OSCE: INVESTIGATION STATION by Suresh paranjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu MMED Anaesthesia en-us 2022-09-16 08:36:56 UTC 2024-10-01 14:08:55 UTC hello@padlet.com https://padlet.net/icons/png/1f42f.png ECG Interpretation in a nutshell sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299678517 A-Z of ECG Interpretation
It's useful to have a systematic and structured way to interpret ECGs. 
Use any method you like. Develop your own. This one is from Oxford Medical Education.]]> 2022-09-16 08:46:05 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299678517 ECG interpretation sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299689288 In case you have forgotten stuff from medical school.]]> 2022-09-16 08:56:11 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299689288 2 years ago.... sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299710004 This ECG is from a MMED Anaesthesia OSCE Investigation Station.

The questions were something like this:

A 50 yr old male is post op day 1 ORIF #Tibia for a crush injury. The nurse was concerned about the ECG on the monitor and obtains a 12 lead ECG.

1) What abnormalities are present in this ECG?


2) What is your differential diagnosis?

You are now shown a set of blood results:

CK-MB Normal     
CK > 20,000
K 7.5
Ur 16
Cr 185     
Urine Dipstick - Blood ++ Myoglobin ++

3) What is your diagnosis ?

4) What is your immediate management ?


Read More Here:


]]> 2022-09-16 09:16:05 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299710004 Pause before answering sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299721481 A 66 year old lady has the following rhythm seen on her vitals monitor in PACU. She is post op laparoscopic cholecystectomy.

1 a) What is the diagnosis ?

1 b) Is this rhythm concerning ? Why ?

2) What are the possible causes for this rhythm ? 

3) What further investigations would you request ?

4) What is your management ?

]]> 2022-09-16 09:27:56 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299721481 Just another day in MBOT sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299728895 You can either create a scenario and questions,

 or just make diagnosis. Doing the former may be more useful. ]]> 2022-09-16 09:34:58 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299728895 Over in AOCC.... sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299738167 You see this ECG in a patient presenting at the AOCC clinic for preop evaluation. His exercise tolerance is limited due to OA and he is anxious to get his TKR done next week.

1) Describe the ECG findings

2) What could be the underlying causes for this ECG ?

3) What further information could help you decide management ?

4) The patient has no past medical history, and no other investigations in his record. How would you proceed preoperatively ?]]> 2022-09-16 09:44:22 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299738167 Time to go home ? sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299740695 You are about to leave PACU after a long day when the nurse calls you to look at a patient. His rhythm strip is shown above.

You can either create a scenario and questions to share with your colleagues or just make a diagnosis.]]> 2022-09-16 09:47:06 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299740695 A rather vague question sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299800618 On a late night pre op visit, you come across a 45 year old lady scheduled for Left Breast WLE first thing tomorrow am.

1) List the medical conditions that could be responsible for the above ECG.

2) What pertinent points in the history and physical examination may suggest a pathological cause ?

3) What further investigations would you request if any ?

4) How will you decide whether to proceed with the case ?

Feel free to edit this or any question.]]> 2022-09-16 10:51:28 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299800618 Pace yourself sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299809600 1) List the TYPES of pacemaker failure.

2) What type of pacemaker failure is shown here ?

3) List the possible CAUSES for pacemaker failure.

4) Describe the pacemaker coding system.

5) Your patient with this ECG presents for emergency laparotomy. Describe your preoperative management. 


A brief summary of pacemakers can be found here


]]> 2022-09-16 11:01:50 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299809600 Have a Quiet break with a Teh-C sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299845501 A 55 year old man presents for urgent laparotomy for perforated bowel. He gives a history of syncope 10 years ago, but was never followed up. This is his ECG.

1) Describe the pathological ECG findings.

2) What are the potential risks of surgery and anaesthesia ?

3) List the drugs that should be avoided ?

4) The patient develops Torsades post intubation. What is your management ?


Read more here:

Anaesthesia For Patients with Congenital Long QT

Long QT Syndrome and Perioperative Torsades de Pointes: What the Anesthesiologist Should Know

]]> 2022-09-16 11:41:46 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299845501 Heart broken sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299862989 A 65 year old male is day 1 post op CABG. He is on the CTICU, but has recurrent episodes of ECG abnormalities. One such episode was captured here. The episodes are self limiting, last for about 15 - 30 seconds, but are increasing in frequency.

1) What does the ECG show?

2) List the possible causes for this in our patient?

3) What investigations would you request ?

