OSCE 5

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.

A

B

C

FiO2

0.8

0.8

0.8

Respiratory rate (breaths /min

12

12

12

Tidal Volume (ml)

600

1200

400

PEEP (cm water)

7

8

0

Peak pressure (cm water)

35

24

45

Plateau pressure (cm water)

32

23

28

Peak inspiratory flow rate (L/min)

80

80

80

Choose one setting that is most likely to represent the findings on this Chest X-Ray.”

“Examine the Chest X-Ray and the pulmonary function assessment of this patient who is short of breath.

Age: 57

Sex: Female

FEV1

2.03

(4-5L)

FVC

3

(4-5L)

FRC

1.9

(2-2.5L)

DLCO

31

(17-20)

pH

7.41

PCO2

39

PO2

68

What is the major abnormality on the X-Ray?”

Examples included pulmonary haemorrhage, and cord compression.

Eleven out of twenty-two candidates passed this station.

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.