FREE OSCE Primary FRCA mock mark schemes! (5 minute read)
Background:
We’ve just launched our brand new on-demand History & Communication workshop (check it out here!), and now we’re on our way to making things even more accessible to you, so you can revise on-the-go, whenever, wherever, and most importantly at a time that suits you. Next we’re going to be launching our mock Primary FRCA OSCE mark schemes so I thought I’d provide you with a sampler of what to expect.
The mark schemes will be available to purchase and download in a pdf format. You can use these as study aids, to test yourself, or to buddy up with a partner and test each other. (We prefer the latter approach, as this really tests your active recall, allows you to practise verbalising, and simulates more of an exam environment!)
Why MOSCE-TO mark schemes?
We know there’s lots of books out there with great stuff, however they’re definitely a little older than we are and therefore won’t have the newer, perhaps more topical stations as we continue to grow and advance in Anaesthesia. We’ll also provide you with references for further reading should you need it.
Our mark schemes can provide you with a break from the norm, keep you on your toes (you want to be asked about the same thing in a million different ways, trust us!), and help you on your way to PASSING THE PRIMARY FRCA!
Sample MOSCE-TO OSCE mark scheme:
Technical skills - RSI and Sellicks manoeuvre
Q1. Define rapid sequence intubation? (2 marks)
Rapid sequence intubation in an airway management technique that involves inducing unresponsiveness and muscular relaxation (using an induction agent and neuromuscular blocking drug) in the fastest way possible as a means of gaining rapid airway control.
Q2. List 3 indications for RSI? (3 marks)
1. Unfasted state
2. “Acute abdomen” – at very high risk of aspiration
3. Lack of airway protection despite patency (swallow, gag, cough, positioning , and tone)
4. Severe hypoxia
5. Hypoventilation
6. Need for neuroprotection (e.g. target PaCO2 35-40 mmHg)
7. Impending obstruction (e.g. airway burn, penetrating neck injury)
8. Prolonged transfer
9. Combativeness
10. Major trauma
11. Cervical spine injury (diaphragmatic paralysis)
Q3. Name 2 neuromuscular blockers and their dosage per body weight used in a rapid sequence induction? (2 marks – must include drug dosing as well as agent)
· Suxamethonium 2mg/kg TBW (accept 1.5mg/kg)
· Rocuronium 1.2mg/kg IBW
Q4. Describe Sellicks manoeuvre (1 mark)
· Aka as cricoid pressure
· Digital pressure applied to the cricoid cartilage with the intention of compression the oesophagus against the vertebrae to prevent passive regurgitation of gastric and oesophageal contents
Q5. Why is the cricoid cartilage ideal for Sellicks manoeuvre? (1 mark)
It is the only complete ring shaped cartilage therefore is able to compress the oesophagus posteriorly
Q6. Show me (on the mannequin), how you would teach your anaesthetic assistant how to perform Sellicks manoeuvre? (4 marks)
1. Identify cricoid cartilage - At C6, find the laryngeal prominence of the thyroid cartilage (Adam’s apple), move inferiorly to find the cricothyroid membrane (ridge), caudal to this will be the cricoid cartilage
2. Place index finger over cricoid cartilage with thumb and middle finger either side
3. Apply moderate pressure (10N) when patient awake
4. Increase pressure (30 – 40N) when the patient loses consciousness
5. Keep pressure applied until tracheal intubation confirmed or asked to remove by anaesthetist only.
Q7. When would you release cricoid pressure? (2 marks)
1. When asked by the anaesthetist (inadequate view, need for other airway interventions – BMV, LMA, ETT secured and confirmed, lack of belief in its utility)
2. If the patient vomits (risk of oesophageal rupture)
Q8. Name 2 contraindications to cricoid pressure? (2 marks)
1. Active vomiting
2. Actual or suspected unstable C spine injury
3. Suspected cricotracheal injury
Q9. You perform a rapid sequence intubation. Once connecting the patient to the ventilator you notice a drop in oxygen saturations. When should tube removal be undertaken? (2 marks)
1. If oesophageal placement cannot be excluded
2. If sustained exhaled carbon dioxide is not seen
3. If oxygen saturation deteriorates at any point before restoration of sustained exhaled carbon dioxide
Q10. What other airway equipment can be used to improve the chance of first chance pass intubation? (1 mark)
1. Use of video laryngoscope
2. Use of stylet/bougie
Mark ___/20
If you like what you see click here to access more Primary FRCA OSCE materials and maximise YOUR revision potential!
References:
1. https://litfl.com/rapid-sequence-intubation-rsi/
2. https://litfl.com/cricoid-pressure/
3. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2044.2003.03545.x
4. https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.15817
