CICM Second Part Exam Practice SAQs 19042018

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

Q1.

A 25-year-old man has admitted to ICU 17 days ago following a severe traumatic brain injury. He has a tracheostomy, ongoing fevers, and is making slow neurological progress.

His serum sodium is 160 mmol/L.

Outline your approach to the assessment and management of his hypernatraemia. (100%).

Learn more here:

Hypernatraemia

Q2.

A 30-year-old woman was admitted from the ED overnight with fever and hypotension. She had been unwell for 2 weeks. She received 2.5L of crystalloid and now requires noradrenaline 15 mcg/min to target a MAP of 65 mmHg. She has normal transthoracic echocardiogram and is not fluid responsive.

Her other vital signs are HR 120/min, RR 25/min, SpO2 96% on 4L via nasal prongs, GCS 15, and T 39.1C.

You note a serum ferritin level was obtained, which is elevated at 11,000 ng/mL.

Outline your approach to her assessment in ICU (100%).

Learn more here:

Rosário C, Zandman-goddard G, Meyron-holtz EG, D’cruz DP, Shoenfeld Y. The hyperferritinemic syndrome (…). BMC Med. 2013;11:185. [article]

Sepsis Definitions and Diagnosis

Unresolved sepsis and antibiotic treatment failure

Haemophagocytic lymphohistiocytosis (HLH)

Q3.

A 62-year-old woman has been admitted to hospital for investigation, giving a history of episodic facial flushing and diarrhoea, and fatigue. You are called to review her on the ward because she is hypotensive. Your examination shows features of right heart failure, with a tricuspid regurgitant murmur.

  1. What is the most likely diagnosis? (10%)
  2. List 2 biochemical laboratory investigations that help confirm the diagnosis. (10%)
  3. What hepatic abnormalities are likely to be present? (30%)
  4. Outline the therapies specific to her condition that may be indicated. (50%)

Learn more here:

It might be carcinoid…

Carcinoid Syndrome

Right Ventricular Failure


You can access all the previous practice questions since 2014 here:
https://docs.google.com/document/d/1_Ta8IvVaVtc5Il7-kJwj6qKGu54OmifJGRUWCXud8dY/edit
See this link on INTENSIVE for exam resources:
https://intensiveblog.com/resources/#3

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