End of 4th Year OSCE

Surgery
Oct. 2008
AL 2003

laminiro@yahoo.com

 OSCE
OSPE
IOP

 Instruments +
Procedures
Imaging + other Ix
Communication skills
Clinical scenarios

Instruments
+
Procedures

Needles

Needles
14G- White - Abscess drainage
18G- Pink
19G- Yellow
21G- Green Blood culture
22G- Black
23G- Blue - IM injections/FNAC
24G- Red - SC injections
25G- Orange VV sclerotherapy
26G- Brown Insulin SC/ Mantoux/ BCG (ID
injec.)
27G- Ash
29G- Dark orange

Suture needles
Straight
Curved
Round body
Cutting Standard
Tapered
Reverse

Traumatic / Eyed
Atraumatic / Eyeless

Suture needles

Suture needles

Suture material
Natural
Synthetic

Absorbable
Non-absorbable
Mono-filament
Multi-filament / Braided

Suture material
Absorbable
Synthetic

Natura
l

Non- absorbable
Synthetic

Natural

Mono Polyglecaprone Catgut Polypropyl

(Monocryl)
ene
filame
(Prolene)
Polydiaxanone
nt
Polyamide
Polyglyconate
/ Nylon
(Monosyn/ Maxon)
Multi
Polyglycolic
acid
filame
(Centicryl/ Dexon)
nt
Polyglactin
(Vicryl)

Polyester

Black
silk

Suture material

Suturing methods
Continuous

Simple
Subcuticular

Interrupted

Simple
Mattrass -

Vertical
Horizontal

Suturing methods

Cannula

Cannula
14G-Orange
16G-Grey

Wide bore

17G-White
18G-Green
20G-Pink
22G-Blue
24G-Yellow
26G-Purple

Paediatric

IV fluids
Crystalloi
ds 0.9 % saline
0.45 % saline
0.18% saline
Hartmanns
solution
5% , 10%
dextrose
Colloids
HES
Albumin

LP / Spinal needle

Uses
Contraindications
Complications

Epidural needle

Uses

Gabriels syringe

Uses
Sclerosent
almond/olive oil

5% phenol in

NG/ Ryles tube

Length

Xiphisternum

Philtrum Tragus

NG/ Ryles tube

Uses
Feeding
Diagnostic

Oeso. atresia +/- TOF

Milk scan
Gastric aspirate
Small bowel Ba meal

Therapeutic

Gastric lavarge
Gastric decompression
As a drain tube / catheter

NG/ Ryles tube

Correct positioning
1.Cough
2.Inject air
3.Aspirate
4.Under water bubbling
5.CXR
6.Correct length

IC tube / Chest drain

IC tube / Chest drain

IC puncture

IC aspiration

IC tube insertion/ Thoracostomy

IC tube / Chest drain

Site Safe triangle
Indications
1.
Pneumothorax
u

e Tension
p
ra
e
Persistent/ Recurrent
Th
tic Large in elderly pt.
Ventilated pt.

2.Traumatic haemopneumothorax
3.Malig. pleural effusion
4.Empyema
5.Post op. - Thoracotomy
c
la
y
h
p
Pro
tic

IC tube / Chest drain

Daily assessment
1.Pts condition
2.Tube functioning
Bubbling
Fluid level
Swinging of fluid column

3.Apparatus
Under water seal
Clamping
Level of the bottle

Airways Oro-pharyngeal/ Guedel

Airways Oro-pharyngeal/ Guedel

Length
Insertion

Airways LMA

Sizes 3cm -
4cm -

Airways ETT
Cuffed soft / hard
Uncuffed
Reinforced
Non-reinforced
North pole
South pole

Airways ETT

Airways ETT

Airways ETT

For children

Airways ETT

For surgeries/GA in prone position

Airways ETT

For neuro/ eye surgeries

Airways ETT
Size ID in mm
2.0
2.5
3.0
4.0
7.0
7.5
8.0
8.5
9.0

Preterm
Preterm
Term
1 year
Children Age/4 + 4
Adult females
Adult males
Large physique

