Viva 5

You are asked to admit a 48-year-old lady who received ablative chemotherapy and an allogeneic bone marrow transplant two weeks ago for acute myeloid leukaemia. She has become progressively more dyspnoeic in the ward. A chest XRay demonstrates  a diffuse pulmonary infiltrate.

Initial observations:

GCS         14
Temp               38.4oC 
Pulse rate       140/min
BP                   90/40 mmHg
Resp rate        35/min
SpO2             88% on 10 L/min O2

The full blood count report from yesterday is at the bedside.

Hb

68 G/L

(135 – 180)

WCC

0.2 x 109/L

(4.0 – 11.0)      No differential

Platelets

39 x 109/L

(150 – 400)

Comment – occasional tear drops, occasional elliptocytes, occasional lymphocyte and neutrophil seen


1.   What is your differential diagnosis?

The viva focused on the management of neutropenic sepsis.

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.