2001, Paper 1 Vivas

Chest X-rays
NG tube in LLL bronchus associated a pulmonary infiltrate, cardiogenic pulmonary oedema and IABP, LUL collapse, old surgical management of TB, barotrauma.

(Radiology) - Pass rate ; highest mark .

 Procedure
Failed intubation drill.
Candidates were called to assist a junior registrar in the reintubation of patient with a head and face injury who was known to be a very difficult intubation even before he developed swelling. He has self-extubated and the registrar can’t intubate and is having problems ventilating.

(Airway Management) - Pass rate ; highest mark .

ECGs
Acute myocardial infarction, bBroad complex irregular tachycardia (300) - ? WPW, diffuse T wave inversion in a hypertensive unconscious female - ? SAH, inferior ischaemia with runs of VT.

(Cardiology) - Pass rate ; highest mark .

Biochem profiles
GIT haemorrhage, rhabdomyolysism mannitol induced hypernatraemia, pyroglutamic acidosis (see CCM 2000; 28:1803-7)

(Electrolytes and Fluids) - Pass rate ; highest mark .

Equipment
Griggs forceps, antibiotic impregnated CVC, codman ICP monitor, pulmonary artery catheter, high flow haemodialysis catheter.

(Equipment and Procedures) - Pass rate ; highest mark .

ICU Case
The ABG, ECG, CXR, haemodynamic profile and IABP tracing of a patient with cardiogenic shock.

(Cardiology) - Pass rate ; highest mark .

 Paediatrics
CXR of bronchiolitis in a 2mth old, RFT in an asthmatic, ECG with prolonged QT syndrome, Jackson Rees modification of the Ayres T piece.

(Neonatal and Paediatric Problems) - Pass rate ; highest mark .

(Acid-Base Disorders) - Pass rate ; highest mark .

X-rays
Supine pneumothorax, ruptured diaphragm, air in the heart, mitral stenosis.

(Radiology) - Pass rate ; highest mark .

Candidates were asked to provide a mid-term In-training Assessment to a junior ICU registrar (actor) in her first year of training. The registrar had previously received good term reports as a junior doctor but colleagues recently find her unreliable, difficult to work with and not seeking appropriate assistance.

Candidates were expected to develop rapport with the registrar and conduct an interview along the lines of:
-Introduction, setting the scene, explaining the aims of the interview
-Information gathering, exploring her circumstances and feelings about the term
-Information imparting, explaining the staff concerns and getting her response to them
-Setting a plan for remedial action
-Organising follow-up review before completing the ITA.

(Communication and Ethics) - Pass rate ; highest mark .

Resuscitation of a young fit male with multiple injuries following a motor vehicle crash. A closed head injury, pulmonary contusion and pelvic fractures necessitated specific management.

(Trauma, Burns, Drowning) - Pass rate ; highest mark .

Respiratory management of a young pregnant woman with respiratory failure due to pneumonia.

(Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark .

Initial assessment and treatment of an 8 month old baby with meningitis.

(Neonatal and Paediatric Problems) - Pass rate ; highest mark .

Recognition and management of a 35 year old woman with thyroid storm following removal of a gangrenous appendix.

(Endocrinology Metabolism and Nutrition) - Pass rate ; highest mark .

Organisation over the telephone of the transport to a cardiac centre of a man with a
suspected Type A aortic dissection. This included assessment and eventual definitive treatment.

(Cardiothoracic Intensive Care) - Pass rate ; highest mark .

Management of a young man with overwhelming post-splenectomy sepsis syndrome.

(Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark .