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.