2014, Paper 1 Vivas

A 74-year-old obese female with type 2 diabetes is transferred to your ICU from a district hospital with a diagnosis of ascending cholangitis. Ultrasound has confirmed an impacted gall-stone in the common bile duct.
 
Her vital signs are: Temperature is 34.5oC. Cold clammy peripheries Capillary refill time 4 secs
Heart rate 130 beats/min, sinus rhythm Blood Pressure 90/50 mmHg
SpO2 100% on 4 LO2/min via nasal prongs
 
Her examination findings are:
GCS 13 being confused and opening eyes to commands. Normal heart sounds with no murmurs or added sounds.
Bibasal inspiratory crepitations, with no wheeze or bronchial breathing.
Abdomen soft with right hypochondrial tenderness, but no rebound tenderness or guarding.
No residual urine in the bladder after catheterisation.
 
Outline your initial management of this patient.

(Gastroenterology and Hepatology) - Pass rate ; highest mark .

A 50-year-old male patient returns to ICU following a laparotomy, splenectomy and partial hepatectomy for intra-abdominal bleeding following a high speed motor vehicle accident with isolated abdominal trauma. He has had a massive transfusion in theatre.

Outline your initial assessment upon his arrival in ICU from the operating room.

(Trauma, Burns, Drowning) - Pass rate ; highest mark .

Leptospirosis, a little bit about malaria, DIC and citrate toxicity

(Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark .

Emergency management of severe burns; also, carbon monoxide and cyanide toxicity

(Trauma, Burns, Drowning) - Pass rate ; highest mark .

Decompressive craniectomy for malignant MCA infarction

(Neurology and Neurosurgery) - Pass rate ; highest mark .

Massive pulmonary embolism and a detailed discussion of thrombolysis

(Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark .

Consisted of 3 CXR images and 3 CT scans for interpretation.

(Radiology) - Pass rate ; highest mark .

You are the duty Intensivist arriving for the first day of your ward service week. One of your patients is a previously independent 60 year old female, Mrs. Jane Smith, who was admitted 5 days ago with community-acquired pneumonia. She has improved, but remains ventilated with progressive renal dysfunction. It was decided last evening to commence renal replacement therapy.

Overnight a registrar inserted a right internal jugular vascath under ultrasound guidance. Local swelling developed, and transducing the line revealed intra-arterial placement. The patient was subsequently transferred to theatre where the vascath was removed and the carotid artery laceration repaired.

This morning the patient was noted to have new left sided weakness. Urgent CT brain reveals   early   changes   consistent   with   a   very   large   right-sided   ischaemic   stroke.

(Communication and Ethics) - Pass rate ; highest mark .