Cert Critical Care(SA) Anaes

THE COLLEGES OF MEDICINE OF SOUTH AFRICA

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

Examination for the Subspecialty Certificate in Critical Care of the College of Anaesthetists of South Africa 23 August 2012 Paper 1 (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)

1 2

Discuss the management of the patient with refractory hypoxaemia Include in your answer relevant specific studies (100) A 15 year old male patient is admitted to your ICU after a motor vehicle accident. The trauma primary survey prior to ICU admission shows that he has an isolated closed head injury. Outline your management of this patient under the following headings: a) Diagnostic investigations (20) b) General supportive treatment measures (20) c) Management of intracranial pressure (20) d) Mechanical ventilator therapy (10) e) The role of steroids, anticonvulsants and free radical scavengers (10) f) Hypothermia in Traumatic Brain Injury (20) [100] With respect to the management of liver disease a) Define hepatic encephalopathy and briefly describe its pathophysiology. (10) b) What are the precipitating factors for the development of hepatic encephalopathy? (8) c) Discuss management interventions directed specifically at hepatic encephalopathy that may be utilized. Indicate their relative efficacy and evidence for benefit. (20) d) What would you recommend in terms of nutrition for the patient with hepatic encephalopathy? (6) e) What pulmonary complications are described in end stage liver disease? Indicate the pathophysiology and therapies available for their management. (40) f) Define the hepato-renal syndrome and indicate how it may be best managed. (16) [100] With reference to the current concepts on peri-operative fluid management, discuss: a) The pathogenesis of oedema Include in your answer a discussion on the following i) capillary permeability. ii) the endothelium and the endothelial surface complex. iii) the validity of Starlings principle. iv) the role and function of lymphatics in oedema.

(50)

b)

The pathophysiology of oedema

Include in your answer a discussion on the following i) capillary perfusion pressure or flow. ii) DO2. iii) Is hypoxia deleterious to the patient? iv) capillary density.

(50) [100]