Miscellaneous Short OSCE Items

Question 1

what pathogens are patients at risk from post-splenectomy

Answer 1

• pneumococcus
• haemophilus
• meningococcus
• capnocytophaga canimorsus; dog bites

Question 2

what vaccinations are required for post-splenectomy patients

Answer 2

• haemophilus influenza b
• meningitis a and c
• annual influenza vaccination
• pneumococcal vaccination every 5 years

should be given 2 weeks pre-elective splenectomy is relevant

Question 3

what antibiotic prophylaxis is recommended post-splenectomy

Answer 3

• penicillin v 500mg bd
• for at least 2 years or up to age 16
• often for life
• advise re malaria endemic regions
• unclear guidance

Question 4

what blood film features are seen post-splenectomy

Answer 4

• howell-jolly bodies; cytoplasmic inclusions
• increased platelet count; may need anitplatelet medication
• target cells, reticulocytes and siderocytes

these changes are largely due to the absence of splenic clearance of defective cells

Question 5

how is mrsa detected

Answer 5

• nasal swab

- dna based test

Question 6

how is mrsa treated

Answer 6

• teicoplanin
• vancomycin
• linezolid as last resort

Question 7

how is mrsa suppressed

Answer 7

• chlorhexidine body wash and shampoo
• mucopiricin nasal ointment
• no retest needed

Question 8

what is clostridium difficile

Answer 8

• gram positive rod that produces an exotoxin that causes intestinal damage leading to pseudomembranous colitis

Question 9

what are the features of a c diff infection

Answer 9

• diarrhoea
• abdominal pain
• raised wcc is characteristic
• severe toxic megacolon may develop

Question 10

how is c diff infection comfirmed

Answer 10

• cdt stool toxin

Question 11

how is c diff managed

Answer 11

• isolation
• barrier nursing
• metronidazole, then vancomycin
• both if severe

Question 12

what are the sites for intramuscular injection

Answer 12

• ventrogluteal site
• dorsogluteal site
• deltoid site
• vastus lateralis site

Question 13

what are the sites for subcutaneous injection

Answer 13

• Vascular areas around outer aspect of upper arms
• Abdomen from below costal margins to iliac crest
• Anterior aspect of thigh

Question 14

lymph node examination

Answer 14

• cervical nodes
• axillary nodes; apex, lateral, medial, anterior, posterior
• epitrochlear
• inguinal
• popliteal
• hepatosplenomegaly
• complete

Question 15

explaining a procedure format

Answer 15

• introduction
• concerns
• before
• during
• after
• check understanding
• complications
• recap and check understanding
• ending

Question 16

explaining a diagnosis format

Answer 16

• introduction
• giving diagnosis with warning shot
• check understanding
• explain cause
• explain symptoms
• explain complications
• explain treatment
• address questions
• recap and check understanding
• ending

Question 17

principles of fracture managment

Answer 17

• reduction
• immobilisation
• rehabilitation

Question 18

open fracture management

Answer 18

• dr abcde; consider need for fluid replacement and/or blood transfusion
• history and examination when the patient is stable
• tetanus booster
• clean and inspect the wound
• lavage, debride, remove necrotic tissue
• surgery
• antibiotics; cefuroxime and metronidazole
• analgesia

Question 19

early complications of fractures

Answer 19

• wound infection
• fat embolism
• compartment syndrome
• chest infection
• disseminated intravascular coagulation

Question 20

late complications of fractures

Answer 20

• deformity
• osteoarthritis
• aseptic necrosis
• reflex sympathetic dystrophy
• pulmonary embolism

Question 21

immediate post-operative complications

Answer 21

• anaesthetic complications; arrhythmia, hypo/hypertension, stroke/mi, damage from intubation, breathing problems, allergy, hyperthermia
• haemorrhage

Question 22

early post-operative complications

Answer 22

• fluid depletion
• electrolyte imbalances
• fluid collection
• local infection
• systemic infection
• dvt/pe
• atelectasis
• wound breakdown
• anastamotic breakdown
• bed sores

Question 23

post-operative complications; small and large bowel

Answer 23

• ileus
• intestinal obstruction
• anastamotic leaks
• stoma retraction
• intra-abdominal collections
• pre-sacral plexus damage

Question 24

post-operative complications; cholecystectomy

Answer 24

• common bile duct injury

- bile leak

Question 25

post-operative complications; cabg/stenting

Answer 25

- reperfusion arrhythmias - post-operative mi - often need inotropes

Question 26

post-operative complications; grafts/stents/bypass procedures

Answer 26

- failure of graft - haemorrhage - infection - limb/organ ischaemia - re-thrombosis arteriopaths at high risk of - mi - cva - pe

Question 27

post-operative complications; thyroidectomy

Answer 27

- airway obstruction secondary to haemorrhage - hypocalcaemia - recurrent laryngeal nerve damage

Question 28

post-operative complications; parotidectomy

Answer 28

- facial nerve damage

Question 29

post-operative complications; orthopaedic operations

Answer 29

- infection of prosthesis - loss of position/failure of fixation - neurovascular injury - compartment syndrome

Question 30

post-operative complications; total hip arthroplasty

Answer 30

- sciatic nerve damage

Question 31

post-operative complications; distal radial fracture repair

Answer 31

- extensor pollicis longus tendon rupture

Question 32

post-operative complications; cystoscopy/turp

Answer 32

- high risk of uti - turp syndrome [hyponatremia] - retrograde ejaculation - external sphincter damage

Question 33

post-operative complications; endovascular surgery

Answer 33

- retroperitoneal haemorrhage

Question 34

post-operative complications; lymph node dissection

Answer 34

- lymphoedema

Question 35

post-operative complications; neck dissection

Answer 35

- cranial nerve 11 damage | - cranial nerve 12 damage