CICM Second Part Exam Practice SAQs 27042016

As prepared by Dash Gantner, here are the practice questions from the last written exam practice session at The Alfred ICU, with recommended reading from Lifeinthefastlane.com’s Critical Care Compendium and other FOAM sources:

Q1. (CICM 2nd Part Exam 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:

Q2. (CICM 2nd Part Exam 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 MRSA infections during an ICU admission in the past 2 months.

Outline your approach to this request.

Learn more here:

Q3.

 (CICM 2nd Part Exam 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:

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.

3.2.

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?

3.3.

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?

Learn more here:



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

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.