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

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
Exams LITFL ACEM 700

Examination Library

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.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.