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
TRALI and other complications of blood transfusion- storage lesions and infections.

Areaof weakness identified by examiners:

°     Very few candidates could clearly articulate the diagnostic criteria and the mechanisms of TRALI
°     Candidates also had difficulty in outlining the storage lesions.

Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.