CICM SAQ 2010.1 Q3

Questions

3.1 What are the distinguishing features on clinical examination between a neuropathy and a myopathy?

3.2 List 4 causes of a mid diastolic murmur over the apex.

3.3 A previously fit 45 year old man was noted to be in respiratory distress 24 hours following maxillofacial surgery. Clinical examination revealed the following:

  • Respiratory rate of 22/min
  • Decreased air entry left side
  • Crackles left base
  • HR-104/min, regular. JVP not raised. Apical impulse 5th left intercostal space anterior axillary line.

Investigations:

  • ECG – normal
  • Chest X-Ray – complete whiteout on the left side.

(a) What is the likely cause of his respiratory distress?


Answers

Answer and interpretation

3.1 What are the distinguishing features on clinical examination between a neuropathy and a myopathy?

3.2 List 4 causes of a mid diastolic murmur over the apex.

  • Mitral stenosis
  • Aortic regurgitation
  • Left to right shunts – VSD or a PDA
  • Severe MR
  • Acute rheumatic fever

3.3 A previously fit 45 year old man was noted to be in respiratory distress 24 hours following maxillofacial surgery. Clinical examination revealed the following:

  • Respiratory rate of 22/min
  • Decreased air entry left side
  • Crackles left base
  • HR-104/min, regular. JVP not raised. Apical impulse 5th left intercostal space anterior axillary line.

Investigations:

  • ECG – normal
  • Chest X-Ray – complete whiteout on the left side.

(a) What is the likely cause of his respiratory distress?

Left lung collapse from

  • Perioperative blood aspiration
  • Aspiration of gastric contents
  • Sputum


Exams LITFL ACEM 700

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CICM

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

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