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Marking
CCS
CBS
CBS - EPIC Part II SET I - Marking
Step
1
of
31
3%
Name of Candidate
Name of Examiner
CBS 1
1) What is the cause of cyanosis? Diagnostic investigation?
MethHb
Co oximetry
CBS 1
2) What is the abnormality? Probable cause?
Discrepancy in plathysmograph on pulse oximeter
Left hand large vessel occlusion
Atherosclerosis
Embolic
Trauma
hypercoagulable states
connective tissue diseases
CBS 1
3) What is the abnormality? Probable causes?
discrepancy between the pulse oximetry reading and the oxygen saturation on the arterial blood gas
pseudo-hypoxaemia
Excessive oxygen consumption following blood sample collection (e.g. massive leukocytosis or thrombocytosis).
Equipment failure: faulty pulse oximeter, faulty blood gas analyser
Blood sample used was actually venous
Blood sample taken from a site affected by localised hypoxemia, e.g. ischaemic limb
CBS 1
4) What is the Probable causes? What is the treatment?
Any prothrombotic state
Anticoagulants
CBS 1
5) What is the graphic show? What changes will you do in the setting?
Patient ventilator asynchrony
Flow starvation (scooping seen in insp portion of pressure time wave)
Increase the flow rate
CBS 1
6) What is the abnormality? Probable diagnosis?
Giant V wave occurs in the PAOP waveform ( after the T wave)
Acute mitral regurgitation
An acute ventricular septal defect complicating myocardial infarction) can also increase the amplitude of the v wave
CBS 1
7) What is the abnormality seen?
SVV 11%
EVLWI 11.2 ml/kg
Vasopressors
CBS 1
8) What does the graphic show? How will you correct?
1:1 inflation
Early inflation
Inflation just at the diacritic notch
CBS 1
9) What does the EEG show? How will you proceed?
Isoelectric EEG
Rule out causes like – sedatives, other preconditions, temp, elec, etc
Brain death testing
CBS 1
10) What does the ECG show? How will you proceed?
U wave in ECG
Check potassium – correct hypokalemia
CBS 2
1) What is diagnosis? How to confirm diagnosis?
Rhabdomyolysis
CPK
Urinary myoglobin
CBS 2
2) What is the biochemical abnormality? What is the cause for this abnormality?
Inappropriately high BUN:Cr
Drug induced (Tigecycline)
CBS 2
3) How to diagnose the condition? Management
Serum cortisol levels
Steroids
Correct hyperkalemia – Calcium, Glucose-insulin, B2 agonist, K bind resins
CBS 2
4) What is the biochemical abnormality? Next biochemical test to order?
Low anion gap
Serum Magnesium levels
CBS 2
5) What else should be tested? What could be the contributory factors?
Amphotericin B
Insulin
Alcoholic
CBS 2
6) What is the diagnosis? How to confirm?
Myxedema Coma
TSH
Free T4
CBS 2
7) What are the abnormalities? What is the next best biochemical investigation in this case?
Metabolic acidosis – High anion gap
Hypocalcemia
Hypokalemia
S Amylase
S Lipase
CBS 2
8) What could be the cause of this biochemical abnormality? How to distinguish between them?
CSW
SIADH
Inappropriate hypotonic fluid therapy
Fluid status assessment
CBS 2
9) What are the medical emergencies? How to manage this condition?
Wernicke’s encephalopathy
Hypophosphatemia
Hypokalemia
HYpomagnesemia
IV Thiamine
Correct electrolytes
Slow calorie build up
CBS 2
10) What intervention was done? What is the interpretation?
Apnoea test
Brain death
CBS 3
1) What is the cause of worsening hypoxia? How will you manage?
Bilateral Pneumothorax
surgical emphysema
Barotrauma
Bilateral ICD insertion
Decrease PEEP
Maintain Pplat below 30 cm H2O
CBS 3
2) What is the cause of deterioration of sensorium? How will you manage?
Acute hydrocephalus
cerebellar infarct
Anti-oedema measures
EVD/VP Shunt
Antiplatelets
CBS 3
3) What is the diagnosis? How will you manage?
Cardiac Tamponade
Pericardiocentesis
CBS 3
4) What is the cause of septic shock? How will you manage?
Bilateral Emphysematous Pyelonephritis
Fluid resuscitation/Vasopressor
Antibiotic
Source control (Percutaneous drainage/ DJ Stenting / Nephrectomy
CBS 3
5) What is the classical echo finding? How will you manage?
McConnel Sign ( Rt ventricular mid wall akinesia with apical hyperkinesia)
Pulmonary embolism
Thrombolysis
Anticoagulation
CBS 3
6) What do you see in the CT scan? Which common organisms are responsible for this lesion?
Rt sided lung abscess
Staphylococcus
Klebsiella
CBS 3
7) What is the cause of his symptoms? How do you manage?
Pacemaker Syndrome due to lead fracture
Lead replacement
CBS 3
8) What is the diagnosis ? How will you treat?
Rhabdomyolysis
aggressively correct hypovolaemia,
Sodium bicarbonate
RRT
CBS 3
9) What device is this? What principle does it work on?
Venturi Mask
Bernoulli principle
CBS 3
10) What is the finding? How will you manage?
Air under diaphragm
Perforation
HD Resuscitation
Antibiotics
Urgent exploratory laparotomy
AllEscort
