| Viva 1 |
A 58 year old man is admitted to the Intensive Care Unit, intubated and ventilated. Haemodynamic monitors have been inserted and the following haemodynamic measurements have been recorded:
Mean arterial pressure 53 mmHg
Central venous pressure 15 mmHg
Cardiac output 6.8 L/min
[Cardiac index 3.8 L/min/m2]
1. Describe this circulatory disturbance.
The rest of the questions focused on the rational approach to uses of inotropes and vasopressor including a discussion of some of the recent evidence.
(Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark . |
| Viva 2 |
Mr Gere, a previously well 47 yo male, has been admitted to the ICU for 5 days with severe sepsis secondary to a perforated sigmoid colon. He had a sigmoid colectomy and washout of his peritoneum, and appropriate antibiotic therapy. His initial course was complicated by severe septic shock and multi-organ failure that is now resolving. He is currently ventilated via an oral endotracheal tube, on SIMV with a rate of 16, TV of 700 ml, PEEP of 5 cm H2O and FIO2 of 0.45. He is receiving a small dose of fentanyl and propofol, but is awake and co-operative although he has generalised weakness. His arterial blood gas result is shown below:
|
pH
|
7.32
|
|
|
PaO2
|
85 mmHg
|
(11.3 Kpa)
|
|
PaCO2
HCO3-
|
45 mmHg
18 mmol/L
|
(6 Kpa)
(24 - 32mmol/L)
|
|
BE
|
-4.9 mmol/L
|
(-2.0 to 2.0 mmol/L)
(Airway Management) - Pass rate ; highest mark . |
| Viva 3 |
A 60 year old man has been transferred to your ICU from another hospital ICU, where he had been admitted 10 days ago with severe pancreatitis and requiring mechanical ventilation. His oral intake was said to be poor during the week leading up to that hospital admission.
1. How would you assess his nutritional state?
The rest of the questions focussed on the route of administration of feeds, calculation of caloric requirements, and the role of immunonutrition.
(Endocrinology Metabolism and Nutrition) - Pass rate ; highest mark . |
| Viva 4 |
A 63 year old woman was admitted to the Intensive Care Unit 4 days ago. She has suffered a cardiac arrest in the community, was resuscitated by Ambulance Officers and was treated with urgent cardiac angiography and stenting of a significant left main coronary artery lesion.
Her clinical condition:
• On moderate sedation, she has started to obey commands this morning
• Intubated and ventilated since admission. Currently FiO2 = 0.6, PaO2 = 120
• Right internal jugular central line, left radial arterial line, right cephalic vein peripheral IV line – all inserted on admission
• She is being treated with clopidogrel, ranitidine and intravenous heparin.
• She has been in atrial fibrillation since admission
This morning she developed a temperature of 38.8°C. What are the likely causes of fever in this lady?
The rest of the question focused on the approach to the febrile critically ill patient.
(Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark . |
| Viva 5 |
A 26 year old male is a passenger in a high speed motor vehicle crash. At the scene his Glasgow coma score is 3 and he is intubated by paramedics and transferred to your hospital. In the emergency room, clinical assessment and radiological investigations are consistent with an isolated severe traumatic brain injury. He is transferred to the ICU.
1) Define severe traumatic brain injury
The rest of the questions focussed on the evidence based approach to ICP and CPP
management.
(Neurology and Neurosurgery) - Pass rate ; highest mark . |
| Viva 6 |
You are the intensivist caring for a patient Mr James Wilson, a 70 year old man admitted to your ICU last night with aspiration pneumonitis associated with a bowel obstruction. He had been in hospital for 4 days prior to admission to the ICU. He is sedated, intubated, ventilated on 80% oxygen and requiring inotropic / vasopressor support.
At the morning hand-over round you are told of an attempt by the new night ICU Registrar to insert an internal jugular central venous catheter just an hour ago that has resulted in technical difficulties with the guidewire being accidentally pushed into the venous circulation. It is seen on X-ray to be in the right atrium, ventricle and pulmonary artery.
The patient's son/daughter has arrived and wishes to speak to someone about their father's condition. You are asked to enter this room and update the patient's relative about the condition of their father.
(Communication and Ethics) - Pass rate ; highest mark . |
| Viva 7 |
Radiology station.
Six sets of X-Rays ( 4 chest X-Rays, 1 CT abdomen and 1 MRI brain) were shown to the candidates and required to identify major radiological findings.
(Radiology) - Pass rate ; highest mark . |
| Viva 8 |
Timing of dialysis and troubleshooting the CRRT circuit
(Renal Failure and Dialysis) - Pass rate ; highest mark . |
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