Intensive care medicine

Question 5 (Sept 2019)

A 65 year old patient on ICU has had a percutaneous tracheostomy inserted 3 days ago you are called to the ICU overnight as there is concern over the tracheostomy.

a) Name 3 indications for tracheostomy placement (3 marks)

 

b) Describe 3 different types of tracheostomy (3 marks)

 

c) Name four immediate complications of tracheostomy insertion (4 marks)

On initial assessment there is concern that the tracheostomy may be blocked

 

d) How do you check if a tracheostomy is patent (3 marks)

 

e) Outline your immediate management of a blocked tracheostomy (3 marks)

 

f)  The patient then develops worsening hypoxia what you do? (4 marks)

Question 5 (March 2019)

 

Refeeding syndrome

a) What is the daily energy requirement of a normal healthy 70kg man (1 mark)

b) What are the recommended daily proportions of carbohydrate, fat and protein (3 marks)

c) What is refeeding syndrome (2 marks)

d) What are the three major electrolyte abnormalities seen in refeeding syndrome (3 marks)

e) What is the commonest nutritional deficiency (1 mark)

f) Which patients are at particular risk of refeeding syndrome (6 marks)

g) How should these patients’ nutritional requirements be managed? (4 marks)

Question 9 (September 2018)

 

a) What is meant by the term ventilator associated pneumonia? (3 marks)

b) List 7 patient factors that increase the risk of development of ventilator associated pneumonia? (7 marks)

c) List 3 other factors that increase the risk of developing ventilator associated pneumonia (3 marks)

d) Why is endotracheal cuff pressure ideally kept between 20-30cm H20 (1 mark)

e) Name 6 other measures (other than cuff pressure) that may reduce th risk of the development of ventilaor associated pneumonia? (6 marks)

Question 4 (March 2018)

 

a) Define delirium (2 marks)

b) List 4 key clinical features that are used to diagnose delirium in critical care (4 marks)

c) List 9 common potentially treatable causes of delirium in a critical care patient (9 marks)

d) Name 2 indications for when pharmacological treatment is indicated in a patient with delirium (2 marks)

e) List 3 classes of drugs that an be used to treat delirium (3 marks)

Question 5 (March 2018)

 A 20 year old man is brough to the emergency department having been pulled from a river following a near drowning.

a) Name 5 relevant features in the history that are important (5 marks)

b) List 8 investigations required for this patient (8 marks)

He has a GCS of 13 but is found to hae arterial oxygen partial presure of 6kPa (45mmHg) breathing 4L/min of oxygen via a variable performance mask

c) Outline your management of this patient  (7 marks)