Viewpoint,Clinical cases and OSPE/OSCE, In Anaesthesiology, 3rd edition

Most anaesthesia texts are written for reference, not for the viva. This one is written for the hour before your exam and the minute before your patient crashes. Postgraduate trainees in anaesthesiology, FCPS or MD candidates, and anyone facing an OSCE in South Asia will find cases that mirror their own wards. It turns examiner logic into a habit you can practise.

1. 1Introduction and overall structure

   Learn anaesthesia the way examiners ask it

   Picture a postgraduate trainee in Dhaka the night before the OSCE, surrounded by heavy reference books that answer everything except the question being asked. Dr. Md. Kamrul Hassan Mozumder, MBBS, DA, has watched this panic from the examiner's side of the table. So he builds a different kind of book: clinical cases told as they actually unfold in theatre, followed by OSPE and OSCE stations laid out as checklists. The outcome is a candidate who practises the exam's format, not just its content.

   The idea

   The insight is that knowing anaesthesia and passing an anaesthesia exam are two separate skills, and most books only teach the first. By structuring cases as examiner-style walkthroughs and stations as checklists, the book trains the second skill directly. What surprises people is how much of exam performance is format recognition — knowing what will be asked, in what order, and what a complete answer sounds like. Rehearse that, and knowledge you already have finally shows up under pressure.

   Try this: Pick one clinical case tonight and answer it aloud, standing up, as if an examiner were in the room — then repeat it tomorrow without notes.

2. 2Airway management cases

   The difficult airway: rehearse the crisis before it happens

   A patient is anaesthetised, the laryngoscope goes in, and nothing appears — no view, no easy tube, a room suddenly quiet except for monitors. This is the scenario anaesthetists dread, and Mozumder gives it to you as a worked case: assessment beforehand, the failed attempt, the escalation plan, the moment someone must decide to wake the patient or push on. The case ends with the airway secured and, just as important, a written sequence the trainee can recite. In the OSCE station version, the same crisis becomes a checklist to score yourself against.

   The idea

   Difficult airway management is less about heroics than about having decided your sequence before the crisis starts. The book's case format forces you to state the plan out loud — preoxygenation, backup devices, the wake-up option — so that in theatre you are executing a rehearsed script rather than improvising. What surprises people is how often the correct move is to stop and return to a safe state, a decision that feels like failure but is the mark of a safe anaesthetist.

   Try this: Write your personal failed-intubation sequence on one card and keep it in your pocket for a week, reading it before every list.

3. 3Intraoperative crisis cases

   Hypoxia on the table: a stepwise rescue you can recite

   The saturation alarm sounds mid-operation and the surgeon keeps cutting. In Mozumder's case walkthrough, the trainee must work through the causes in order — circuit, airway, breathing, circulation — while the clock runs. The case shows the wrong way too: the trainee who grabs for a cause at random and loses the thread. The right way ends with the cause found, the saturation climbing, and a debrief that turns the scare into a sequence. The paired OSCE station asks the candidate to do the same triage on paper, under time.

   The idea

   In an intraoperative desaturation, the order of your questions matters more than the speed of your hands. A structured sweep from machine to patient prevents the classic error of anchoring on one dramatic cause while missing a disconnected circuit. The case format works because it makes you verbalise the sweep until it becomes automatic. What surprises people is how often the answer is mundane — a kink, a leak, a disconnection — found only because the search was systematic.

   Try this: Run a one-minute mental DOPE-style sweep at the start of every case this week, naming each checkpoint aloud before induction.

4. 4Obstetric anaesthesia cases

   Obstetric anaesthesia: two patients, one decision

   A labouring mother needs anaesthesia and every decision carries a second, unseen patient. Mozumder's cases walk through the scenarios that fill obstetric theatres — the emergency caesarean, the choice between spinal and general, the dose calculations and the physiological shifts of pregnancy that change every answer. The trainee in the case must justify the technique aloud, the way a viva examiner will demand. The outcome is a candidate who can defend not just what they would do, but why, with the fetus in mind the whole time.

   The idea

   Obstetric anaesthesia is the specialty's clearest test of reasoning under dual stakes: every drug, dose and technique is chosen for two patients at once. The book's case method makes you argue your choice, which is exactly what a viva rewards. What surprises people is how much of the correct answer is physiology — aortocaval compression, altered airway anatomy, changed drug requirements — rather than technique memorisation. Know the physiology and the technique chooses itself.

   Try this: Before your next obstetric list, write down the three physiological changes of pregnancy that most alter your anaesthetic plan, and check them against the case answers.

5. 5Paediatric anaesthesia cases

   Paediatric cases: small patients, smaller margins

   A child arrives for surgery and the numbers that guide adults no longer apply — weights, doses, fluid volumes, tube sizes, all scaled down and all less forgiving. Mozumder's paediatric cases put the trainee in the preoperative room doing exactly this arithmetic, then through induction choices shaped by the child's age and condition. The case ends with the numbers correct and the reasoning explicit, because in a viva a right answer without the working scores nothing. The OSCE station version turns the calculations into a timed exercise you can drill.

   The idea

   Paediatric anaesthesia rewards preparation and punishes approximation, because the margins between therapeutic and toxic doses shrink with body weight. The book's insistence on showing your working mirrors how examiners — and safe practice — actually judge decisions. What surprises people is how much paediatric safety is arithmetic done in advance: formulas for tubes, fluids and doses written down before the child arrives, not worked out during a crisis.

