OSCE in Critical Care Medicine - I (Mar 1, 2020)_(9390020492)_(Jaypee Brothers Medical Pub).pdf 9789390020492

Citation preview

our website www.jaypeebrothers.com, for detailed information on anesthesia books, visit our website www.jaypeebrothers.com

V

\

•

li

Critical Care Medicine-I

Atul Prabhakar Kulkarni Shilpushp Jagannath Bhosale Jacob George Pulinilkunnathil

OSCE in Critkal Care Medicine-I

OSCE in Critical Care Medicine-I

Editors Atul Prabhakar Kulkarni MD FISCCM PGDHHM FICCM

Editor-in-Chief, Indian Journal of Critical Care Medicine Past President, Indian Society of Critical Care Medicine Past Chancellor, Indian College of Critical Care Medicine Past President, Association of SAARC Critical Care Societies Secretary General, Asia Pacific Association of Critical Care Medicine Professor and Head, Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Maharashtra India

Shilpushp Jagannath Bhosale MD DM (Critical Care Medicine)

Associate Professor Consultant Intensivist, Division of Critical Care Department of Anesthesiology, Critical Care and Pain Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Maharashtra India

Jacob George Pulinilkunnathil MD (Respiratory Medicine) DM (Critical Care) IDCCMIFCCM EDIC FCCP

Consultant Pulmonologist and Intensivist Department of Critical Care Medicine Mar Sleeva Medicity Palai Cherpunkal, Kerala, India

JAYPEE BROTHERS MEDICAL PUBLISHERS The Health Sciences Publisher New Delhi | London

Jaypee Brothers Medica! Publishers (P) Ltd

Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee @ jaypeebrothers.com

Overseas Office J.P. Medical Ltd 83 Victoria Street, London SW1H 0HW (UK) Phone: +44 20 3170 8910 Fax: +44 (0)20 3008 6180 Email: info @ jpmedpub.com

Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2020, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s) /author(s) and do not necessarily represent those of editor(s) of the book.

All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s) /editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical Services. If such advice or Services are required, the Services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. The CD/DVD-ROM (if any) provided in the sealed envelope with this book is complimentary and free of cost. Not meant for sale.

Inquiries for bulk sales may be solicited at: jaypee @ jaypeebrothers.com OSCE in Critical Care Medicine-I First Edition: 2020

ISBN 978-93-90020-49-2 Printed at : Samrat Offset Pvt. Ltd.

Dedicated to The Most Hard Working Residents in Medicine: The Critical Care Trainees !

CONTRIBU TORS Carol Dsilva MD FNB EDIC Assistant Professor Department of Critical Care Medicine St Johns Medical College Hospital Bengaluru, Karnataka, India

Deepthi Madhu MBBS MD Consultant Clinical Microbiologist Mar Sleeva Medicity Palai Cherpunkal, Kerala, India Harish Mallapura Maheshwarappa MBBS MD DM ( Critical care medicine) DNB IDCCM EDIC ( Dublin ) MBA ( Health Care Management)

Natesh Prabu R MD DNB DM (Critical Care Medicine)

Assistant Professor Department of Critical Care Medicine St John 's Medical College and Hospital

Bengaluru, Karnataka, India

Reeba George Pulinilkunnathil DMRD DNB Radiodiagnosis

Associate Professor Department of Radiodiagnosis Government Medical College Thiruvananthapuram, Kerala, India

Ruchira Khasne

Consultant Department of Critical Care Medicine Mazumdar Shaw Medical Center Narayana Hrudayalaya Bengaluru, Karnataka, India

Consultant and Head Department of Critical Care Medicine

Kiran Vishnu Narayan

Shiva Kumar N

MD DNB DM Diploma in Allergy and Immunology ( CMC Vellore) Specialty certificate in Resp Medicine- MRCP UK European Diploma in Adult Respiratory Medicine (EDARM) European Diploma in Intensive Care Medicine ( EDIC )

Assistant Professor Department of Pulmonary Medicine Government Medical College Kottayam, Kerala, India

