2007, Paper 1 Vivas

(Acid-Base Disorders) - Pass rate ; highest mark .

Three Chest X-Rays (with brief case histories) were shown. Candidates were required to list findings and answer questions relevant to the findings and history.

a)   Trauma with fractured ribs, contusions and hemothorax
b)  Trauma with pulmonaty contusion, ruptured diaphragm  and a widened mediastinum
c)   Raised right hemidiaphragm with a prosthetic valve

(Radiology) - Pass rate ; highest mark .

Equipment station consisted of answering questions relating to a conventional and a reinforced percutaneous tracheostomy tube.

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

Clinical Case History: The following case history was provided:

A previously healthy 34 year old woman is transferred to your hospital with a history of a prolonged generalized tonic-clonic convulsion.She is intubated and ventilated. By the time she arrives she is no longer convulsing but she is deeply unconscious with a GCS of3, fixed dilated pupils, absent tendon reflexes and bilateral up-going plantar reflexes. She has received no drugs. Blood samples have been collected for a full blood count, biochemistry and a coagulation profile. The results are awaited.

Candidates were required to answer questions relating to the differential diagnoses, CT appearances and comment on a blood picture report and the role of an EEG

(Neurology and Neurosurgery) - Pass rate ; highest mark .

CT scan station:

Four CT scans (with brief case histories) were shown.

Candidates were required to list findings and answer questions relevant to the findings and history.
a) Bilateral subdurals with an old infarct

b) CT-neck with a burst fracture
c) CT-chest showing an acute pneumothorax with underlying chronic bullous disease

d) Acute pancreatitis

(Radiology) - Pass rate ; highest mark .

ECG station. Five ECGs were shown and candidates were required to either report the findings or answer related questions. ECGs included:

a) prolonged QT interval

b) Broad complex tachycardia

c) Acute inferior and posterior infarction

d) J- waves

e) Signs of right heart strain.

(Cardiology) - Pass rate ; highest mark .

Communication station: The scenario  was as follows:

'You are the consultant for your intensive care unit. One of the patients, David Cullen, had brain death confirmed yesterday by clinical testing performed by two of your colleagues who have gone off duty. Brain death had complicated a subarachnoid haemorrhage, which occurred two days earlier.

Information handed over to you by your colleague:

• Sarah Cullen (David's daughter) is the patient's only living relative; • She has only just arrived yesterday from England and was informed of the diagnosis by your colleague.

• She was devastated by the news and does not accept the diagnosis.

• She has demanded that everything be done to keep her father "alive"

A nuclear medicine which your colleague organised has just been completed, and it clearly demonstrates the absence of intracranial blood flow. Sarah is in this room. She is aware that another test was being done today. You are required to explain to her the results of the test and discuss with her David's clinical condition and next steps to be employed.'

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

Procedure station:

Candidates were provided the scenario below and and were required to demonstrate their ability with dealing with a blocked ET tube.

You are called urgently to see a 67 year old, 50kg  man who is being ventilated in ICU for severe pneumonia. The nurse says his ventilator is constantly high pressure alarming.

Please manage his ventilation problem.

NOTE: the nurse is familiar with the ventilator and can tell you any parameters you wish to know and will adjust the ventilator for you

(Airway Management) - Pass rate ; highest mark .

Management of a multi-trauma patient

A 16 year old man is hospitalised after crashing a mountain bike into a tree at high speed. Initial observations in the Emergency Department were GCS 15 ,HR. 135/min, BP 130/85, and SpO2 91% on partial non rebreather mask. Obvious injuries included.

1..   multiple right sided rib fractures
2..   a displaced midshaft fracture of the right femur

3.   midshaft fractures of right radius and ulna.

He was intubated and taken to the CT scanner.
1.  CT brain and neck were normal.
2.   CT chest revealed pulmonary contusions and a small anterior pneumothorax
on the right
3.   CT abdomen revealed a grade 2 hepatic injury and a 'burst' right kidney..

Surgeons request conservative management for the abdomen. He is taken to theatre for a Steinmann pin to the right tibia (for traction) and then transferred to the ICU.

What are your immediate priorities in managing this patient?

(Trauma, Burns, Drowning) - Pass rate ; highest mark .

Management of snake bite

A 32 year old otherwise fit male from regional  New South  Wales presents with acute onset of headache, abdominal pain, confusion and agitation. He has been working in the garden all day on a hot summer day. On examination, he was a bit clammy at the extremities. Temp 38.5 C. The rest of the examination was unremarkable.

His initial bloods: