Zachary is a previously well 19-year-old male admitted to your ICU three days ago with refractory status epilepticus. No infective cause has been found and the working diagnosis is auto-immune encephalitis.
Zachary has been intubated and sedated. He continues to have frequent seizures despite adequate treatment with phenytoin, midazolam and levetiracetam and so propofol sedation has been increased to induce burst-suppression on continuous EEG monitoring.
The neurologist responsible for Zachary is considering immunosuppressive therapy, which you agree is appropriate treatment for this condition.
Zachary’s parent has asked to meet with you, the Intensivist on duty. This is your first meeting with them. The nurse caring for Zachary has already been told by his parent that he will only receive immunosuppressive therapy “over my dead body!”
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.