4) The patient has another episode, during which he becomes unconscious with unrecordable BP. Describe your immediate management.]]> 2022-09-16 11:57:19 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299862989 What's the Investigation Station About ? sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299897522 Format:
4 Questions
Each Question has about 3-4 sub questions
Each question lasts 3-4 minutes
Usually starts with you being given an investigation & a scenario.

Types of investigations:
Anything you may encounter perioperatively, of relavance to anaesthesia / perioperative period / ICU.

Typically:

ECGs
X-rays - CXR, C-Spine, CT Head, etc
Blood Investigations
POCUS - Heart / Lungs
Pulmonary Function Tests
Arterial Blood Gases
etc

A DETAILED SYLLABUS FOR THE INVESTIGATION STATION IS PROVIDED ON THE DGMS WEBSITE. THE LINK IS BELOW:

INVESTIGATION STATION SYLLABUS


THE SYLLABUS FOR MMED PART B CAN BE FOUND HERE


]]> 2022-09-16 12:26:28 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299897522 Here's a Howler sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299913344 A 50 year old lady presents for lap cholecystectomy. This is her preoperative ECG.

1) Describe the pertinent ECG findings.

2) What is your diagnosis ?

3) What other pre-excitation syndromes are you aware off ?

4) What are the potential complications of anaesthesia and surgery ?


Read More:

Perioperative Management of Pateints with pre-excitation syndromes.

SVTs and their management.]]> 2022-09-16 12:37:52 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2299913344 Seen in MMED before sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300045208 A 67 year old man complains of SOB and chest pain in the PACU. He has just undergone ORIF of elbow # with a supraclavicular block. SpO2 is 89% and BP is 85/45.

1) Describe the CXR findings

2) What is the diagnosis?

3) List the complications of supraclavicular block

4) What is your immediate management in PACU.]]> 2022-09-16 13:59:55 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300045208 DRSABCDE - from Life in the fast lane sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300052221 One way of structuring your answers for CXR interpretation.

Here is another way if you are more 'kiasu' - THE A to I method:

]]> 2022-09-16 14:04:24 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300052221 Fear me not sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300087124 Feel free to create a scenario. This has come up in the Investigation station before.





Reading -

1) Book Chapter by Peter Slinger

2) Review article in EJA

3) BJA Educational Article - Anaesthesia for Mediastinoscopy

]]> 2022-09-16 14:24:58 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300087124 HOCUS POCUS & Seductive Technology sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300099273 There are modules on Cardiac and Lung Ultrasound here.]]> 2022-09-16 14:32:44 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300099273 Half & Half https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300159641 Write a scenario and some questions.


Read more:

]]> 2022-09-16 15:14:17 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300159641 Hands off - reasonable question? https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300226909 A patient with the above x ray is scheduled for TURBT.

1) List the implications of his medical condition for anaesthesia.

2) What further investigations would you request pre operatively ? Give reasons for each investigation.

3) List possible cervical spine pathology in this patient that may impact anaesthesia management.


 

Reading:

If you don't have time, just read this - The AAABBBCs method to read a C-Spine xray

1) Rheumatoid arthritis and anaesthesia

2) Anaesthesia for the adult patient with rheumatoid arthritis

3) Cervical Spine complications of rheumatoid

]]> 2022-09-16 16:01:05 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300226909 "Iron makes you strong like a lion" Harry Belafonte sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300632838 This is the full blood count of a patient scheduled for elective FESS next week.

1) What is the most likely diagnosis and why ?

2) List the causes of this type of anaemia.

3) How would you optimize this patient preoperatively?

4) What would your expert opinion be on timing of surgery?




Read More From Association of Anaesthetists & BJA:

International consensus statement on the peri-operative management of anaemia and iron deficiency


Iron homeostasis and perioperative management of iron deficiency


Ask Dr Chris King
]]> 2022-09-17 00:16:06 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300632838 How to interpret FBC - Also available on TikTok sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300636458
Here is a simple description of evaluation of FBC, from Geeky Medics. Of relevance - They can also be found on TikTok !]]> 2022-09-17 00:26:09 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300636458 exams give me a headache sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300659329 This has come out in MMED OSCE before !


How to interpret a CT Head - Blood Can Be Very Bad (BCBVB) - by Dr Andrew Perron

Tell us how you do it - what's your method ?]]> 2022-09-17 01:22:34 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300659329 Quite a bad headache sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300667373 A 45 year old man is rushed to the OT from the emergency room for decompressive craniectomy. This is his CT Head.

