CICM Second Part Exam Practice SAQs 14112018

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.

Learn more here:

https://lifeinthefastlane.com/cicm-saq-2011-1-q2/

http://lifeinthefastlane.com/ccc/transjugular-intrahepatic-porto-systemic-shunt-procedure-tipss/

http://lifeinthefastlane.com/ccc/liver-failure-definitions/

http://lifeinthefastlane.com/ccc/fulminant-hepatic-failure/

http://lifeinthefastlane.com/ccc/chronic-liver-disease/

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.

Learn more here:

https://lifeinthefastlane.com/cicm-saq-2011-1-q7/

http://lifeinthefastlane.com/ccc/multi-resistant-bacteria-outbreak/

http://lifeinthefastlane.com/ccc/healthcare-associated-infections-hais/

http://lifeinthefastlane.com/ccc/transmission-based-precautions/

Q3. (CICM SAQ 2011.1 Q8)

3.1.     

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:

* 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.

3.2.     

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

The coagulation profile was as follows:

1. What is the most likely diagnosis?
2. What would you confirm your diagnosis?

3.3.     

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

These blood results are from her admission:

1. What is the APTT mixing test and what is its significance in this patient?

Learn more here:

https://lifeinthefastlane.com/cicm-saq-2011-1-q8/

http://lifeinthefastlane.com/ccc/coagulation-profile/

https://lifeinthefastlane.com/ccc/disseminated-intravascular-coagulation/

http://lifeinthefastlane.com/epistaxis/

http://lifeinthefastlane.com/ccc/bleeding-time/