CICM SAQ 2015.2 Q3
Question
3.1. A 35-year-old female with no known previous medical history presents to the emergency department with a decreased conscious level.
- a) Give one diagnosis which will explain the clinical and laboratory findings. (10% marks)
- b) List six possible aetiologies. (20% marks)
3.2. The following data were obtained from a patient who had been observed overnight in the Emergency Department with minor fractures. The patient is otherwise well and currently asymptomatic.
- Give the most likely cause for the above biochemical abnormalities? Justify your answer. (40% marks)
3.3. You are asked to review a 44-year-old male known epileptic following a prolonged generalised tonic-clonic convulsion. He is intubated and ventilated. The arterial blood gas analysis is below.
- List the abnormalities on the blood gas and give the most likely cause of each abnormality. (30% marks)
Answer
Answer and interpretation
3.1a. Give one diagnosis which will explain the clinical and laboratory findings. (10% marks)
- Acute liver failure
3.1b. List six possible aetiologies. (20% marks)
- Toxins – paracetamol, alcohol, mushrooms.
- Viral hepatitis – Hep A,B,C,D,E, EBV,CMV
- Idiosyncratic drug reaction
- Ischaemic hepatitis due to shock – cardiogenic, septic
- Acute fatty liver of pregnancy
- Congenital/genetic – Wilson’s disease
- Hyperthermia – Heat stroke
- Autoimmune hepatitis
- Budd-Chiari syndrome
- Malignant hepatic infiltrations – breast cancer, lung cancer, melanoma, lymphoma, myeloma
3.2 Give the most likely cause for the above biochemical abnormalities? Justify your answer. (40% marks)
Artefact; – This blood sample was left longer than 6 hours before it was processed for above investigations. (Note to examiners – This is not just a haemolysed sample – haemolysis alone does not cause hypoglycaemia and lactic acidosis, though it will cause other abnormalities).
- Potassium, phosphate and LD enter the serum from red cell due to haemolysis and Na/K pump dysfunction
- Low Na – shift into red cell in exchange for potassium
- RBCs consume glucose and generate lactate
3.3 List the abnormalities on the blood gas and give the most likely cause of each abnormality. (30% marks)
- Metabolic acidosis – lactic acidosis secondary to prolonged seizures
- Respiratory acidosis (or inadequate compensation) – central hypoventilation or Inadequate mechanical ventilation
- Increased A-a gradient – aspiration pneumonia
- Pass rate: 61%
- Highest mark: 9.5
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.
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