Viva 1

A 50-year-old man has been admitted to your ICU with acute respiratory failure. He has a two-day history of fatigue, weakness, generalized myalgia, headache and fever; followed by dry cough and increasing shortness of breath. He is previously well and has recently returned from a business trip overseas.

Physical examination reveals temperature of 390C, heart rate 120/min, blood pressure 140/75 mm Hg. He is being ventilated with Fi02 of 0.65 with oxygen saturations of 92%, and has bilateral crepitations audible on chest auscultation. He has been commenced on IV Ceftriaxone and Azithromycin as empirical antimicrobial therapy.

Given the history, what infections will you consider as a cause for this man’s presentation?

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.