Intensive care medicine
Question 5 (Sept 2019)
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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.
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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)
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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
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a) What is the daily energy requirement of a normal healthy 70kg man (1 mark)
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b) What are the recommended daily proportions of carbohydrate, fat and protein (3 marks)
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c) What is refeeding syndrome (2 marks)
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d) What are the three major electrolyte abnormalities seen in refeeding syndrome (3 marks)
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e) What is the commonest nutritional deficiency (1 mark)
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f) Which patients are at particular risk of refeeding syndrome (6 marks)
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g) How should these patients’ nutritional requirements be managed? (4 marks)
Question 9 (September 2018)
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a) What is meant by the term ventilator associated pneumonia? (3 marks)
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b) List 7 patient factors that increase the risk of development of ventilator associated pneumonia? (7 marks)
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c) List 3 other factors that increase the risk of developing ventilator associated pneumonia (3 marks)
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d) Why is endotracheal cuff pressure ideally kept between 20-30cm H20 (1 mark)
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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)
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b) List 4 key clinical features that are used to diagnose delirium in critical care (4 marks)
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c) List 9 common potentially treatable causes of delirium in a critical care patient (9 marks)
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d) Name 2 indications for when pharmacological treatment is indicated in a patient with delirium (2 marks)
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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.
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a) Name 5 relevant features in the history that are important (5 marks)
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b) List 8 investigations required for this patient (8 marks)
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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
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c) Outline your management of this patient (7 marks)