CICM SAQ 2011.2 Q26
Questions
26.1. List 4 clinical signs which may be noticeable on examination of the head in a patient with cerebellar disease
26.2. A patient presented with sudden onset of weakness involving his left upper and lower limb. On examination, he was conscious, with a dilated non-reactive right pupil, normal power in the right upper and lower limbs, and a left hemiparesis. What is the likely site of lesion? Outline your reasoning.
26.3. List 4 causes of a diastolic murmur over the apical area
26.4. On examination of a critically ill patient who was in respiratory distress, the following signs were noted:
Tachypnoea
SpO2 88%
Trachea shifted to the left
Reduced air entry and dullness to percussion in the infraclavicular and axillary areas on the left side.
- a) What is the likely lung pathology?
- b) List 3 causes of this pathology in critically ill patients.
Answers
Answer and interpretation
26.1. List 4 clinical signs which may be noticeable on examination of the head in a patient with cerebellar disease
- Nystagmus
- Titubation
- Staccato speech
- Skew deviation of the eyes Impairment of finger-nose test
26.2. A patient presented with sudden onset of weakness involving his left upper and lower limb. On examination, he was conscious, with a dilated non-reactive right pupil, normal power in the right upper and lower limbs, and a left hemiparesis. What is the likely site of lesion? Outline your reasoning.
- Right side of the midbrain. It is a crossed hemiplegia suggesting a brainstem stroke and the 3rd nerve nucleus is located in the midbrain.
26.3. List 4 causes of a diastolic murmur over the apical area
- Mitral stenosis
- Severe mitral regurgitation (flow murmur)
- Significant left to right shunt (VSD)
- Austin Flint murmur of aortic regurgitation
- Carey Coombs murmur
26.4. a) What is the likely lung pathology?
- Left lung collapse
26.4. b) List 3 causes of this pathology in critically ill patients.
- Right bronchial intubation
- Mucus plugging – left main bronchus
- Obstructive lesions left main bronchus
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC