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.
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.