to the ICU for 3 days. What is the most likely diagnosis? How to explain this to a non medical personnel? 4m
c) She wants to know if she can knows if she is susceptible to this condition preop. What do you tell her? 3m
d) If unable to know pre-op regarding susceptibility, she wants to know if she still can proceed for op, is it safe. 4m
e) She wants to know after discharge, what she needs to do in case she needs another operation. 3m
f) She wants to know if there is any drug for this condition. 2m