Viva 3

You are called to assess a 56-year-old male in the Emergency Department. He was admitted with a two-day history of severe epigastric pain and vomiting.

On current examination he is conscious and distressed, has a blood pressure of 75/45 mmHg, heart rate 120 beats/minute, respiratory rate of 38 breaths/minute and a temperature of 38.6ºC. Oxygen saturations are 91% on room air.

The abdomen is distended and diffusely tender without guarding. He is oliguric.
 

 

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What are your differential diagnoses and how would you investigate this patient?.

(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.