1) Describe the likely clinical symptoms and signs that he may have presented with.

2) Describe the CT head. What is the diagnosis ?

3) What can you do as an anaesthetist to control intracranial pressure?

4) The patient is transferred to ICU post op. What methods of CBF and ICP monitoring are you aware of?




Read More:

Cerebral Physiology - BJA

Monitoring the Injured Brain - ICP and CBF - BJA - It's a bit old from 2006, check elsewhere for updates]]> 2022-09-17 01:43:07 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300667373 ABGs by Dr Hatton - anaesthesiologist from Kentucky sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300688525 Watch Part 2 of his explanation below]]> 2022-09-17 02:35:53 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300688525 ABGs Part 2 sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300689086 By Dr Hatton...]]> 2022-09-17 02:37:20 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300689086 pfft...what's all the fuss about ? sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300729525 From the American College of Physicians - probably covers all you need to know !

Article here.]]> 2022-09-17 04:26:49 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300729525 Swinging 60s sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300740369 A 30 year old man sustains blunt traumatic injury to his chest. As part of the eFAST scan the above is seen in the cardiac box.

1) Which view is shown ? What are the other required views for a complete eFAST scan ?

2) Describe the findings. What is the diagnosis ?

3) What ECG findings are associated with this ?

4) He is tachycardic with a BP of 60/35. The CTVS team wants to bring him to EOT for emergency sternotomy. Describe your management.



Read/Watch More:

Perioperative Implications of Pericardial Effusions - BJA Ed

Echocardiographic Assessment of Pericardial Effusion by Peters & Schuck

A great tutorial on eFAST by Vi Dinh - POCUS 101]]> 2022-09-17 05:00:36 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300740369 Doughnuts Anyone? sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300748738 Feel free to edit and create a scenario.





Read More:

More about imaging in PE

European Soc cardiology: PE: Role of Echo]]> 2022-09-17 05:28:37 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300748738 I'll huff and I'll puff and I'll blow your house down sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300759262 Feel free to create]]> 2022-09-17 06:04:25 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300759262 Burp... sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300803581 Create ....




Read More:

All you need to know about anaesthesia for esophageal surgery]]> 2022-09-17 07:44:52 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300803581 Plan A, Plan B, Plan C, ....... sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300844977 A 72 year old lady presents for total thyroidectomy and neck dissection. This is her CT neck.

1) Write some questions....




Read More:

Anaesthesia for Head & Neck Cancer Surgery

Imaging in Head and Neck Cancers - BJA Ed

eFONA - BJA Ed]]> 2022-09-17 09:23:38 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300844977 Review Article - Acid Base Physiology sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300851538 2022-09-17 09:39:18 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300851538 Hot day for a beer sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300977253 A 22 year old man is brought in unconscious to the EMD. His friend gives a history of him consuming some unknown liquid.

1) Describe the ABG and comment on the type of acid base abnormality.

2) Explain your reason for your chosen type of acid base abnormality.

3) What is the calculated osmolarity ? How did you calculate this ?

4) What is the osmolar gap ? How did you determine this ?

5) What is the most likely diagnosis ?


Read more:

Mind the Gap from ATS Journal

LITFL - Osmolar Gap]]> 2022-09-17 13:48:02 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2300977253 How to explore content here sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2301019972 Easiest on laptop/desktop.
Mobile works.
Open up the post - top right hand corner 3 dots.
Scroll through posts like a presentation.
Watch the screencast video for details

]]> 2022-09-17 14:51:16 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2301019972 Transducer Manipulations sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2301032062 How to communicate and describe transducer manipulations. A standardised method.]]> 2022-09-17 15:09:16 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2301032062 sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2301966273 2022-09-18 23:28:12 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2301966273 Make a Bee Line for it sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2302413734 2022-09-19 05:52:38 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2302413734 Sudden onset chest pain sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2302444280 2022-09-19 06:18:43 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2302444280 ? sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2302463243 2022-09-19 06:34:49 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2302463243 Articles: Further Reading sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2315144594 2022-09-27 08:25:02 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2315144594 Cardiac or Respiratory ? sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2315168864 2022-09-27 08:43:44 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2315168864 Panda's favourite food sureshparanjothy https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2315229310


Radiological Features

Recent Developments & Anaesthetic Implications

Video - C-Spine Interpretation - AABBCDEs]]> 2022-09-27 09:29:33 UTC https://padlet.com/sureshparanjothy/k370m6os8hqnffsu/wish/2315229310