Critical Care and Anesthesiology

Question 1

Gold standard in the diagnosis of subarachnoid hemorrhage

Answer 1

Cerebral angiography

Question 2

Treatment to prevent cerebral vasospasm in subarachnoid hemorrhage

Answer 2

Nimodipine

Question 3

Artery involved in EDH and SDH

Answer 3

Epidural hematoma - middle meningeal artery

Subdural hematoma - bridging veins

Question 4

Why does EDH show as biconvex or lentiform while SDH show as crescent-shaped?

Answer 4

Review anatomy and how dura is attached to the skull.

In an epidural hematoma, it is usually caused by skull fracture. The middle meningeal artery is then torn by this massive impact. The expanding hematoma then pushes the dura from the skull which, on CT scan, appears as biconvex or lentiform-shaped.

In a subdural hematoma, the bridging veins are involved. Since it does not cross the falx cerebri and the dura is still attached to the skull, on CT scan, it appears as lentiform-shaped.

Question 5

Differentiate EDH from SDH

Answer 5

Epidural Hematoma

• follows a skull frature resulting in rupture of the middle meningeal artery
• expanding hematoma between the layer of the dura and the skull shows as biconvex on CT scan
• associated with lucid interval
• burr holing for big hematoma or conservative for small hematoma

Subdural Hemorrhage
- follows a blunt head injury resulting in rupture of bridging veins

Question 6

Chest pain, shortness of breath, cough + history of infection + sickle cell disease

Answer 6

Acute Chest Syndrome

Question 7

Investigation of choice for pulmonary embolism

Answer 7

CT pulmonary angiography

Question 8

With a history of blunt abdominal trauma, differentiate features of diaphragm rupture from splenic rupture.

Answer 8

Diaphragm Rupture

• presents with chest pain and abdominal pain
• on CXR - there is presence of gas bubble in the pleural cavity

Splenic Rupture

• presents with abdominal pain and pain usually in the epigastrium as well as left flank
• patient is usually hypotensive
• can be diagnosed with FAST in an unstable patient (CT for stable patients)
• usually presents with hemodynamic compromise

Question 9

Most appropriate management for a patient with history of fall from a significant height

Answer 9

IV fluids until stable

Once stable, arrange for CT (FAST if CT is not an option)

Question 10

Complications of electrolyte disturbances post massive BT

Answer 10

HYPOCALCEMIA
Hypomagnesemia
HYPERKALEMIA
Metabolic Alkalosis

Question 11

The only type of shock where PCWP is raised

Answer 11

Cardiogenic shock

Question 12

Normal value for PCWP

Answer 12

4-12 mm Hg

Question 13

A patient comes in with ecstacy OD + muscle rigidity + fever above 40

Diagnosis?
Management?

Answer 13

Malignant Hyperthermia

IV Dantrolene

Question 14

Define status epilepticus

Answer 14

Single epileptic seizure lasting for more than 5 minutes
OR
Two seizures within 5 minutes without full recovery in between

Question 15

First-line drug for status epilepticus

Answer 15

IV Lorazepam

Question 16

What to give for a patient with status epilepticus if no IV access has been established

Answer 16

Buccal midazolam or rectal diazepam

Question 17

IV Lorazepam or buccal midazolam failed to control status epilepticus, what to give next?

Answer 17

IV Phenytoin

Question 18

Patient was given IV lorazepam (or buccal midazolam or rectal diazepam) and IV phenytoin, however, seizure is still ongoing. What to give next?

Answer 18

IV Phenobarbital

Question 19

Hypotension after induction of general anesthesia. What drugs should be avoided?

Answer 19

ACE inihibitors

Angiotensin-receptor blockers

Question 20

Management for a patient undergoing laparoscopy with insufflation being done then suddenly going hypotensive and bradycardic

Answer 20

Stop insufflation and deflate a little