2004, Paper 2 Vivas

Communication station:   Candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the mother. The clinical scenario provided was as follows:
You are the intensivist in charge of the unit where a 15 year old boy (John) is critically ill having been a pedestrian hit by a motor vehicle. He has sustained severe chest injuries complicated by significant blood loss.

It is now day 3 into his admission, he is sedated and mechanically ventilated. The patient and his mother are both Jehovah’s Witnesses and his mother has refused administration of blood products to her son during this admission.
His clinical condition is such that he is now developing end-organ dysfunction and a lactic acidosis associated with a haemoglobin of 23g/L. He has re-commenced bleeding out one of his chest drains, and needs to go to the operating theatre.

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

Other X-rays:  Candidates were expected to describe the X-ray findings and list potential aetiologies. Examples provided included epiglottitis, free intra-peritoneal gas, acute on chronic subdural haemorrhage, infarction of pons/cerebellum and midbrain, and emphysematous destruction of a kidney.

Eighteen out of twenty-eight candidates passed this section.

(Radiology) - Pass rate ; highest mark .

Clinical case:  Material presented regarding management of a hypothermic infant after a drowning episode: a blood gas demonstrating a mixed metabolic and respiratory acidosis, CXRs demonstrating lung infiltrates and pneumothoraces, and equipment (single bottle underwater sealed drain and a suction catheter).

Twenty-one out of twenty-eight candidates passed this section.

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

Clinical case: Material presented regarding management of a man with a past history of diabetes, ischaemic heart disease and chronic lymphatic leukemia who presented with hours of severe abdominal and back pain and hypotension: biochemistry (pseudohyperkalaemia), microbiology (oxidase positive non lactose fermenting Gram negative rod), haemodynamics (wrongly calculated SVRI), CXR (ARDS and tension pneumothorax).

Twelve out of twenty-eight candidates passed this section.

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

Haematology:  Candidates were asked to describe abnormalities and potential aetiologies, and provide suggestions regarding management. Material presented included a hypochromic microcytic anaemia, post-splenectomy changes, a microangiopathic haemolytic anaemia and a leukoerythroblastic blood film.

Sixteen out of twenty-eight candidates passed this section.

(Haematology and Oncology) - Pass rate ; highest mark .

Chest X-Rays:  Candidates were asked to describe the X-ray findings, list possible aetiologies, and suggest relevant further investigations. Examples included bilateral lung infiltrates, gastric dilatation, and a traumatic aortic injury.

Three out of twenty-eight candidates passed this section.

(Radiology) - Pass rate ; highest mark .

Atrial fibrillation

(Cardiology) - Pass rate ; highest mark .

Biochemistry:  Candidates were asked to describe abnormalities and list possible aetiologies. Examples included hepatic and renal dysfunction, plasmacholinesterase deficiency (homozygous), an elevated osmolar gap, and a normal anion gap (renal tubular) metabolic acidosis.

Fifteen out of twenty-eight candidates passed this section.

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

 IABP anatomy, contraindications and complications, waveform analysis

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

Procedure station:   Candidates were expected to provide a systematic approach to the principles of insertion and management of a Minnesota tube.

The scenario provided was as follows:
A 50-year-old man, with a history of cirrhosis due to hepatitis C and known gastroesophageal varices, is admitted to the Intensive Care Unit with massive haematemesis and melaena from the endoscopy suite.

Fifteen out of twenty-eight candidates passed this section.

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

Paediatric

Scenario:  A 13-year-old girl presents with a one-week history of nausea, dry retching and crampy abdominal pain.  She has been up during the night to pass urine and this morning complained of feeling very cold. This morning she became rigid with her eyes staring.  This was followed by a brief period of apnoea and cyanosis.
Her mother drove her to the local hospital where she was noted to be pale and cool peripherally. Her heart rate was 66 bpm with a BP of 100/80.

Introductory question:  Describe your initial management?

Twenty out of twenty-eight candidates passed this section.

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

Infectious diseases

Scenario:  You are asked by the Emergency Department to review a 44 year old woman with known hepatitis C. She has presented with abdominal distension, and has not passed urine for over a day. On examination she is drowsy and obviously jaundiced.  Her BP is 80/40 and she has a heart rate of 110.
Introductory question:  What is your initial approach?

Eleven out of twenty-eight candidates passed this section.

(Gastroenterology and Hepatology) - Pass rate ; highest mark .