Viva 4

Sepsis

“The Medical Emergency Team is called to see a shocked 74 year old woman on the surgical ward.
Until the last  few  hours  she had  been progressing  well since undergoing  an  elective left hemicolectomy for carcinoma 5 days earlier.
The result of a Full Blood Examination (FBE) and blood picture taken one hour earlier  is available (previous FBE results had been unremarkable):

White cells

3.4

4.0-10.0 x 109/L

Haemoglobin

95

125-175g/L

Platelets

98

150-500 x 109/L

Haematocrit

0.30

0.40-0.56

Neutrophils

0.56

2.0-7.5 x 109/L

Lymphocytes

1.5

1.0-4.0 x 109/L

Monocytes

0.08

0.2-1.0 x 109/L

Eosinophils

0.00

<0.5 x 109/L

Basophils

0.00

<0.2 x 109/L

Nucleated red cells

21

0/100 WBC

Bands

0.56

<0.6 x 109/L

Metamyelocytes

0.28

<0.01 x 109/L

Myelocytes

0.26

<0.01 x 109/L

Promyelocytes

0.06

<0.01 x 109/L

Blasts

0.06

<0.01 x 109/L

Film. Marked toxic change. Can you explain this result?”
Nineteen out of twenty-two 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.