As prepared by Chris Nickson, here are the practice written questions from this week’s CICM Second Part exam practice session at The Alfred ICU, with recommended reading from LITF.com’s Critical Care Compendium and other FOAM sources:
Q1.
a) The following laboratory results are obtained from a venous blood sample:
- What is the most likely cause? (10%)
- What differences would you expect in a patient with hyperosmolar hyperglycaemic syndrome (HHS)? (30%)
b) The following laboratory results are also obtained from a venous blood sample:
- What is the most likely cause? Explain your reasoning. (30%)
- What other investigations would support your diagnosis. (30%)
Q1. a) The cause is an artefact due to venous sampling proximal to an IV infusion of 5% glucose. 5% glucose is 278 mmol/L, so will cause an elevated blood glucose measurement and dilute the other laboratory values. Differences in the laboratory results that may seen in HHS include: The diagnostic features of HHS are: b) The diagnosis is multiple myeloma. Key features are: Other consistent findings would include:
Q2.
Critically evaluate the use of therapeutic hypothermia in the management of severe traumatic brain injury.
Learn more here:
Q3.
Describe your approach to the management of refractory hypoxaemia in intubated patients with severe acute respiratory distress syndrome (ARDS).
Provide justification(s) where appropriate.
Learn more here:
https://lifeinthefastlane.com/ccc/improving-oxygenation-in-ards/
https://lifeinthefastlane.com/ccc/post-intubation-hypoxia/
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