A 30 year old man has been admitted to hospital with severe multiple injuries following a motor vehicle accident.
On day 2, his intracranial pressure has stabilised and his head CT shows scattered punctate haemorrhage with subarachnoid blood, with no mass lesion requiring evacuation. His pelvic fracture and right tibial/fibula fracture have been managed with external fixation and a left leg femoral fracture has undergone open reduction and internal fixation.
He has been in good health, but had a DVT 3 years ago and is not on any regular medication.
Outline your approach to prophylaxis for venous thrombo-embolism in this patient.
The other questions focussed on priniciples of DVT prophylaxis, use of various agents in a variety of clinical situations, HITTS and management of DVT prophylaxis in TBI.
You are reviewing an intubated and ventilated 35 year old 4 days following traumatic subarachnoid haemorrhage. Overnight he has developed a temperature of 39.3 and has developed a new tachycardia of 130 beats/minute and has been commenced on noradrenaline for a low blood pressure (90 mm Hg systolic).
What could be the causes of fever in this man?
The rest of the viva focussed on evaluation of sepsis in a critically ill patient, interpretation of CSF results and biomarkers of sepsis.
Aortic dissection: diagnosis and management
A 26 year old lady presents from home confused with a low-grade fever. Her blood pressure is
What would you include in your differential diagnosis for her confusion and temperature?
The rest of the viva focussed on the evaluation and management of encephalopathy and DIC in the pregnant patient. .
Areas of weakness identified by examiners:
A 68 year old man had both legs trapped under a heavy concrete slab for 4 hours. He has just been admitted to the ICU, 8 hours post injury, following adequate resuscitation and definitive operative wound debridement. His observations are that he is, fully conscious, his blood pressure is 110/70 mmHg, pulse 86 beats/min and respiratory rate 24 breaths/min. He is anuric, and has been for the past 3 hours.
Relevant blood results at that time are: