Viva 3

Neurological 
Scenario: 
“A 35 year old male with pneumococcal pneumonia and septicaemia has been in ICU for 4 days.
His antibiotic treatment is intravenous penicillin G 2 million units 4 hourly, and he has been improving steadily. His septic shock has now resolved, his gas exchange has improved (FiO2 = 0.35), and he has begun to obey commands. However, he still has anuric renal failure, requiring bicarbonate based CVVHDF.
While you are conducting the morning ward round he suddenly has a tonic - clonic convulsion, then commences another.

What is your initial management of this patient?”


Follow up question: “There are no lateralising neurological signs. He continues to fit intermittently, and is unresponsive between fits. What are the most likely causes to be considered at this point?”

Common  problems  encountered  included  ones  related  to  knowledge  deficits,  questionable judgement, and poor exam technique.
Seventeen out of twenty-seven 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.