A 26 year old lady presents from home confused with a low-grade fever. Her blood pressure is
160/100. She has no gross motor deficits. Ten days ago she had an emergency termination of pregnancy for an intrauterine death that was complicated by disseminated intravascular coagulation. She was 32 weeks gestation and had been on labetalol for a pregnancy-induced hypertension. Her discharge medications included paracetamol, tramadol and a selective serotonin reuptake inhibitor. She has a 6-year history of uncomplicated Hepatitis C.
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:
• Candidates were confused about the concept of fluid responsiveness, and frequently equated fluid responsiveness to a low CVP. They could not explain why CVP was not a reliable measure of fluid status or responsiveness.
• Many candidates were not familiar with the VISEP study (candidates were not required to know the name of the study but an awareness of a large RCT on starches and their potential problems was important).
• Many were unaware of the composition and associated drawbacks of Compound Sodium Lactate solution
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.