MCAI OSCE PAPER 1 NOV 2021
1. 55yo male post triple A surgery, complain of chest pain and collapse in ward.
a) Describe the steps in BLS and how you provide single responder CPR. 5m
b) Describe A B C D rhythm, which is shockable and which is non shockable. 4m
c) Energy of biphasic defibrillation for adult. 1m
d) How many times can you repeat shock according to CPR algorithm? 1m
e) 2 medications to use in this scenario and dose. 4m
f) What is another medication that you would consider in this situation? 1m
g) List down 4H and 4T. 4m
2.
a) V1 - V6 lead placement. 6m
b) What are the unipolar leads other than chest leads? 2m
c) What are the bipolar leads? 2m
ECG of STEMI
d) Comment on HR and rhythm. 2m
e) State 3 abnormalities 3m and the possible diagnosis 2m
f) Other than pharmacological causes, what are the other 3 causes that can cause this? 3m
3. 60yo male plan for elective incision hernia repair. He is a heavy smoker and has chronic respiratory disease.
a) What is the first thing you do upon seeing g this patient? 2m
b) What will you look for in tongue or finger? 1m
c) 3 signs during inspection of hands and fingers that is related to the respiratory system. 3m
d) 4 things to look for during chest inspection. 4m
e) Normal apex beat location. 1m
f) 3 things to look for during palpation of the chest. 3m
g) During percussion, where is normal dullness, and what is the pathological condition that cause dullness? 2m
h) What area of hyperresonance means? 1m
i) Which side should you auscultate and which part of the stethoscope to use? 2m
4. 46yo female schedule for subtotal thyroidectomy.
a) 3 indications for subtotal or total thyroidectomy. 3m
b) What is the clinical suspicion to suspect for hyperthyroidism? 2m
c) If patient has a significant goiter, how do you establish for airway involvement or compromise? 3m
d) Clinical examination to establish airway involvement in significant goiter.
e) 3 things to inspect during examination.
f) 3 preoperative imaging. 3m
g) What other aspect of patient condition have to stabilize preop? 1m How to check? 1m
h) 2 options if airway is concern / compromise. 2m
i) What is the common biochemistry abnormality post total thyroidectomy and why? 2m
5. 30yo ASA 1, plan for sinus surgery. After intubation, pack nasal with co-phenyl. HR 60 BP 110/70 etco2 4.6 etsevo 2.2% temp 36.8
a) Surgery haven't start, HR 48 BP 180/80 etco2 4.6 etsevo 2.2% temp 36.8 What is the major concern? 1m
b) What is the possible cause? 1m
c) What are the other causes? 2m
d) 4 immediate management. 2m
e) Despite adequate deepening of anaesthesia, hypertension persist, what medication and dose to give?
f) How the drug act? 1m
g) 2 medication option for infusion. 2m
h) 4 immediate complication of hypertensive crisis / malignant hyperthermia.
i) BP is well controlled intraop, but you are unsure of the causes. 4 investigations to send post op.
6. 71yo ASA II, underlying hypertension on bisoprolol, diuretic and aspirin 7.5mg (withheld 10 days). Hypertension is well controlled. You explain regarding SAB during pre med last night, he is anxious but agree. Medication is not serve on the morning of op.
a) On the OT table, you noted ECG monitoring (picture of AF, no HR BP provided, no symptoms provided). What is this rhythm? 1m
b) 4 factors that may cause this rhythm. 4m
c) 2 pathophysiology implication of this rhythm. 2m
d) 3 immediate measurements. 3m
e) 3 drugs to control the heart rate with dose. 3m
f) Will you postpone this surgery and why? 2m
g) Signs of unstable AF. 2m
h) Despite rate control, the patient is unstable, 3 things you can do that might help. 3m
7. Picture of transesophageal doppler.
a) 3 clinical indications. 3m
b) 2 advantages. 2m
c) Optimal depth of insertion. 1m
d) Contraindications.
e) What is FTc. 2m
f) Normal range for FTc. 2m
g) What is frequency shift in doppler and what measurement in TOE. 2m
h) SV 47 CO 4.7 Ftc 300 63. Interpret 1 m and treatment 1m
8. Trauma case GCS 4/15, facial fracture, blood in mouth. Vitals normal, spo2 90% under HFM
a) How would you induce and list the steps BEFORE securing airway. 5m
b) What equipment do you want to prepare? 5m
c) 2 medications that can be used as sole induction agent and dose. 2md) 2 muscle relaxants to use in this situation and dose. 2m
e) After induction, direct laryngoscope CL 4 despite BURP. What is your next step according to DAS? 4m
f) Still unsuccessful, next step? 1m
g) You are able to oxygenate and ventilate using SAD. What are your 2 options? 1m
MCAI OSCE TRIAL NOV 2021
1. Identify each equipment
a) Macintosh blade (1m)
b) Miller (1m)
c) Airtraq (1m)
d) Polio (1m)
e) Mccoy (1m)
f) Optical stylet (1m)
g) Fiberoptic Rigid laryngoscope (1m)
h) 4 features of macintosh blade (4m)
i) Components of fiberoptic intubating bronchoscopes. (4m)
j) Label the diagram A to C showing light travelling through a fiber optic cable and explain the physical priciple involved. (5m) (Internal refraction, cladding and core)
2. ECG same as sample question provided in MCAI candidate handbook.