“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 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.