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.

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.