PEDIATRIC INTENSIVE CARE

SAUDI FELLOWSHIP PROGRAM

SAUDI FELLOWSHIP FINAL CLINICAL EXAMINATION OF PEDIATRIC INTENSIVE CARE

(2021)

Saudi Fellowship Final Clinical Examination; Pediatric Intensive Care Pediatric Intensive Care -BP -Jan 2021 v.1

I Exam Format

a. Pediatric Intensive Care final clinical examination shall consist of 4 graded stations each with 15

minute encounters.

a. The 4 stations consist of 4 Structured Oral Exam (SOE) stations with 2 examiners each.

b. All stations shall be designed to assess integrated clinical encounters.

c. SOE stations are designed with preset questions and ideal answers.

II Final Clinical Exam Blueprint*

DIMENSIONS OF CARE

Health Promotion

& Illness

Prevention

Acute

Chronic

Psychosocial

Aspects

# Stations

DO

MA

INS

FO

R I

NT

EG

RA

TE

D

CL

INIC

AL

EN

CO

UN

TE

R

Patient Care

1 1

Patient Safety &

Procedural Skills

1 1

Communication &

Interpersonal Skills

1 1

Professional

Behaviors

1 1

Total Stations 1 2 1 4

Saudi Fellowship Final Clinical Examination; Pediatric Intensive Care Pediatric Intensive Care -BP -Jan 2021 v.1

III Definitions

Dimensions of Care Focus of care for the patient, family, community, and/or population

Health Promotion &

Illness Prevention

The process of enabling people to increase control over their health & its determinants, & thereby improve their

health. Illness prevention covers measures not only to prevent the occurrence of illness such as risk factor

reduction but also arrest its progress & reduce its consequences once established. This includes but is not

limited to screening, periodic health exam, health maintenance, patient education & advocacy, & community &

population health.

Acute

Brief episode of illness, within the time span defined by initial presentation through to transition of care.

This dimension includes but is not limited to urgent, emergent, & life-threatening conditions, new

conditions, & exacerbation of underlying conditions.

Psychosocial Aspects Presentations rooted in the social & psychological determinants of health that include but are not limited to

life challenges, income, culture, & the impact of the patient`s social & physical environment.

Domains Reflects the scope of practice & behaviors of a practicing clinician

Patient Care

Exploration of illness & disease through gathering, interpreting & synthesizing relevant

information that includes but is not limited to history taking, physical examination &

investigation. Management is a process that includes but is not limited to generating,

planning, organizing care in collaboration with patients, families, communities,

populations, & health care professionals (e.g. finding common ground, agreeing on

problems & goals of care, time & resource management, roles to arrive at mutual

decisions for treatment)

Patient Safety & Procedural Skills

Patient safety emphasizes the reporting, analysis, and prevention of medical error that

often leads to adverse healthcare events. Procedural skills encompass the areas of clinical

care that require physical and practical skills of the clinician integrated with other

clinical competencies in order to accomplish a specific and well characterized technical

task or procedure.

Communication & Interpersonal Skills

Interactions with patients, families, caregivers, other professionals, communities,

& populations. Elements include but are not limited to active listening, relationship

development, education, verbal, non-verbal & written communication (e.g. patient

centered interview, disclosure of error, informed consent).

Professional Behaviors

Attitudes, knowledge, and skills based on clinical &/or medical administrative

competence, ethics, societal, & legal duties resulting in the wise application of behaviors

that demonstrate a commitment to excellence, respect, integrity, accountability &

altruism (e.g. self-awareness, reflection, life-long learning, scholarly habits, & physician

health for sustainable practice).

Note:

Percentages and content are subject to change at any time. See the SCFHS website for the most up-to-date

information.

Pediatric Intensive Care

Clinical Exam

Station

Instructions to Resident

A 7-year-old girl sustained a traumatic brain injury as a result of a motor vehicle crash. She is

transferred to PICU following intubation and placement of an external ventricular drain after

receiving Etomidate and cisatracurium. Her intracranial pressure in transit was 8 mm Hg but is

now noted to be 28 mm Hg. Her HR is 125/min, BP is 110/55 mm Hg (mean arterial pressure of

73 mm Hg), RR is 24/min, SaO2 is 100%, and temperature is 37°C. Pupils are 4 mm bilaterally

with brisk reactivity.

YOU HAVE 15 MINUTES TO DO THE FOLLOWING:

Answer the examiner questions

Final Clinical Exam Blueprint*

Please indicate the proper area which best describes this station by adding the

letter X in the appropriate location (only one cell)

DIMENSIONS OF CARE

Health Promotion &

Illness Prevention

Acute

Chronic

Psychosocial

Aspects

DO

MA

INS

FO

R

INT

EG

RA

TE

D C

LIN

ICA

L

EN

CO

UN

TE

R

Patient Care

X

Patient Safety &

Procedural Skills

Communication &

Interpersonal Skills

Professional

Behaviors

STATION 2

Instructions to candidate:

A 7-year-old girl sustained a traumatic brain injury as a result of a motor vehicle crash. She is transferred to

PICU following intubation and placement of an external ventricular drain after receiving Etomidate and

cisatracurium. Her intracranial pressure in transit was 8 mm Hg but is now noted to be 28 mm Hg. Her HR is

125/min, BP is 110/55 mm Hg (mean arterial pressure of 73 mm Hg), RR is 24/min, SaO2 is 100%, and

temperature is 37°C. Pupils are 4 mm bilaterally with brisk reactivity.

Examination

Not done

Incomplete ½ mark

Done Full

mark

Examiner

A-What are the most appropriate next steps in the management?

Candidate

Initiate the sedation and analgesia

Bed-Head Elevation 30

CSF drainage

Initiate hyperosmolar therapy (NaCl 3% or Mannitol)

Examiner B-Cerebral blood flow is affected by several parameters. See Index 1 According to the diagram, can you explain the clinical application of each curve?

Candidate

MAP curve:

MAP should be kept in normal range because if the autoregulation is intact: High MAP→ cerebral arteriolar vessel dilatation →↑CBV (cerebral blood volume) →↑ ICP→↓ CPP

Conversely, Low MAP→↑ CPP →↓ ICP via cerebral vasoconstriction

PaCO2 curve: Hypocarbia results in vasoconstriction, reducing CBF, CBV, and therefore ICP, making hyperventilation a favorite tool for the acute control of intracerebral hyperemia and elevated ICP.

PaO2 curve:

PaO2 should be kept in normal range as hypoxia will lead to cerebral vasodilatation, increased CBF, increased CBV and increased ICP

Examiner

C-While you were examining her, she developed generalized tonic-clonic convulsion

1. What will be your first action?

Candidate

STAT doses of Benzodiazepine then

Loading dose of phenytoin 20mg/kg slow infusion over 20-30 minutes OR fosphenytoin 20mg/kg over 5-10 minute

Or phenobarbital 20mg/kg

Examiner 2. 40 minutes passed, Still seizing, what will be your action?

Candidate

Start midazolam infusion and increase gradually till clinical and electrical seizures stops

Ask for continuous EEG

3. Still seizing after 24ug/kg/min midazolam

Examiner

Candidate

Consider thiopental/ pentobarbital coma

OR General anesthesia/propofol

Examiner

Index 1