A 55 year old lady presents to the Emergency Department irritable, confused and complaining of a severe headache. Her husband reports that she had been very drowsy since earlier that day when she was heard to suddenly cry out. She was apparently well the day before. Examination findings include Temp 37.8 deg C, HR 95, BP 150/80mmHg, RR 24, Pulse oximetry 91%, GCS E2, V3, M6.
List the most likely differential diagnoses.
(Neurology and Neurosurgery) - Pass rate ; highest mark .
A 70 year old man is admitted to ICU from theatre following routine coronary artery bypass grafting. Surgery was uneventful. He is brought back intubated and ventilated. Following handover, you are going to continue ventilation on the ICU ventilator.
What controls do you do you need to set and how would you determine the value of the settings?
(Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark .
A 25 year old cyclist fell of his cycle at high speed and was found unconscious. In the Emergency Department initial observations are pulse 108/minute, blood pressure 100/60 mm Hg, saturation 89% on 15 litres/min oxygen via face mask. He is unconscious, tachypnoeic but has symmetrical chest movement, what would be the immediate management of this patient?
What would be the immediate management of this patient?
(Trauma, Burns, Drowning) - Pass rate ; highest mark .
A 74-yr-old man with a past history of hypertension and NIDDM has just undergone a 3- vessel graft and aortic valve replacement for aortic stenosis. You are on duty when the patient is transferred to ICU postoperatively.
On admission, you note the following vital signs and haemodynamic observations:
Temperature 35.5 0 C
Heart rate 66 bpm, sinus rhythm
Serum HCO3 19 mEq/L
Systemic blood pressure 94/60 mm Hg
Serum lactate 2.4 mmol/L
Pulmonary artery pressure 22/10 mm Hg
Cardiac index 1.7 L/min/m2
Systemic vascular resistance index 1600 dynes. sec. cm-5
What would you like to know about his pre-operative health status and work-up that would influence your post-operative management?
(Cardiothoracic Intensive Care) - Pass rate ; highest mark .
You are asked to see a 72 year old man who is 5 days post elective left hemicolectomy for cancer. His co-morbidities include COPD, ischaemic heart disease and rheumatoid arthritis.
On assessment he is drowsy but responsive to voice. He is poorly perfused, HR =120, BP = 100/60. His heart sounds and lung fields are normal; his abdomen is diffusely tender and distended. He has intravenous access, and has been commenced on fluids and O2 .
Please outline your most likely diagnosis and a differential diagnosis for this patient’s deterioration.
(Gastroenterology and Hepatology) - Pass rate ; highest mark .
You have taken over the care of Matthew, a 28 year old male, admitted to the Intensive Care Unit overnight following a motor bike accident. His GCS was 3 at the scene and was intubated and ventilated by the paramedics. He was noted to have dilated non reactive pupils, and feeble respirations, prior to intubation. An urgent CT head showed severe diffuse axonal injury with a 1.5 cm midline shift, evidence of transtentorial herniation but no drainable intracranial collection. The consensus opinion of the neurosurgical and ICU team was that the outcome was dismal and would not be altered by ICP monitoring and neuro protective measures. The findings on your clinical assessment the following morning are as follows: GCS -3, Pupils 5mm not reactive to light, absent corneal cough and gag reflexes. Spontaneous respirations present (6-8 breaths per minute). He has been off sedation, analgesics and neuromuscular blocking agents since admission.
The patient’s next of kin (Pat) is waiting to talk to you. The nursing staff informs you that while Pat was briefed by senior registrar (John) over night about the poor outcome, Pat was hoping for a miracle.
(Communication and Ethics) - Pass rate ; highest mark .
You are working as an ICU specialist in a small regional hospital. You are called to give urgent assistance with a 65 year old male who has presented to the Emergency Department with increasing shortness of breath one week after discharge from a Metropolitan hospital following an apparently uncomplicated cardiac surgery. He has rapidly deteriorated. A junior registrar and nurse are in attendance.
How will you respond to this crisis?
The rest of the question focused on the differential diagnosis of a cardiac arrest post cardiac surgery, approach to BLS and pericardiocentesis.
(Cardiac Arrest and Resuscitation) - Pass rate ; highest mark .
There were 4 Chest X-Rays and 2 CT scans for interpretation. Problems included identification of artifacts on the X-Rays, lung collapse, and pneumothoraces. CT scans included a carotid territory infarct and a lung CT showing extensive bilateral interstitial pneumoninits.
(Radiology) - Pass rate ; highest mark .