Toxicology

“A 79 year old man is admitted to the Intensive Care Unit following a right hemi-hepatectomy for excision of liver metastases.  He was previously in good health, except for depression.  Past surgical history includes a colectomy 6 months previously for carcinoma of the colon. Medications – Paroxetine (Aropax) 20 mg oral nocte. Allergies – Nil
Post-operative analgesia consists of –
-     thoracic epidural (T7/8), with an infusion of pethidine (10mg/ml concentration) in the range 5-10 ml/hr via the catheter
-     paracetamol 1gm 4 hourly IV/PR/NG as supplemental analgesia.
Observations on admission to the Intensive Care Unit are stable.  The patient is conscious and comfortable.
After an uneventful 18 hour stay in the Intensive Care Unit, the patient is discharged to the surgical ward the next morning. 8 hours later you are consulted by the surgical team because they are concerned the patient is very drowsy. BP and HR are stable.


What is your differential diagnosis for the drowsiness?”

All twenty-two candidates passed this section.

Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.