Viva 3

A 73-year-old female has been admitted following a collapse. She has a history of 3 days of anorexia, nausea, diarrhoea, vomiting and palpitations. Her past medical history includes heart failure, type 2 diabetes, atrial fibrillation, hypertension and COPD.

Her usual medications comprise Frusemide, Digoxin, Amiodarone, Metformin, Aspirin, Omeprazole, Atorvastatin, and Salbutamol inhaler.

Her initial observations are as follows:

  • Heart Rate 51 bpm
  • Blood Pressure 100/65 mmHg
  • Respiratory Rate 30/min
  • Oxygen saturation on air 93%

Initial blood results from Emergency Department are shown below:

Parameter

Result

Reference Range

Hb

110 g/L*

120 – 160

White Cell Count

14.9 x 109/L*

4.0 – 11.0

Platelets

100 x 109/L*

150 – 400

Sodium

148 mmol/L*

135 – 145

Potassium

6.5 mmol/L*

3.5 – 5.0

Urea

29.5 mmol/L*

2.4 – 7.5

Creatinine

223 µmol/L*

45 – 90

Glucose

3.5 mmol/L

3.5 – 7.7

Lactate

7.1 mmol/L*

0.5 – 1.6

Outline your differential diagnosis and discuss the investigations that you would order. 

(This viva dealt with the management of digoxin toxicity.)

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.