CICM Second Part Exam Practice SAQs 28052020

Q1.

A 60 year-old man with COVID-19 pneumonia was admitted to the ward yesterday. He is developing progressive hypoxaemia and now requires 10 L/min O2 via non-rebreather mask to maintain SpO2 88%. 

Discuss the role of highflow nasal oxygen, CPAP/NIV, and intubation in the management of this patient’s worsening hypoxaemia.

Learn more here:

(especially the “oxygenation and ventilation” section)

(discusses the controversy of when to intubate COVID-19 patients)

(discusses the controversy of whether COVID-19 should be managed like ARDS)

Q2.

Regarding patient consent for invasive procedures:

1. What are the requirements for consent to be valid? (20%)
2. In Australian law, adults are presumed to be competent. What do you understand by the legal term ‘competence’? (20%)
3. What questions can you ask a patient to assess their competence? (30%)
4. Describe the different ways of making treatment decisions when patients lack competence (30%)

Learn more here:

Q3.

1.1 (35%)

A 65 year-old male has a MET call for chest pain with hypotension. What are the important findings on the ECG and what is the likely diagnosis.

1.2 (35%)

You are asked to review a 25 year-old male in the ED. He presented with hypotension following a syncopal event. What are the important findings on the ECG and what is the likely diagnosis.

1.3 (30%)

In the following stroke patients, localise the lesion based on the clinical presentation:

Patient A

• left-sided limb ataxia
• left-sided alteration of pain and temperature on the face
• left-sided ipsilateral Homer’s syndrome
• right-sided alteration of pain and temperature affecting the arm and leg
• dysarthria and decreased gag reflex on the left, with the palate pulling up on the right-side

Patient B

• failure of adduction past the midline (movement towards the nose) of the left eye and leading eye (right) nystagmus on looking laterally to the right
• Normal eye movements on looking to the left
• There is no hemiparesis and further examination is unremarkable.

Patient C

• right-sided Horner’s syndrome
• right-sided limb ataxia
• left-sided total loss of sensation affecting the arm and leg

Learn more here:

(the 1st ECG case)

(the 2nd ECG case)

(approach to brainstem localisation)

(4 practice scenarios – includes the scenarios used in this question, find the answers there!)

(4 more practice scenarios – includes the scenarios used in this question, find the answers there!)