Viva 3

A 45-year-old male is admitted to hospital with an upper gastrointestinal bleed and undergoes endoscopy and banding of oesophageal varices. His Glasgow Coma Scale (GCS) at presentation was 15.

Over the next 24 hours the patient has a progressive decrease in conscious level. You are called by the new medical consultant, who suspects the patient has hepatic encephalopathy, and wants him admitted to ICU.

How would you assess the patient to determine the cause of the altered level of consciousness?

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.