Acute Multi-Organ Dysfunction and Sepsis Resuscitation — WACS Viva & Clinical Scenarios (Acute Medical Care and Intensive Care Medicine)

Exam-style acute multi-organ dysfunction and sepsis resuscitation viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: Primary Multiple Choice / Basic Science Essay Question: Describe the cellular, vascular, and molecular mechanisms underlying sepsis-induced endothelial barrier disruption, microvascular thrombosis, and cellular metabolic hibernation. Detail how these pathophysiological processes lead to multi-organ dysfunction syndrome (MODS).
• SCENARIO 2: Membership Written Clinical Management Problem: A 54-year-old male with poorly controlled diabetes mellitus presents with a 3-day history of high fever, productive cough, and worsening confusion. On admission, pulse rate is 128 beats per minute, blood pressure is 82/46 mmHg, respiratory rate is 32 breaths per minute, oxygen saturation is 88% on room air, and capillary blood glucose is 18.2 mmol/L. Arterial blood gas reveals pH 7.22, pCO2 28 mmHg, pO2 56 mmHg, HCO3 11 mmol/L, base excess -14 mmol/L, and arterial blood lactate 5.4 mmol/L. Outline your initial Hour-1 resuscitation protocol, empir
• SCENARIO 3: Membership Clinical Case / Viva Voce Station: A 62-year-old female admitted for severe intra-abdominal sepsis following perforated diverticulitis develops worsening oliguria (urine output 15 mL/hour for 6 hours), serum creatinine increase from 88 to 284 micromol/L, and bilateral alveolar infiltrates on chest radiography with PaO2/FiO2 ratio of 140 mmHg. Discuss your step-by-step evaluation of sepsis-induced acute kidney injury (KDIGO staging), criteria and modalities for renal replacement therapy, and the principles of lung-protective mechanical ventilation in moderate-to-severe ARDS.
• SCENARIO 4: Membership Bedside / OSCE Management Station: A 40-year-old patient in the intensive care unit is on day 4 of resuscitation for severe uroseptic shock. The patient remains intubated, blood pressure is 115/70 mmHg on tapering noradrenaline (0.04 mcg/kg/min), central venous pressure is 14 mmHg, and physical examination reveals 3-plus bilateral lower extremity pitting oedema and bibasilar lung crackles. Serum lactate has cleared to 1.1 mmol/L. Formulate a comprehensive fluid de-escalation (dereanimation) and organ recovery plan, including antimicrobial stewardship, nutrition, stress ulcer prophyl
• SCENARIO 5: Membership Oral Defense / Clinical Scenario: Discuss the diagnostic criteria and clinical utility of quick SOFA (qSOFA) versus full Sequential Organ Failure Assessment (SOFA) scoring in low-resource emergency departments. Explain the limitations of isolated systemic inflammatory response syndrome (SIRS) criteria and justify the restrictive red blood cell transfusion policy in septic shock.