OSCE 11

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 daughter. Other factors looked for included delineation of next-of-kin, expressed wishes,
clear plan of management etc. The clinical scenario provided was as follows:

“You have been asked to consider admission to the ICU of an 86 year old woman, Flavia Arcadia. She has presented with confusion, fever and hypotension thought to be due to urosepsis as microscopy has shown Gram negative bacilli in her urine. Despite fluids she remains oliguric and her creatinine is now 300 micromol/L with a K+ of 5.4 mmol/L. Her JVP is clearly elevated, and there are basal crackles heard.


The medical team has started to discuss management options, but her daughter wants ‘everything done.’ You have one ICU bed left on Friday evening running into a long weekend. There are two HDU beds available.


You meet the daughter at the bedside as you finish examining the patient.”

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.