Cert Critical Care(SA) Surg

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 Surgeons of South Africa

Paper 1 27 August 2015 (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 Discuss the practical application of the principles of bioethics to the following situations
a) End of life decisions and futility. (25)
b) Informed consent. (25)
[50]

2 Write short notes on

a) The clinical manifestations of tricyclic antidepressant overdose. (10)
b) Management of complications due to tricyclic antidepressant overdose. (10)
c) Management of paracetamol overdose. (10)
d) Clinical manifestations of organophosphate poisoning. (10)
e) Management of amlodipine overdose. (10)
[50]

3 a) Neuro-protective strategies are an important consideration following brain injury.

Discuss currently available and investigational strategies that may be utilised in the
context of
i) General strategies that are common for brain injury following ischaemic stroke
and traumatic brain injury. (7)
b) Strategies that are specific to the following
i) Traumatic brain injury. (7)
c) i) Ischaemic stroke. (4)
ii) Sepsis. (2)
iii) Novel or experimental strategies following brain injury. (5)
d) Discuss Crush syndrome as follows
i) Clinical and biochemical manifestations. (7)
ii) Prevention of acute kidney injury and the efficacy of these interventions. (18)
[50]

PTO/Page Question 4…
4 A 42-year-old man underwent surgery for a perforated peptic ulcer 6 days ago. He has had a
complicated course and is still being ventilated. You now suspect that he has developed
ventilator-associated pneumonia (VAP). Discuss the following
a) Discuss the pathogenesis of VAP. (15)
b) The utility of all the tools you would consider to make a diagnosis of VAP. (15)
c) Your treatment strategy (including the rationale). (10)
d) A comprehensive plan for the prevention of VAP. (10)
[50]