CICM Second Part Exam Practice SAQs 14112018

As prepared by Bevan Roodenburg, here are the practice written questions from a recent CICM Second Part exam practice session at The Alfred ICU, with recommended reading from’s Critical Care Compendium and other FOAM sources:

Q1. (CICM SAQ 2011.1 Q2)

Answer the following questions about transjugular intrahepatic portosystemic shunts (TIPS):

  1. What is a TIPS procedure and why is it used in patients with portal hypertension?
  2. What are 2 recognised indications for this procedure?
  3. Excluding mortality list 5 COMMON complications of TIPS procedure
  4. Describe one classification system used in assessing severity of chronic liver disease and outline its utility.

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Q2. (CICM SAQ 2011.1 Q7)

As director of ICU, the general manager of your hospital asks you to review your current infection control policy following an increase of 200% in the number of newly acquired VRE infections during an ICU admission in the past 2 months.

Outline your approach to this request.

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Q3. (CICM SAQ 2011.1 Q8)


A 40 year old previously well male presents with a ruptured appendix and associated peritonitis (Day 0). He returns to theatre 3 days later with ischaemic colitis and requires a right hemicolectomy. At laparotomy, he is noted to have extensive thrombosis in his superior mesenteric vein and portal vein. Attempts to anticoagulate him postoperatively (day 5 onwards) with intravenous heparin have been unsuccessful.

His post op haematology results are as follows:

  Day 0 Day 1 Day 3 Day 5 Day 7 Day 9 Range
INR 1.2 1.7 1.8 1.6     0.8-1.3
APTT 36 38 36 28* 31* 37* 24-35
Fibrinogen 5.8 1.8 1.4 1.7      
INR Mix   1.9         0.8-1.3
APTT Mix   32.5         30-40
D Dimer   >4         <0.5mg/L

* On I.V. heparin. APTT therapeutic range for I.V. heparin therapy: 60 – 90 seconds

Additional tests performed on Day 7:

Tests of hypercoagulability (plasma)

Antithrombin (functional) 20%  (Reference: 80 – 120%)

Factor assays (plasma)

Factor VIII 4.10 IU/ml (Reference: 0.5 – 1.5)

Anti-Factor Xa assay (plasma)

Anti-Factor Xa 0 IU/ml (Reference for IV heparin therapy: 0.3 – 0.7)

  1. What are the possible factors preventing therapeutic anticoagulation in this patient?
  2. List 2 strategies to effect anticoagulation with intravenous heparin.


A 28 year old man presented with a persistent epistaxis to the emergency department.

The coagulation profile was as follows:

Test Value Reference Range
INR 1.2 0.8-1.3
APTT 50 25-39
Platelets 250 x 10^9 / L 150-350
Bleeding time 16 minutes 2-8
Fibrinogen 3 g/L 1.5-4
FDPs <10mg/L 0-10
Thrombin clotting time 15 seconds 12-17
  1. What is the most likely diagnosis?
  2. What would you confirm your diagnosis?


A 50 year old female presents with a right deep vein thrombosis and haemoptysis.

These blood results are from her admission:

Test Value Reference Range
PT 12 seconds 12-14
APTT 69 seconds 34-38
Thrombin time 16 seconds 14-18
APTT Mixing test 60 seconds  
  1. What is the APTT mixing test and what is its significance in this patient?

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You can access all the previous practice questions since 2014 here:
See this link on INTENSIVE for exam resources:

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