Viva 1

You have been called to the gynaecology ward to review a 45-year-old female who is 48 hr post- laparotomy for large bowel obstruction, and is now tachypnoeic and hypotensive. She has a background of known ovarian malignancy for which she has received chemotherapy. At surgery she was found to have metastatic disease and has undergone a debulking procedure and bowel resection with formation of a de-functioning ileostomy.

Her vital signs are as follows:

    • GCS 15
    • Respiratory rate 35
    • SpO2 90% on 8l via Hudson Mask
    • Few bibasal crepitations
    • Heart rate 110
    • BP 80/40
    • Soft distended abdomen with pink functioning stoma List your differential diagnoses for her presentation.
List your differential diagnoses for her presentation.

(This viva dealt with the diagnosis and management of pulmonary embolus.)

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.