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