Here are the practice questions from this week’s written exam practice at The Alfred ICU, with recommended reading from Lifeinthefastlane.com’s Critical Care Compendium and (this week) ICM Case Summaries:

Q1.

a) A 30 year-old woman presents with abdominal pain and paraesthesia. She was diagnosed with CML 2 months previously and is being treated with chemotherapy.

These are her blood test results:

Describe the abnormalities and give the likely pathophysiological explanation for each. (35%) What specific therapies (other than resuscitation and supportive care) are appropriate? (35%)

b) Regarding patients with haematological malignancies admitted to ICU:

List 3 likely reasons for an overall improvement in mortality over the past 20 years (15%) List 3 important risk factors for increased mortality in this patient group (15%)

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Q2.

Discuss how your approach to cardiac arrest occurring in a post-cardiac surgery patient in the ICU differs from the standard ALS approach. (100%)

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Q3.

An obtunded patient on the ward is found to have hyperammonaemia.

List the differential diagnosis for the underlying cause(s) of hyperammonaemia (40%) List investigations that are useful for determining the underlying cause (20%) Discuss the pros and cons of serum ammonia as an investigation in patients with encephalopathy (40%)

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