Viva 4

A 56-year-old male with history of gout and rheumatoid arthritis was admitted to hospital with 24-hour history of fever, generalised joint pains, fatigue, cough, shortness of breath and erythematous skin rash. Over the next 24 hours, the rash worsened to involve his entire body (see clinical photographs below). His chest X-ray showed widespread interstitial opacities and he rapidly progressed to type 1 respiratory failure needing intensive care.

Describe the skin lesions, provide a differential diagnosis and outline your initial assessment.

(Images removed from report.)

Describe the skin lesions, provide a differential diagnosis and outline your initial assessment.

(This viva dealt with Toxic Epidermal Necrolysis Syndrome (TENS).)

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.