Manu Varma MK MBBS MD DM PDCC Assistant Professor Department of Critical Care Medicine St John’s Medical College and Hospital Bengaluru , Karnataka, India

MBBS DA DNB IDCCM EDAIC & EDIC

Ashoka Medicover Hospital Nashik, Maharashtra, India MBBS MD DNB DM ( Critical Care) EDIC Assistant Professor Department of Critical Care Medicines St John’s Medical College Bengaluru , Karnataka, India

Suhail Sarwar Siddiqui MD DM EDIC Assistant Professor Department of Critical Care Medicine King George’s Medical University ( KGMU ) Lucknow, Uttar Pradesh, India

PREFACE It gives us great pleasure to present the OSCE in Critical Care Medicine- I . Objective Structured Clinical Examination (OSCE) was first described by Harden RM and Gleeson FA in 1975. OSCE dramatically changed the assessment of professional competence because it used actors and choreographed scenarios to evaluate the performance of professional behaviors. An OSCE usually comprises a circuit of short (the usual is 5-10 minutes, although some use up to 15 minute ) stations. The examination pattern has now changed and the examinee is expected to answer briefly the questions given at each station. These questions may include the results of tests or investigations or laboratory results. Since each question has a standard answer there is no risk of bias of the examiners influencing the marks obtained by the students. It is therefore more credible way to examine the knowledge and ability of the examinee to apply it to clinical problem solving. The OSCEs have become a part of most examinations in Critical Care Medicine, and righdy so. There is no way anyone can predict the questions that the examinee is likely to face in various examinations. But we all know Practice makes Perfect! (this is actually grammatically incorrect and should have been Practice makes Perfection!). This idiom is very old, dates back to 1550, when it was first said "Use makes Perfect" by John Adams, and then in Latin is "Uses promptos facit ” Though it is old, it still makes sense, and therefore this book for all our future examinees. As the title suggests, this is but the first book in a series of books on OSCEs in Critical Care Medicine. A word about the origin of the idea. Jacob George, my friend (still!) and a colleague till last year, suggested that such a book will be of great help to the examinees. I am grateful to him for the idea and for the hard work he has put into making this book possible, and hopefully he will still be enthusiastic about the future books in the series. The last but not least, thanks are due to the Contributors who helped in making the book what it is. Their untiring support (of course with some nagging from Shil, Jacob, and me) was invaluable and we hope for their contributions in the future as well. We wish all of you happy reading and the best for your examinations! Atul Prabhakar Kulkarni Shilpushp Jagannath Bhosale Jacob George Pulinilkunnathil

ACKNOWLEDGMENTS We would like to acknowledge the support of all our colleagues in the department who worked hard and spared us from our clinical duties so we could work on the book and our sincere thanks to them. Acknowledgments are due to Dr Jigeeshu Divatia, our head, whose support and backing make all our academic endeavors possible. Ms Chetna Malhotra (Associate Director Content Strategy), an old friend from Jaypee Brothers Medical Publishers ( P) Ltd. who always helps in our publication ventures. Our families have been particularly supportive (no fights, at least about this book), while we labored for the sake of the book.

—

CONTENTS QUESTIONS 1 . Respiratory Medicine

1

2. Neurology

34

3. Nephrology

,

48

4. Microbiology and Infection Control

54

5. Hemodynamics

73

6. Drugs

108

7. Biochemistry

,

8. Miscellaneous

,

116

9. Case Scenarios

,

135

111

ANSWERS 1 . Respiratory Medicine

143

2. Neurology

168

3. Nephrology

183

4. Microbiology and Infection Control

189

5. Hemodynamics

.219

6. Drugs

.241

7. Biochemistry

.247

8. Miscellaneous

.252 .275

9. Case Scenarios

QUESTIONS

H RESPIRATORY MEDICINE 1. You are called in to see a postoperative patientwho is becoming difficult to ventilate and desaturating despite providing 100% Fi02.

•

•

What is the diagnosis? How will you manage the case?

2. Comment on the chest X- ray of a patient who is being electively

ventilated for breathlessness.