   Try this: Memorise and write out the age-based formulas for paediatric tube size, fluid maintenance and common drug doses, then test yourself cold tomorrow morning.

6. 6OSPE sections

   OSPE and OSCE stations: score points by structure

   The station clock starts and the candidate freezes — not from ignorance, but from not knowing what the examiner wants. Mozumder's OSPE and OSCE sections dismantle that fear by presenting stations in the exact format of the exam: the stem, the task, and a model answer structured as scoring points. A trainee working through them learns that marks come from sequence and completeness, not eloquence. The outcome the book aims for is a candidate who walks into the station, recognises the task, and delivers the checklist calmly.

   The idea

   Objective structured exams are as much a test of format as of knowledge, and treating them that way changes scores. A model answer is essentially a checklist, and checklists can be rehearsed alone, without a study partner or a tutor. What surprises people is how many marks are lost to omission rather than error — the step you knew but never said. Practising against structured model answers trains you to say every step, in order, every time.

   Try this: Attempt one OSCE station this week under a strict two-minute timer, then mark yourself against the model answer and note every point you omitted.

7. 7Viva-oriented case discussions

   Viva preparation: answering the question behind the question

   In the viva room, a short question is rarely short. Mozumder's case discussions show a trainee giving a one-word answer and watching the examiner push deeper, then a trainee who answers in structured layers — definition, physiology, technique, complications — and steers the conversation. The cases model that fuller style, showing how a well-built answer pre-empts the next three questions. The outcome is a candidate who controls the viva's direction instead of being dragged through it.

   The idea

   A viva examiner is mapping the edges of your knowledge, and a structured answer lets them stop early with a good impression. Layering your answer — first principles, then practice, then complications — signals depth and buys you time to think. What surprises people is that long answers are not the goal; complete, ordered answers are. Saying the structure out loud ('there are three causes...') is a legitimate, learnable technique that keeps both you and the examiner oriented.

   Try this: Answer one practice viva question aloud in three named layers — definition, management, complications — and record yourself to hear where the structure breaks.

8. 8Drug and equipment stations

   Pharmacology and equipment: the facts you must not fumble

   A station hands the candidate a syringe and asks for the dose, dilution and dangers of the drug inside; another shows a piece of equipment and waits. These are the free marks of the exam, and Mozumder's cases and stations drill them directly — the anaesthetic agents, the muscle relaxants, the machines and monitors, each with the specifics an examiner expects verbatim. The trainee in the case who hesitates on a dose loses points that a prepared candidate banks in seconds. The outcome is a base of guaranteed marks under every candidate's feet.

   The idea

   Every anaesthesia exam contains a block of questions with single right answers — doses, concentrations, machine checks, monitor traces — and these are the cheapest marks available. The case-and-station format turns them into flashcard-style drills you can cycle daily. What surprises people is how many candidates lose these marks not to difficulty but to neglect, assuming the basics will look after themselves. They don't; they need the same rehearsal as the crises.

   Try this: Make a one-page sheet of the ten drugs and doses most used in your theatre and recite it from memory at the start of each shift this week.

9. 9Regional anaesthesia cases

   Regional anaesthesia: blocks, doses and the anatomy examiners love

   The case opens with a patient scheduled for a block and the trainee asked, in viva style, to trace the anatomy, name the landmarks, calculate the maximum safe dose and list what happens when it goes wrong. Mozumder walks the sequence through, ending with the block performed and the complications — toxicity, failed block, the rescue plan — spelled out. The paired station tests the same chain in isolation. The outcome is a trainee who can rebuild the whole logic from anatomy to antidote without notes.

   The idea

   Regional anaesthesia is a chain: anatomy, technique, dose, complications, rescue. Examiners test the chain link by link, and a candidate who knows one link but not the next scores in fragments. The book's case format rehearses the whole chain in order, which is why it transfers to both viva and OSCE. What surprises people is that the maximum safe dose calculation, a two-line sum, is one of the most commonly fumbled items in the entire exam — and one of the easiest to fix.

   Try this: For each block you perform or observe this week, calculate the maximum safe local anaesthetic dose aloud before the block is done.

10. 10Recovery and postoperative cases

    Postoperative care: the case doesn't end at extubation

    The patient is extubated, transferred, and the trainee relaxes — which is exactly when Mozumder's cases turn to the recovery room. Airway obstruction, pain, nausea, hypothermia and the monitoring that catches them form the next set of walkthroughs, each ending with a stable patient and a stated plan for escalation. The cases make the point that anaesthetic judgement is judged in recovery too, and the stations test it with the same checklist rigour. The outcome is a trainee who hands over a patient with a complete, defensible plan.

    The idea

    A large share of anaesthetic harm happens after the theatre, in the unglamorous hours of recovery, and exams test this period precisely because it is neglected. The structured cases train a handover habit: what was done, what to watch, what to do if it deteriorates. What surprises people is that a strong recovery-room answer is mostly a list of predictable problems — airway, breathing, circulation, pain, temperature, nausea — and listing them in that order is itself the skill being examined.

    Try this: For every patient you hand over this week, give a spoken plan covering airway, breathing, circulation, pain and temperature — in that order, every time.

Postgraduate anaesthesiology trainees facing viva and OSCE exams, especially in South Asian exam systems, will get direct, exam-shaped value from it. Anaesthesia tutors and examiners will also find it a ready source of case material and station templates.

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