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CICM Second Part Viva practice

Defend your decisions in the Second Part Viva.

Practise prioritising complex intensive care problems, explaining your reasoning and communicating clearly under pressure.

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Station 01Candidate instructions

Hyperglycaemia with circulatory collapse

2 minutes reading · 10 minutes viva

You are the ICU consultant receiving a 72-year-old woman with type 2 diabetes who has had three days of dysuria, vomiting and increasing confusion. She is drowsy but rousable, with dry mucous membranes, cool peripheries and right loin tenderness.

Temperature is 39.1°C, heart rate 128/min, blood pressure 76/42 mmHg, respiratory rate 30/min and SpO2 96% on 4 L/min oxygen.

Additional initial result
  • Blood beta-hydroxybutyrate 5.8 mmol/L
Opening question

Interpret the initial arterial blood gas, ECG and clinical information, and describe your immediate management priorities.

E
Examiner

Interpret the initial arterial blood gas, ECG and clinical information, and describe your immediate management priorities.

You

This is mixed DKA and hyperosmolar crisis with septic shock and acute kidney injury. The ECG shows hyperkalaemic T-wave peaking. I would give IV calcium, begin reassessed crystalloid, antibiotics and norepinephrine, arrange urgent urological source control, then start insulin with close potassium and osmolality monitoring.

E
Examiner

Explain how you will prescribe and adjust fluid while managing the sodium and osmolality.

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Inside a CICM Second Part Viva

Prioritise and defend your clinical decisions.

State your priorities, justify management and respond to examiner questions or role-player interaction written for the station.

“Explain how you will prescribe and adjust fluid while managing the sodium and osmolality.”

01Read

Review the stem, available clinical information and opening question.

02Respond

Answer aloud as the examiner probes your judgement or a role-player responds to your communication.

03Review

See how your judgement aligned with the viva rubric and full transcript.

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01Choose a stationDASHBOARD
CICM station libraryChoose what to practise next
  • 01
    GeneralHyperglycaemia with circulatory collapse
  • 02
    CommunicationFamily concern about transfer from intensive care
  • 03
    RadiologyICU chest radiology and acute complications
  • 04
    ProcedureFlexible bronchoscopy in a ventilated patient
02Perform out loudSTATION RUNNER
E
Examiner

Interpret the initial arterial blood gas, ECG and clinical information, and describe your immediate management priorities.

You

This is mixed DKA and hyperosmolar crisis with septic shock and acute kidney injury. The ECG shows hyperkalaemic T-wave peaking. I would give IV calcium, begin reassessed crystalloid, antibiotics and norepinephrine, arrange urgent urological source control, then start insulin with close potassium and osmolality monitoring.

E
Examiner

Explain how you will prescribe and adjust fluid while managing the sodium and osmolality.

Type your response...
03Understand the resultFEEDBACK
Practice ratingAt Standard

You integrated the mixed hyperglycaemic crisis, septic shock and immediately dangerous hyperkalaemia. Next, make the fluid plan explicit by linking the prescription to perfusion, sodium and the rate of osmolality change.

Next focus: Control fluid and tonicity with explicit targets.

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