Coma, Altered Mental Status, and Toxicological Emergencies — WACS Viva & Clinical Scenarios (Acute Medical Care and Intensive Care Medicine)

Exam-style coma, altered mental status, and toxicological emergencies viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 32-year-old farm worker is brought to the emergency department in a state of altered consciousness, accompanied by profuse sweating, hypersalivation, pinpoint pupils, and generalized muscle fasciculations. Demonstrate your structured clinical assessment, immediate airway intervention, diagnostic prioritization, and definitive pharmacological stabilization for this patient.
• SCENARIO 2: A 45-year-old known hypertensive and diabetic patient presents in active generalized tonic-clonic convulsions lasting >15 minutes without recovery of consciousness. Outline your step-by-step pharmacotherapeutic escalation, physiological goals, advanced airway protection strategy, and intensive care management for established and refractory status epilepticus.
• SCENARIO 3: A 58-year-old patient with decompensated chronic liver disease presents with sudden deterioration in conscious level (Glasgow Coma Scale 6), decerebrate posturing, and an unreactive dilated right pupil. Explain the underlying pathophysiology of brain herniation, discuss the Monro-Kellie doctrine, and detail the urgent medical measures used to reduce intracranial pressure and maintain cerebral perfusion pressure.
• SCENARIO 4: A 28-year-old hunter presents to the emergency room 4 hours after a snakebite to the right foot. He exhibits bilateral ptosis, slurred speech, pooling of saliva, and active oozing of blood from the puncture site. Detail your clinical categorization of the envenomation, bedside diagnostic clotting tests, antivenom administration protocol, and respiratory monitoring plan.
• SCENARIO 5: You are requested to perform a brainstem death assessment on a 62-year-old mechanically ventilated patient following a catastrophic non-traumatic intracranial haemorrhage. State the mandatory preconditions, exclusion criteria, clinical brainstem reflex tests, and the execution of the formal apnoea test in accordance with regional and international standards.