| Viva 1 | You are asked to review a 64 year old man who has been brought to the emergency department having been rescued from a house fire. There is no coherent history available from the patient and you observe that he is drowsy and confused, and, has a persistent cough. His heart rate is 120 bpm, blood pressure 88/52 mmhg, respiratory rate 28 and oxygen saturations are 94 % on high flow oxygen via a non re-breather mask. Q1: What are the initial priorities in management? The other questions focussed on resuscitation, airway management, recognition of airway burns and management of burn shock Areas of weakness identified by examiners: (Trauma, Burns, Drowning) - Pass rate ; highest mark . |
| Viva 2 | A 65 year old male with a past history of ischaemic heart disease is admitted to the ICU after a motorcycle crash having sustained long bone fractures of the lower limbs. He has no head, chest or abdominal injuries. Prior to surgery, his GCS was 15 and SpO2 was 98% on 4l oxygen via Hudson mask with a normal chest X-Ray. He required prolonged operative fixation of his fractures and that was complicated by significant blood loss. Intra-operatively, he also developed increasing oxygen requirement. On arrival in ICU, his most recent ABG on an FiO2 of 0.7 shows a PaO2 55 mmHg. Q1: What are the possible differential diagnoses for his respiratory failure? The rest of the viva focussed on progressing to TRALI related respiratory failure, pathogenesis of Areas of weakness identified by examiners: (Haematology and Oncology) - Pass rate ; highest mark . |
| Viva 3 | A 72 year old female is admitted following a laparotomy for a perforated gastric ulcer. She was thought to have aspirated at the induction of anaesthesia, but was otherwise stable throughout the case. On arrival in the ICU she is haemodynamically stable, is ventilated on an SIMV mode, ° 10 breaths per minute, ° Tidal volume = 700ml, ° PEEP = 5cm H2O, ° Inspiratory time 25% ° Inspiratory Pause 10%, ° FiO2 = 0.4. The junior registrar working with you is unsure what this mode of ventilation is, and asks you to explain how this mode of ventilation works. 1. Can you draw a flow vs time, a pressure vs time and a volume vs time curve to explain this mode of ventilation to the junior registrar? The rest of the viva focussed on pressure control and pressure support ventilation (Respiratory Medicine and Mechanical Ventilation) - Pass rate ; highest mark . |
| Viva 4 | A 54 yr old female is in ICU with sepsis after repair of a leaking ileo-colic anastamosis. When you take over management on day 3, she is febrile and vasodilated. T 38.5O C, pulse 110 / min, MAP 58 mm Hg. CVP 12 mm Hg. Urine output 15 mL/hr. Plasma creatinine is normal, but rising. Your colleague has been giving fluid replacement guided by arterial waveform analysis, administering a fluid load when Stroke Volume Variation > 13%. She now has generalized oedema, with an acute weight gain of 12 kg. Q1. What is Stroke Volume Variation designed to monitor? The rest of the viva focussed on fluid responsiveness, complications of fluid therapy and a discussion on the suitability of crystalloids and colloids in various clinical situations. (Electrolytes and Fluids) - Pass rate ; highest mark . |
| Viva 5 | A 75-year-old man has suffered chest trauma with multiple fractured ribs after falling off a ladder. There is no other significant injury after a tertiary survey and a trauma radiology series. His past history includes a history of depression treated with sertraline, chronic renal dysfunction with a creatinine of 190 µmol/L (normal range 60-120 µmol/L) and a heavy (10 standard drinks/day) alcohol consumption. He has just arrived in the ICU via radiology and is intubated and ventilated. (Pharmacology and Toxicology) - Pass rate ; highest mark . |
| Viva 6 | You are the intensivist caring for Mrs June Hay, a 56 year old lady recently admitted comatose to the ICU following a subarachnoid haemorrhage, but who had made good progress to the point of obeying commands and had been discharged to the ward with a tracheostomy in situ. She was readmitted to ICU following a prolonged resuscitation in the ward. It transpired that she had suffered a major anaphylactic reaction to Flucloxacillin that had been prescribed by an intern for a presumed infection around the tracheostomy site. This was despite the fact that she had clearly documented penicillin allergy and she wore a Medic-Alert bracelet indicating her allergy. The husband has been appraised about the drug error. It is now 3 days later, she is deeply comatose and has clearly suffered irreversible neurological damage based on clinical assessment and CT scan studies. (Communication and Ethics) - Pass rate ; highest mark . |
| Viva 7 | Radiology station: 7 X-rays were shown. The X-rays included chest Xrays of thoracic trauma, pneumonia, COPD with respiratory failure and the CT scans included that of brain injury, pericardial tamponade and free abdominal gas contrast extravasation in to the abdominal cavity. Areas of weakness identified by examiners: ° Failure to identifiy common pathologies (Radiology) - Pass rate ; highest mark . |
| Viva 8 | Cardiac tamponade, pericardiocentesis and gas embolism (Cardiac Arrest and Resuscitation) - Pass rate ; highest mark . |