Viva 1

A 75-year-old male patient is admitted to ICU following a MET call for tachycardia and fever, one week after a Whipple’s procedure. The post-operative period was complicated by a surgical site infection needing IV antibiotics. He is receiving morphine and tramadol for analgesia, and regular haloperidol for delirium.

He has a background medical history of diabetes, Graves’ disease and rheumatoid arthritis for which he takes regular prednisolone.

On ICU admission, he was noted to be confused, restless, and diaphoretic with a temperature of 42ºC.

Provide a differential diagnosis for his fever and outline your management plan.

(This viva dealt with hyperthermia.)

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.