Viva 5

You are asked to review a confused 65-year-old female with ischaemic heart disease, chronic obstructive airways disease and atrial fibrillation in the Emergency Department, who has presented with abdominal pain and vomiting.

Her vital signs, after 4 litres 0.9% saline intravenously are as follows:

  • Temperature 39.5oC
  • Respiratory rate 30 breaths/min
  • SpO2 92% on 15 L/min oxygen via a reservoir mask
  • Heart rate 120 beats/min (atrial fibrillation)
  • Blood pressure 88/48 mmHg 

She is icteric, has right upper quadrant tenderness and is mildly confused.

What is your differential diagnosis?

The viva focussed on the management of biliary sepsis

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.