Airways ETT
Duration
ETT

7 days

Tracheal stenosis
Tracheostomy

Uses
Maintain airway
Ventilation IPPV
Administer drugs
Prevent aspiration
Remove secretions

Airways Tracheostomy tubes

Airways Tracheostomy tubes

Airways Tracheostomy tubes

Indications
Upper airway obstruction
Prolonged mechanical ventilation
To remove retained secretions in LRT
To reduce dead space

Airways Tracheostomy tubes

Complications
Pneumothorax
Haemorrage
Surgical emphysema
Tube displacement
Stenosis

Urinary catheters
1. Simple rubber catheter
2. Foley catheter
3. Pauls tube (Condom
catheter)
4. Self intermittent catheter
5. Metal catheter

Uses

Urinary catheter

. FG Foleys self retaining 2 way

urinary catheter
3way catheter
Rubber Vs Silicone catheters
Males - 16 FG
Females 14 FG

Urinary catheter

Self intermittent catheter

Ambu

Trays

Uses

Mosquito artery forcep

Uses

Laryngoscopes

Laryngoscopes

Indirect Laryngeal mirror

Posterior rhinoscopy mirror

External fixators

External fixators
Indications
Pelvic fractures Unstable /
Bleeding

Nonunion
Compound fractures
Limb lengthening

CPR
Recent changes ATLS 2005
guidelines
Hands over the centre of the chest
30:2 chest compressions
All 3 DC Shocks each 360J

Imaging
+
Other Ix

XR CXR erect

XR CXR erect
Abnormality Air under the
diaphragm

Causes
Perforated peptic ulcer
Perforated bowel
Ruptured appendix

Presentation
Acute abdomen

XR Abdomen supine

Small intestinal
obstruction

Large intestinal
obstruction

XR Abdomen supine
Abnormality
Dilated bowel loops

Causes

Presentation
Acute abdomen

XR Abdomen supine

XR Abdomen erect

XR KUB / IVU

XR - KUB

IVU

XR KUB / IVU

Stag horn calculus

IVU

XR Hip

XR Hip

Other fractures XR + POP casts

Colles distal radial

Other fractures XR + POP casts

Colles distal radial

Other fractures XR + POP casts

Scaphoid

Paediatric radiology

Double bubble
appearance

Diaphragmatic hernia

CT - Brain

CT - Brain
Lesion
A hyper dense, biconvex shaped area in the
right
temporo-parietal region

Condition
R/S acute EDH
Causes
Trauma Damage to middle meningeal artery

Mx
Resuscitation, HIO, Craniotomy & evacuation

CT - Brain

CT - Brain
Lesion
A crescent shape, hyper dense area in left
temporo- parietal region
+ Midline shift

Condition
L/S acute SDH
Age group
Elderly Wide SD space due to brain atrophy

CT - Brain

CT - Brain
Lesion
A crescent shape, large hypo dense
area in left temporal region
+ Midline shift

Condition
L/S chronic SDH
Causes
Alcoholic
Elderly following recurrent falls
Child abuse

CT - Brain

Cerebral abscess in L/Occipital area

CT - Brain

SAH

CT - Brain

ICH

Criteria for admission after head

injury
Altered level of consciousness

Skull fracture
Neurological symptoms or signs
Difficult assessment - drugs, alcohol
No responsible care giver

CT - Brain
Indications for CT scan
GCS < 13 at any point since the injury
Suspected open or depressed skull
fracture
Any sign of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
If GCS 8

Intubation & ventilation

Audiogram

Conductive
hearing loss
Wax impaction
Otitis media
Otosclerosis

Audiogram
Sensorineural
hearing loss
Acoustic
neuroma
Meningitis
Ototoxic drugs
Noise induced

Communication skills

Consent for Ix / Sx

BRAIDED
Bbenefits
Rrisks
Aalternatives
I - inquiry
Ddecision
E - education
Ddocumentation

Short case
C 2 P 2 E2 T
C - consent Greet, Introduction,
Explain
C - chaperone
P - positioning
P - privacy
E - exposure
E - examination
T - thanking

Clinical scenarios

Ulcers

Ulcers

Ostomy

Ostomy

Ostomy

The end

Good
luck!