CT head is one investigation that has and will appear in the Final OSCE
Introduction to CT head – interactive on-line course (about an hour to do) introducing the basic patterns on CT head
ECGs are frequently presented to candidates sitting the OSCE element of the exam, a systematic approach is essential.
P peaked, tall Dright atrial hypertrophy
notched, broad Dleft atrial hypertrophy
P-R >5 small squares
I degree block: prolonged PR interval
II degree block:
Wekeneback: sequential of PR interval
Mobitz typ II: fixed PR, dropped QRS (2:1, 3:1…)
III degree block: disassociation of P and QRS
QRS wide (<2.5 small squares)
MarroW Dright bundle branch block
WilliM Dleft bundle branch block
Q 1mm wide, 2mm/25% of R-wave
D old MI
Normal in lead I, aVL V6
ST raised: 1mm 2xconsangious limb-leads, 2mm chest-leads
Depression: myocardial ischemia
Reverse tick: digoxin effect
Saddle shaped elevation: acute constrictive pericarditis
T peaked hyperkalaemia
Flat, prolonged, hypokalaemia
Normal in III, V1-2 (and V3 in Negroes)
MI: Hyperacute T-waves, ST-elevation T-wave inversion, Q-waves. Inf. (II, III, aVF) Ant. (V1-4), Lat. (I, aVL,V5-6) Post. look at V1-2. New LBBB.
PE: S-I (deep S-waves in I), Q-III (Q-waves in III), T-III (inverted T-waves in III). More generally a sign of R-heart strain.
Hyperkalaemia: tall tented T, wide QRS
Hypokalaemia: flattened T, prominent U, (muscle weakness, cramps, tetany)
ECG Wave-Maven – is a resource with many “barn-door” ECGs, presented in a quiz format; large database, expert explanations.
Bedside Critical care Echo (POCUS – Point of Care UltraSound) deserves it’s own page, while not featured prominently on the exam, it is becoming a standard of care on most units. There are lots of pages out there, here are a few I’ve found helpful
Joint Statement: Appropriate Use Criteria for Echocardiography (2011) – this statement considers the evidence and utility of performing echo in specific situations.
Virtual Transthoracic Echocardiography – this page shows high quality, interactive 3D images which will help you understand what your seeing on echo and also gives a few tips.
Matt and Mike are constantly putting new podcasts out, they carry several lectures on the physics of ultrasound alongside the use of ultrasound of other parts of the body.
Clinical practice guideline on diagnosis and treatment of hyponatraemia. Intensive Care Med (2014) 40:320–331