Cert Critical Care(SA) Anaes

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

Incorporated Association not for gain Reg No 1955/000003/08

Subspeciality Examination for the Certificate in Critical Care of the College of Anaesthetists of South Africa 17 March 2010 Paper I (3 hours)
All questions to be answered. Each question to be answered in a separate book (or books if more than one is required for the one answer)

Shock is a clinical syndrome where the body is unable to maintain adequate tissue perfusion. Discuss shock under the following headings a) The causes and classification. (10) b) The pathophysiology of shock. (10) c) Clinical criteria utilised to differentiate the different types of shock. (10) d) The differences in the various classes of inotropic agents used to treat shock. (10) e) Other supportive measures employed in the management of the shocked state. (10) [50] With respect to the use of antibiotics in intensive care units (ICU) a) Describe the mechanisms of resistance that microbes employ to combat the effects of antibiotics. (15) b) Explain the concept of collateral damage. (5) c) What are the steps that can be taken to combat collateral damage? (10) d) What antibiotic therapy do you preferentially prescribe for the treatment of ventilator associated pneumonia? (5) e) Justify your answer to d above with reference to the principles of empiric antibiotic therapy. (15) [50] A 36-year-old male with acute pancreatitis is referred from the surgical intake team to ICU for ventilation and cardiovascular support a) How would you objectively assess the severity of the pancreatitis in this patient? (10) b) Describe in detail how you would manage the ventilation of this patient with particular regard to i) General principles. (20) ii) Quantifying improvement or deterioration of gas exchange in response to ventilatory intervention. (10) iii) Management of refractory hypoxaemia. (10) PTO/ Page 2 Question 4

-24 With respect to glucose control in the intensive care unit improving patient outcome a) Describe, the physiologic effects of, and mechanism of action of insulin. (5) b) How may glucose be measured in a patient in the intensive care unit? Discuss the pros and cons of the various modalities and tests available. (5) c) Provide a brief historical narrative of published research that has generated the most discussion and argument with respect to this topic. Indicate the general results or conclusion of any literature that you may cite. (20) d) Clearly state the glucose levels that you choose to target in patients in the intensive care unit. Justify the targets that you have chosen. (5) e) In the light of your answer provided to above discuss your approach to the management of blood glucose in the intensive care unit. Give a detailed and practical description of how you would prescribe drugs to alter a patients glucose and how you would monitor the results of your therapy. (15) [50]