2007, Paper 2 Vivas

Vivas in Order of Appearance
OSCE 1	Multiple myeloma, hyperviscosity syndrome and plasmapheresis (Haematology and Oncology) - Pass rate ; highest mark .
OSCE 2	Equipment OSCE The list of equipment included a) a transducer with questions relating to phlebostatic axes for hemodynamic and ICP measurements, principles of operation including the electrical circuitry b) a flanged tracheostomy set and a Shiley tracheostomy with questions relating to their design features and indications for use. c) A rapid infuser set and questions relating to their design features (Equipment and Procedures) - Pass rate ; highest mark .
OSCE 3	Microbiology OSCE Data sets provided for interpretation included a) a Gram positive bacilli bacteremia with neurological symptoms and signs - Listeriosis b) an antibiogram of a multiresistant Gram negative bacillus in a patient on meropenem (Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark .
OSCE 4	Monitoring OSCE Data sets provided for interpretation included a) pulmonary function tests, flow volume loops, and flow time curves in a patient with obstructive lung disease b) analysis of venous oxygen saturation data from a patient with septic shock and the samples were drawn from a PAFC, internal jugular and femoral vein cannulae. c) Pulse oximetry data in patients with carboxyhemoglobin. (Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark .
OSCE 5	Chest X-Rays The films included a) chest trauma, b) distally positioned PA catheter with h/o pulmonary hemorrhage c) multiple pneumatocoeles in a young patient presenting with fever and sepsis d) RUL collapse (Radiology) - Pass rate ; highest mark .
OSCE 6	CT scans The films included a) a brain CT of a patient with head injury post craniotomy and an accompanying four vessel angiogram indicating absence of intracranial blood flow and diagnostic of brain death b) a neck CT showing a pharyngeal space infection c) an abdominal CT showing a hypodense lesion in the liver, a filling defect in the superior mesenteric vein indicative of a thrombus and an incidental renal cyst d) a brain CT with a ring enhancing lesion in the occipital lobe. (Radiology) - Pass rate ; highest mark .
OSCE 7	The following scenario was given to the candidates. Mr Horomia, age 76, a bachelor of Maori extraction, was brought by ambulance to the ED today with hypercarbic respiratory failure. He was intubated, and is now sedated and ventilated in your ICU. His problems are: • Morbid obesity • Type 2 diabetes mellitus on insulin. • Advanced diabetic nephropathy, rejected for chronic dialysis. • Ischaemic cardiomyopathy -LVEF 38%. • Cor pulmonale - marked RV systolic dysfunction and dilatation, severe TR. • Anuric renal failure. Plasma creatinine 1360 micromol/L. His paid carer, (not a relative), tells you that Mr Horomia has been unable to lie flat for months, and sits in a chair all night. Six months ago he ceased all medication, including insulin, and still smokes cigarettes. He has refused all requests to seek medical attention, stating frequently that he only wants to die at home. The ambulance was called when he was too weak to resist. His niece Miramia, has now arrived, and wishes to speak to you. (Communication and Ethics) - Pass rate ; highest mark .
OSCE 8	Procedure: The procedure examined in this station was an intra-aortic balloon pump, focussing on identifying the position, timing, complications, balloon rupture and contra- indications. (Equipment and Procedures) - Pass rate ; highest mark .
Viva 1	A 54 year old man was brought into the Accident and Emergency Department after having been found unconscious on the floor of his hostel accommodation. He was lying in vomitus and was noted to be incontinent of urine. His GCS was E2V2M4 at the hostel. His initial observations were: Temp of 38.2 ºC, PR 96/min, BP 160/90 mm Hg and SaO2 92% on 6 lpm O . The only available history was one of alcohol abuse and epilepsy. He was also known to be a heavy smoker. 1. What are your differential diagnoses for his unconsciousness? (Neurology and Neurosurgery) - Pass rate ; highest mark .
Viva 2	A 69 yr old male is admitted to Emergency Department with 3 day history of central abdominal pain and vomiting. His past surgical history includes a total colectomy four years ago for a perforated sigmoid carcinoma followed by chemotherapy and no evidence of recurrence. Past medical history: Hypertension, and he has a Body Mass Index (BMI) of 40. Medications: Perindopril and metoprolol. Examination: He is confused, has a respiratory rate of 36/min and is receiving 3l O2/min by nasal prongs. His oxygen saturation is 90% and his blood pressure is 90/40 mmHg. He is in atrial fibrillation with a heart rate of 110 BPM. Take us through your initial priorities for management (Gastroenterology and Hepatology) - Pass rate ; highest mark .
Viva 3	A 56 year old gentleman with chronic obstructive pulmonary disease returns to the intensive care unit following a left pneumonectomy for a squamous cell carcinoma. There is no other past medical history. Examination reveals that he is fully alert, comfortable, with a thoracic epidural catheter in situ, respiratory rate 16 bpm, HR 60 bpm, BP 100/80 mmHg and warm peripheries. Auscultation reveals reduced breath sounds over the left lung field. There is no bubbling and minimal drainage from the left intercostal catheter. His arterial blood gas on return from theatre reveals: FiO2 0.5 pH 7.27 Pa CO2 50 mmHg Pa O2 90 mmHg HCO3- 22mmol/L BE -4.7 mEq/L 1. What explanations would you give for the abnormalities in this arterial blood gas report? (Acid-Base Disorders) - Pass rate ; highest mark .
Viva 4	A 65 year old lady is admitted to your ICU with a 2 week history of weakness, lethargy, confusion, anorexia, vomiting and polyuria On examination she has a Glasgow coma score of 8 with generally reduced deep tendon reflexes. Pupils are equal and react to light. Her pulse rate is 55 beats/minute and BP 150/80 mm Hg. What is your initial management of this lady? (Neurology and Neurosurgery) - Pass rate ; highest mark .
Viva 5	As the Intensive Care specialist on call in a regional hospital, you are asked to assist in the management of a 3 week old infant who has presented in extremis to the Emergency Department. There was a 2 day history of Upper Respiratory Tract Infection (URTI) symptoms, and poor feeding for the last 8 hours. There were no problems at delivery. There is no family illness other than URTI. On examination the following vital signs have been recorded: T 35oC, HR 189, RR 68 Child is pale, cold to touch with a thready pulse. The child is unresponsive to pain. There is no rash. What is your assessment of this child ? (Neonatal and Paediatric Problems) - Pass rate ; highest mark .
Viva 6	A 38 years old man with recent past history of treated hypertension and depression is transferred to your ICU from operating theatre. He had been undergoing shoulder arthroscopy under general anaesthesia. His heart rate and blood pressure were stable for the first 45 minutes when he developed a sinus tachycardia (130 bpm) and severe hypertension (265/165 mm Hg). The anaesthetist treated this by increasing depth of anaesthesia, and repeated doses of metoprolol and hydralazine. The problem persisted and an arterial line was inserted. Invasive blood pressure was 305/178 mm Hg. BIS monitoring suggested deep anaesthesia (BIS 25). Surgery was expedited and he was transferred intubated and sedated to the ICU for ongoing management. 1. What is your initial management? (Pharmacology and Toxicology) - Pass rate ; highest mark .

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