Outline the advantages and disadvantages of the various techniques used in the diagnosis and monitoring of vasospasm secondary to aneurysmal subarachnoid haemorrhage.

Compare and contrast the intraventricular catheter and the intraparenchymal fibreoptic transducer for intracranial pressure monitoring in critically ill patients.

List the possible reasons why a patient with septic shock from infected pancreatitis may have ongoing hypotension despite intravenous fluid therapy, antibiotics and escalating inotrope requirement.

A 28-year-old male has been involved in a high-speed motor vehicle crash and admitted to your hospital. His initial GCS at the scene was 5 (E2, V2, M1). He has been intubated and has a hard collar in place.

When the preconditions for the clinical determination of brain death cannot be met, what imaging modalities are recommended to determine absence of intracranial blood flow? What findings in each test confirm brain death?

Outline the role of ECMO (Extracorporeal membrane oxygenation) as a supportive strategy in the critically ill.

Q1. A 49-year-old female, with a history of pulmonary vasculitis is found collapsed in the ward with shallow breathing and a GCS of 6.

Questions a) List the clinical features that indicate a poor prognosis in a patient with community-acquired pneumonia? b) List 5 common organisms causing severe community acquired pneumonia in immunocompetent adults. c) What are the possible reasons for non-response to empiric…

A 40 year old man with a history of ankylosing spondylitis and known difficulty with intubation on previous elective surgery is admitted to your ICU for hypoxic respiratory failure.

Questions With reference to clinical studies: a)  Define the term “external validity”. b)  Define the term “bias”. c)  Briefly explain selection bias and measures to reduce it. Answers

A 45-year-old man is admitted to the Emergency Department after ingesting an unknown quantity of “headache tablets”. His initial complaints are nausea, vomiting, shortness of breath and tinnitus. Fluid resuscitation has been commenced. You are asked to assess him as he is getting more dyspnoeic.

Outline the potential mechanisms of ventilator associated lung injury in patients with Acute Respiratory Distress Syndrome and the steps that can be taken to minimise them.