2011, Paper 1 Vivas

Vivas in Order of Appearance

Viva 1

Management of raised ICP, post-TBI seizure propjhylaxis and decompressive craniectomy

(Neurology and Neurosurgery) - Pass rate ; highest mark .

Viva 2

An 18-year-old male has been involved in a high-speed motor vehicle accident. His initial GCS at the scene was 5 (E2,V2,M1) and he was intubated without any drugs. He has been a primary retrieval from the crash scene to your hospital.

On arrival he is intubated and has a hard collar in place. There is poor chest wall movement on the left side. He has a dilated left pupil and is noted to be bleeding from the left ear and nose. He has an obviously fractured left femur and shortened and externally rotated left leg.

Vital signs:
Heart rate      130/min sinus rhythm
BP                  85/50 mmHg
SpO2               90% (FiO2 1.0) on Oxylog transport ventilator
Temp              34.0C

(Trauma, Burns, Drowning) - Pass rate ; highest mark .

Viva 3

Severe acute pancreatitis and abdominal compartment syndrome

(Gastroenterology and Hepatology) - Pass rate ; highest mark .

Viva 4

A 35-year-old woman, gravida 2, para 1, who is 30 weeks pregnant, has been admitted to your ICU with pre-eclampsia. Her blood pressure is 160/100 mmHg treated with hydralazine and metoprolol prior to her admission. IV vasodilators are being considered. She has moderate proteinuria, normal liver function and a platelet count of 120 x 109. There is no evidence of foetal distress. Her significant past history included a Factor V Leiden mutation and a history of proximal vein thrombosis during her first pregnancy.

1. What pharmacological regime would you recommend for DVT prophylaxis and why? The rest of the viva was a discussion on thromboprophylaxis in pregnancy including the
results of the recent PROTECT study.

(Haematology and Oncology) - Pass rate ; highest mark .

Viva 5

You are asked to admit a 48-year-old lady who received ablative chemotherapy and an allogeneic bone marrow transplant two weeks ago for acute myeloid leukaemia. She has become progressively more dyspnoeic in the ward. A chest XRay demonstrates a diffuse pulmonary infiltrate.

Initial observations:

GCS         14
Temp              38.4oC
Pulse rate      140/min
BP                  90/40 mmHg
Resp rate       35/min
SpO2             88% on 10 L/min O2

The full blood count report from yesterday is at the bedside.

Hb	68 G/L	(135 – 180)
WCC	0.2 x 109/L (Infectious Disease Antibiotics and Sepsis) - Pass rate ; highest mark .
Viva 6	Radiology Station (4 chest X-rays, and 1 each of a CT head, chest and abdomen were shown) (Radiology) - Pass rate ; highest mark .
Viva 7	Mr Soul is an 82-year-old man who, despite severe dementia, has been living at home with his elderly wife. He is fully dependent for activities of daily living and was assessed last year as requiring high-level nursing care. He was admitted to your hospital 2 days ago with drowsiness. A CT scan of his head shows a large acute subdural haematoma. The neurosurgeon has said she is prepared to operate if the family so wish. Last night a MET call was instituted because the nurse was worried about his breathing. The night Registrar assessed his GCS as 8, admitted him to ICU and intubated him before discussing the case with you. You have now completed your morning ward round and have been asked to meet with his son/daughter Nick. The bedside nurse tells you he/she has medical power of attorney and is upset and unsure how to proceed. (Communication and Ethics) - Pass rate ; highest mark .
Viva 8	Procedure Station You have just reviewed a 40-year-old man, who was in a motor vehicle accident, in the Intensive Care Unit. He has been admitted for optimization of analgesia and non-invasive ventilation for several rib fractures. You are about to enter a relatives’ room to speak to his wife, Jennifer. Jennifer is alone in this room and has just finished speaking with one of the nursing staff. The nurse has left the rook and told you that Jennifer, who is the third trimester of a normal pregnancy, was not in the car at the time of the accident. When you enter the room, you find Jennifer lying on the floor. The viva focused on practical and theoretical aspects of basic and advanced life support in the pregnant patient. (Cardiac Arrest and Resuscitation) - Pass rate ; highest mark .

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