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Primary Viva 3 (Clinical)

Created: 14/9/2004


A 22-year-old female presents to an accident and emergency department with right abdominal lower quadrant pain. She is given an injection of morphine, 10 mg. Her blood pressure is now 85/60 mmHg and her heart rate is HR 120 bpm.


1. What is the differential diagnosis?

2. What are the possible medical causes?

3. What investigations would you perform in this patient and why?

4. Does injection of morphine, given for pain relief, affect your decision or management?

5. Should the patient go straight to the operating theatre or should she undergo preoperative optimisation first? If you feel she requires optimisation, how, where, when, why and what are the end points?

6. When she has been taken to the operating theatre, discuss the maintenance drugs and anaesthetic technique you would use.

7. A diagnosis of ruptured ectopic pregnancy is made; discuss how you would manage blood loss.

8. Complications of blood transfusion:

a) Discuss the problem of mismatched blood.

b) What are the causes, types and management?

c) Explain how a mismatched transfusion can lead to acute renal failure.

d) List some other causes of acute renal failure, other than blockage of renal tubules with haemoglobin.

e) Why should Rhesus positive blood not be given to females, and why is it only the Rhesus group that causes problems with females? Why not the ABO system?

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