2005, Paper 1 Vivas

Procedure Station

Candidates were expected to provide a systematic approach to the management of a cardiac arrest in a pregnant patient.  The scenario provided was as follows:
“You are about to meet with the wife of a patient who was admitted with life threatening head injuries to the Intensive Care Unit and who has been declared dead after 30 min of CPR. You are about to break the news to his wife (who was not involved in the accident). She is 36 weeks pregnant.
As you are preparing to enter the room, you are called urgently as the wife has dropped off from the chair and has become unresponsive.”

Nineteen out of twenty-two candidates passed this station.

(Cardiac Arrest and Resuscitation) - Pass rate ; highest mark .

As for communication stations in general, candidates were expected to provide an empathic explanation of the situation, using appropriate body language, and appropriate attention to the needs of the wife.  Other factors looked for included appropriate listening to the wife’s concerns, and  conveying the need to give the benefit  of the doubt with regard  to final neurological outcome. The clinical scenario provided was as follows:

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

Chest X-rays.

Candidates were asked to describe the X-ray findings, list possible aetiologies, and suggest relevant further investigations or treatment.

Introductory questions included:

"Identify causes of respiratory inadequacy which are revealed on the initial Chest X-ray and outline appropriate treatments for these conditions"

"This is the Chest X-ray of a man who suddenly developed rapid AF and pleuritic chest pain which was proceeded by a 2-hour history of severe nausea and vomiting. What abnormalities are revealed on his Chest X-ray?"

"This is the Chest X-ray of a patient who was the subject of a Medical Emergency Team (MET) call due to hypoxia. He had his jaw wired 24 hours earlier for a major comminuted mandibular fracture. Describe the abnormalities on this Chest X-ray, and list the possible causes of the abnormalities."

Examples included tension pneumothorax, gastric dilatation, lobar collapse and oesoghageal rupture.

Seventeen out of twenty-two candidates passed this station.

(Radiology) - Pass rate ; highest mark .

CT Scans.

Candidates were asked to describe the X-ray findings, list possible aetiologies, and suggest relevant further investigations or treatment.

Introductory questions included:

“This is the abdominal CT scan of an 86 year old lady who presented with sepsis and metabolic acidosis. She is complaining of abdominal pain and tenderness.
List two clinical diagnoses based upon the CT scan provided which may explain the clinical presentation.”

“This is the CT Scan of a 38 year old male following a motor vehicle accident. Describe the abnormalities.”

“This is the CT Scan of a 65 year old female with chronic lung disease who presents with chest pain and shortness of breath.
What are the diagnostic findings (site and nature) on this CT scan?”

Examples included cholecystitis, cervical spine subluxation, and pulmonary emboli.

Five out of twenty-two candidates passed this station

(Radiology) - Pass rate ; highest mark .

Clinical Case 1.

Case presented regarding investigation and management of a patient with multiple trauma
(including a pelvic fracture).  Introductory material and initial question was:

“You are asked to see a male motorbike rider in his early 20’s.  He was the rider of a bike that hit a car at high speed.  He was wearing a helmet.  Ambulance officers say that he was thrown 15 meters and sustained a brief loss of consciousness at the scene. Vital signs en route to hospital included: GCS 15, P 125/min, BP 70 systolic. He was pale, complaining of back, abdominal and pelvic pain.  Ambulance officers have commenced IV fluid resuscitation.
You are attending to him in the Emergency Department as part of the hospital Trauma Team. He has GCS 15, but is agitated and uncooperative. He has low BP and tachycardia with impaired peripheral perfusion.

What are your immediate priorities and what immediate investigations do you order?”

Eighteen out of twenty-two candidates passed this station.

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

Candidates were asked to describe the X-ray findings, list possible aetiologies, and suggest relevant further investigations or treatment.

Introductory questions included:

“This is the Chest X-ray of an adult who presents with status epilepticus. List the abnormal findings on this chest X-Ray.”

“Examine the Chest X-Ray of this 80 kg male who is being ventilated for respiratory failure in the setting of Acute Pancreatitis. He has no past history of respiratory illness.
Three sets of ventilator settings (A, B & C) are shown below.