2006, Paper 1 Vivas

Procedure station.
Candidates were expected to demonstrate that they could accurately determine brain death.
Introductory material presented was:
“Mrs Thompson is a 55 year old woman with a history of severe airways disease who suffered a sudden loss of consciousness 48 hours ago. She is now being mechanically ventilated and has fixed dilated pupils. You are required to evaluate her for brain death. What additional information would you like to know?”
Fifteen out of twenty-seven candidates passed this station.

(Cardiac Arrest and Resuscitation) - Pass rate ; highest mark .

The clinical scenario provided was as follows:
“Peter is a 12 year old who is severely disabled with cerebral palsy. He has poor bulbar function, is totally tube fed, and is in hospital awaiting insertion of a percutaneous feeding tube. A short while ago he was urgently transferred to your intensive care unit after a nurse accidentally placed the nasogastric tube in his right main bronchus and commenced enteral feeds. He is now profoundly hypoxic, shocked and oliguric. He has been intubated and ventilated, is requiring 100% oxygen and is receiving high dose inotropic support. There is a strong possibility that he will die. As the consultant intensivist, you are about to meet with Rebecca White (the child’s mother) for the first time to explain the situation.”
As for communication stations in general, candidates were expected to provide an empathic clear explanation of the situation, using appropriate body language, and appropriate attention to the needs of the mother.

(Communication and Ethics) - Pass rate ; highest mark .

Clinical case.
“A previously well fully immunized 6 year old girl is admitted to your ICU in a regional hospital with a 5 day history of high fevers, and a blanching macular rash. Twenty four hours prior to admission, she passed loose stools on four occasions with no obvious blood or mucus in the stool. On examination she is tachycardic with warm peripheries with an unrecordable blood pressure.” Candidates were asked to review an ECG, a CXR and to discuss potential aetiologies.
Twenty out of twenty-seven candidates passed this station.

(Neonatal and Paediatric Problems) - Pass rate ; highest mark .

Other X-rays.
Candidates were asked to describe the X-ray findings, list possible aetiologies, and suggest relevant further investigations or treatment. Pathology presented included pleural and pericardial effusions, a cerebral tumour, a (saddle) pulmonary embolus, and a bowel obstruction. Introductory questions included:
“This is the CT scan of a patient 3 days post cardiac surgery who is hypoxaemic.”
“This is a non-contrast CT scan of a 37 yr. old man who presents with a 6 week history of vague headaches.”
“This is a CT investigation of a 56 year old man 5 days post hip replacement. He was found collapsed on the ward.”
“These are abdominal x rays of a 55 yr. old woman who presents to the Emergency Department with severe generalised abdominal pain. She has a history of long-standing constipation.” Twenty-five out of twenty-seven candidates passed this station.

(Radiology) - Pass rate ; highest mark .

Clinical case.
Case presented regarding severely ill patient with meningitis and discussion of intubation, and drug concentration time curves.

Introductory material provided was:
“An 18 year old girl is brought into the emergency department critically ill with headache, photophobia, fever, hypotension (70 systolic), a widespread petechial rash, rhabdomyolysis, acute renal failure and hypoxia. Due to a deteriorating mental state, a decision is made to intubate her. (She ‘looks’ a straight forward intubation.)”
Twenty-seven out of twenty-seven candidates passed this station.

(Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark .

Equipment station.
Candidates were expected to describe or discuss advantages or problems with devices presented.
Examples included a Head box, a Halo brace, a plasma exchange-filter and an oxygen cylinder.
Twelve out of twenty-seven candidates passed this station.

(Equipment and Procedures) - Pass rate ; highest mark .

Monitoring.
Candidates were asked to identify 3 devices used for haemodynamic monitoring (Swan Ganz Catheter, PiCCo Machine, SCVO2 monitor) and list relevant obtained variables.

Twenty-four out of twenty-seven candidates passed this station.

(Equipment and Procedures) - Pass rate ; highest mark .

Chest X-rays.
Candidates were asked to describe the X-ray findings, and list possible aetiologies. Abnormalities present included a collapsed left upper lobe, a pneumothorax, mediastinal widening, and diffuse alveolar infiltrates.

Introductory questions included:
“What is the major finding on this X-ray? List four features on the X-ray that support this diagnosis.”

“List six differential diagnoses for the appearances on this chest X-Ray. These differential diagnoses should be broad diagnostic categories, and encompass the full range of diagnostic possibilities.”
“This 30 year old man was in a car crash 2 hours ago. He was unconscious for 10 minutes, but now has a GCS of 15. Respiratory rate 40 per minute, SpO2 85% on high flow oxygen. Pulse 120/min, BP 160/90. List the three most important abnormalities on this X-Ray.”
Twenty-three out of twenty-seven candidates passed this station.

(Radiology) - Pass rate ; highest mark .

Paediatrics 
Scenario: 
“Your Paediatric Intensive Care colleagues have asked you for advice regarding a 10 year old boy
with insulin dependent diabetes mellitus since the age of 2 years. His diabetes is poorly controlled due to poor patient compliance. Prior to this admission, he had flu like symptoms for two weeks with a sore throat and cough. Twenty four hours prior to admission, he experienced nausea and vomiting with severe epigastric pain.
His initial biochemistry reveals: