A 60 year old man has been transferred to your ICU from another hospital ICU, where he had been admitted 10 days ago with severe pancreatitis and requiring mechanical ventilation. His oral intake was said to be poor during the week leading up to that hospital admission.

1. How would you assess his nutritional state?

The rest of the questions focussed on the route of administration of feeds, calculation of caloric requirements, and the role of immunonutrition.

A 63 year old woman was admitted to the Intensive Care Unit 4 days ago. She has suffered a cardiac arrest in the community, was resuscitated by Ambulance Officers and was treated with urgent cardiac angiography and stenting of a significant left main coronary artery lesion.

Her clinical condition:

•    On moderate sedation, she has started to obey commands this morning
•    Intubated and ventilated since admission. Currently FiO2 = 0.6, PaO2 = 120
•    Right internal jugular central line, left radial arterial line, right cephalic vein peripheral IV line – all inserted on admission

•    She is being treated with clopidogrel, ranitidine and intravenous heparin.
•    She has been in atrial fibrillation since admission

This morning she developed a temperature of 38.8°C. What are the likely causes of fever in this lady?

The rest of the question focused on the approach to the febrile critically ill patient.

A 26 year old male is a passenger in a high speed motor vehicle crash. At the scene his Glasgow coma score is 3 and he is intubated by paramedics and transferred to your hospital. In the emergency room, clinical assessment and radiological investigations are consistent with an  isolated severe traumatic brain injury. He is transferred to the ICU.

1) Define severe traumatic brain injury

The rest of the questions focussed on the evidence based approach to ICP and CPP
management.

You are the intensivist caring for a patient Mr James Wilson, a 70 year old man admitted to your ICU last night with aspiration pneumonitis associated with a bowel obstruction. He had been in hospital for 4 days prior to admission to the ICU.  He is sedated, intubated, ventilated on 80% oxygen and requiring inotropic / vasopressor support.

At the morning hand-over round you are told of an attempt by the new night ICU Registrar to insert an internal jugular central venous catheter just an hour ago that has resulted in technical difficulties with the guidewire being accidentally pushed into the venous circulation.  It is seen on X-ray to be in the right atrium, ventricle and pulmonary artery.

The patient's son/daughter has arrived and wishes to speak to someone about their father's condition.  You are asked to enter this room and update the patient's relative about the condition of their father.

Radiology station.

Six sets of X-Rays ( 4 chest X-Rays, 1 CT abdomen and 1 MRI brain) were shown to the candidates and required to identify major radiological findings.

Timing of dialysis and troubleshooting the CRRT circuit