| Viva 1 | You are asked to review a 23-year old female in the Emergency Department who has presented via ambulance with her first seizure. She was still fitting after being given 5mg of diazepam IV by the ambulance officers and a further 20mg of midazolam by the staff in the Emergency Department. She was then intubated and taken for a head CT scan, which is reported as normal. She is currently intubated, sedated with fentanyl and midazolam, has been paralysed with vecuronium, with a BP 140/80, HR 98, O2 saturation 100%, temp 37.8°C. What will you look for on initial assessment as she arrives in the ICU? The rest of the questions focused on the causes of seizures in a young patient, monitoring (including role of EEG) during status and management of status. (Neurology and Neurosurgery) - Pass rate ; highest mark . |
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| Viva 2 | 54 year old woman was referred to the emergency department by her GP with a 3 day history of vomiting accompanied by upper abdominal pain. On examination she was obese, appeared restless and confused, GCS 13, febrile 38.6 C, heart rate of 90 min, BP 150/100. She has SpO2 of 88% on oxygen via a non-rebreather bag. There was diffuse abdominal tenderness on palpation in particular in the upper abdomen. Bowel sounds were sluggish. Blood tests taken in a private laboratory the preceding day had revealed a lipase of 860 U/l (< 70). What are the differential diagnoses of this patient’s presentation? The rest of the questions focused on management of pancreatitis including controversies such as antibiotic therapy, surgical management and the role of biomarkers. (Gastroenterology and Hepatology) - Pass rate ; highest mark . |
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| Viva 3 | A previously well 17 year old male is admitted to your intensive care with severe respiratory distress. He had influenza diagnosed 1 week ago and now presents pyrexial 39.5°C, hypotensive with bilateral patchy infiltrates on the Chest X-Ray. You suspect a secondary bacterial infection. What are the most likely causative organisms in this patient? The rest of the questions focussed on the management of severe respiratory failure including the management of bronchopleural fistula and the role of ECMO. (Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark . |
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| Viva 4 | A 45 year old man is brought to the Emergency Department following a motor vehicle accident. He was the driver in a frontal collision. The other occupant of the car is dead. There is no history of loss of consciousness and he is fully conscious on presentation to the Emergency Department. His airway is patent. Respiratory rate 26/min. BP 70/45 mm Hg, HR 110/min. He has two 14G IV cannulae in situ. Chest expansion is symmetrical but he has seatbelt abrasion across his chest. Describe your initial management. The rest of the questions focused on the management of severe trauma, recognition of abdominal injuries, damage control surgery, and management of ongoing hypotension, and oliguria. (Trauma, Burns, Drowning) - Pass rate ; highest mark . |
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| Viva 5 | A 25-year-old female presents with a 2-day history of nausea and upper abdominal pain. She is a previously well lady with no significant medical history. However, she has had a severe toothache for 1 week and has been taking painkillers for 1 week. Examination reveals that she is slightly jaundiced. Her blood pressure is 80/50 mm Hg, HR 105, GCS 15. Temperature 37.5
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