Scenario: A 70-year-old female has been transferred from a regional hospital with a 2-week history of profuse diarrhoea. She has a Glasgow Coma Score of 15 but looks unwell with a dry tongue. Her temperature is 38˚C, her pulse is 130/min, and her blood pressure is 110/70. The pulse oximeter reads 98% on oxygen via facemask of 6 L/minute.
Her serum biochemistry is as follows:
|
TEST |
RESULT |
UNITS |
RANGE |
|
Sodium |
123 |
mmol/L |
136-146 |
|
Potassium |
7.0 |
mmol/L |
3.5-5.2 |
|
Chloride |
108 |
mmol/L |
98-109 |
|
Bicarbonate |
12 |
mmol/L |
20-33 |
|
Urea |
28 |
mmol/L |
3.0-8.0 |
|
Creatinine |
0.22 |
mmol/L |
0.06-0.12 |
|
Glucose |
4.3 |
mmol/L |
3.0-6.5 |
|
Albumin |
23 |
G/L |
35-50 |
Introductory Question: What would be your initial management of this patient?
Eighteen out of twenty-eight candidates passed this section.
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.