Viva 3

“A 62 year old male patient, with a past history of recently diagnosed ischaemic heart disease,
treated with aspirin and simvastatin, was admitted for overnight ventilation to the intensive care unit after total cystectomy and formation of ileal conduit for extensive TCC of the bladder.
20 hrs after admission your resident shows you his blood results, which demonstrate the following:

Na

135 mmol/l

(137-145)

K

6.2 mmol/l

(3.8-4.9 serum)

Cl

103 mmol/l

(98-106)

Bicarb

16 mmol/l

(22-32)

Urea

5.6 mmol/l

(3-8)

Creatinine

0.212 mmol/l

(0.05-0.12)

Urate

0.58 mmol/l

(0.15-0.50)

Phosphate

3.40 mmol/l

(0.7-1.4)

Calcium

1.61 mmol/l

(2.15-2.60)

Albumin

36 g/l

(33-47)

Total protein
Bilirubin

62 g/l
10 )lmol/L

(62-83)
(<20)

ALP

85 U/l

(40-110)

LDH

4876 U/l

(100-200)

ALT

698 U/l

(5-45)

AST

2423 U/l

(10-45)

What is the likely diagnosis?”

“What are the supporting biochemical features?”

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.