1. An 84 year old female is admitted with an episode of loss of consciousness.

Her blood
pressure is 76/44 on cuff measurement. Her heart rate is 40. No collateral history is
available.

2. A 74 year old female was admitted to intensive care on Friday evening, following a
laporotomy for bowel obstruction. There was a small amount of fecal soiling intra
operatively, but the patient remained reasonably stable. The patient has a 40 pack year
history of smoking, type II diabetes, two previous myocardial infarctions, a permanent
pacemaker, and had a right carotid endarterectomy four years ago. During the night
following the operation, she became hypotensive, blood pressure 80/56, heart rate 70. The
resident on call commenced treatment with dobutamine, titrated against blood pressure
response to a mean arterial pressure of 70.
When you come into work on Monday morning, the patient is still in the intensive care,
extubated, apparently well, and still on dobutamine at 5 mic/kg/min, blood pressure 110/70,
heart rate 70. You need the bed for the day’s admissions, but the patient cannot go out to
the floor on inotropes, which the weekend staff were unable to wean.

3. A 79 year old female presents with central abdominal pain radiating through to the
back. Background history of hypertension, treated with nifedipne 20 mg bid and enalapril
10 mg daily. She is cold and clammy. ECG normal. Pulse 100. Blood Pressure 100/60.
Femoral pulses impalpable. Catheterized: only 10 ml of urine in the bladder. Hemoglobin
6.0.

4. A 56 year old male presents to ER. He is cold, clammy, dysphoric and complaining of
central chest pain. His pulse is 130, blood pressure is 84/50, lung fields: bilateral crackles, a
third heart sound is audible. ECG reveals ST segment elevation leads V2 to V4

5. A 63 year old male is admitted to the coronary care unit for thrombolysis following an
anterior wall myocardial infarction. Eight hours after admission, and apparent resolution
of ischemia, his blood pressure falls precipitously, his pulse rises to 140, his pulse oximeter
registers a SpO2 of 88%. On examination, his lung fields are clear, his heart sounds are
inaudible and his jugular veins are distended and a pulsation can not be identified.

6. A 43 year old female is admitted to ICU with acute pancreatitis. She develops acute
respiratory distress syndrome and is managed with difficulty with high oxygen
requirements, prone positioning, high levels of PEEP and vasopressor. On day 29 following
admission, the patient, who had been hemodynamically stable, without support, on
minimal ventilation settings, acutely deteriorates. Her blood pressure falls to 60/40. SpO2 is
80%, heart sounds are inaudible, heart rate is 45, jugular veins are distended.
7. A 42 year old female is transferred from another hospital for chemotherapy. Two days
prior to transfer the patient had undergone a laparotomy for a hysterectomy. The
procedure was abandoned when the surgeon realized that there was an inoperable tumor
present in the pelvis, and there was a considerable amount of blood loss, which continued
into the post-operative period.

Hours after transfer the patient becomes initially hypoxemic and subsequently hypotensive.
Her temperature is 37 degrees Celsius, her heart rate is 140, blood pressure is 80/36, ECG
shows a sinus tachycardia, SpO2 is 79%. The patient’s hemoglobin is 10.2g/l, and
creatinine is 1.4.

What is your differential diagnosis, and how would you manage this patient?

8. A 63 year old male is admitted through the ER. He presented with acute shortness of
breath. On admission his BP was 90/50, heart rate 110, PaO2 80 on 100% oxygen. His ECG
shows left ventricular hypertrophy with T wave across his antero-lateral leads. His chest x-
ray shows cardiac hypertrophy with bilateral infiltrates. He has a history of hypertension,
treated with lisinopril, and has a 40 pack-year history of smoking.

What is your diagnosis and how would you manage this patient?

9. A 22 year old male motorcyclist is involved in a accident. He arrives in the ER intubated

and hypotensive. His blood pressure is 82/40, minimal urinary output, heart rate 130,
fractured left acetabulum, fractured left femur, flail chest on the right, normal cardiac
silhouette, grade 2 liver laceration. His hemoglobin is 9.2g/L, creatinine 1.6, and creatine
kinase 1084, MB 15%. ECG: ST segment elevation along anterior leads.

What is the diagnosis, and how would you manage this patient?

10. A 72 year old female is admitted complaining of weakness, sweating and dysuria. Her
temperature is 390C, pulse 130, BP 76/44, warm peripherally, lung fields: reduced air entry
bilaterally, oliguria, Hb 16 g/dl, WCC 27, PO2 8.2, MSU gram -ve bacilli, >105 organisms.

11. A 27 year old male is involved in an motor vehicle accident. He sustains a burst fracture
of T2 with complete neurological deficit below this level. Fours hours following admission
his SpO2 is 85%, his blood pressure is 80/40 and his heart rate is 45.

What is the diagnosis?