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 7 April 2016 (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 Write short notes on the following topics

a) Management of fulminant hepatic failure. (10)
b) Diagnosis and treatment of myasthenia gravis. (15)
c) Risk factors for the development of Intensive Care Unit-acquired weakness. (10)
d) Pathophysiology of Intensive Care Unit-acquired weakness. (10)
e) Differential diagnosis of Intensive Care Unit-acquired weakness. (5)
[50]

2 Compare and contrast the available options for cardiac output monitoring in critical care. Your
answer should include their respective physical basis, clinical considerations and their utility
in specific situations. [50]

3 a) Discuss Respiratory Recruitment Manoeuvres (RRM) using the following structure

i) Define what is meant by a RRM. (2)
ii) Outline the proposed mechanisms whereby a RRM may benefit patients. (10)
iii) Summarise the indications for attempting a RRM. (3)
iv) What are the contra-indications to an RRM? (5)
v) Briefly outline the various RRM techniques described in the literature, including
an outline of their practical implementation. (20)
b) Outline, with brief explanation, an effective pharmacological protocol for analgo-
sedation and adjunctive supportive therapy for an intubated patient undergoing a
RRM. (10)
[50]

4 a) Describe and critically discuss the classification of acute kidney injury (AKI). Include
the rationale, advantages and limitations. (20)
b) List the important risk factors for AKI. (5)
c) List strategies that may be employed to prevent the occurrence or progression of AKI.
(5)
d) Discuss the principles of drug dosing in a critically ill patient with AKI undergoing renal
replacement therapy. (15)
e) A critically ill patient with AKI undergoing renal replacement therapy requires
therapeutic amikacin. Outline your dosing strategy. (5)
[50]