Viva 4

You are taking over the care of a 26-year-old male who remains ventilated one week after a motor vehicle accident in which he sustained severe intraabdominal and head injuries as well as multiple fractures. He underwent an immediate trauma laparotomy and required a splenectomy and repair of a bowel perforation.

He has had persistent fevers since admission, and has received a course of Piperacillin and Tazobactam.

He is currently receiving low dose noradrenaline, and parenteral nutrition via a nontunnelled central venous catheter.

He has a history of intravenous drug use.

Give a differential diagnosis for the fever in this patient and outline your management.

(This viva focussed on issues relating to fungal 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.