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:
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 |
(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.