Gastrointestinal

“A 39 year old male with a history of heavy alcohol intake is admitted to the emergency department with an acute massive upper GI haemorrhage.
He is hypotensive (BP 60/40), tachycardic (HR 140/min), combative, confused and agitated. He proceeds to have another 1 litre haematemesis in front of you, together with profuse malaena. Outline your initial management of this patient.”

“What is the differential diagnosis?”
Fifteen out of sixteen 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.