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Folio edition · Set in Instrument Serif & Archivo

Phys · Vivas

Vivas

239 units across 15 domains — Structured oral examination scripts for DCE viva defence.

Back to PhysJump to first domain
Physician Medicine Vivas
Plate — physMedVellum Press
239Units
15Domains
general-medicinerenalhaematologicalhepaticgastrointestinalendocrinecardiovascularpharmacologicalrheumatologicalinfectiousrespiratoryoncologicalgeriatricdermatologicalneurological
AtlasPhysVivas

Domain

general-medicine

43

Abdominal Examination Routine — Viva Defence

Structured DCE viva for the abdominal examination short case: defence of the twelve-step routine, the interpretation of chronic liver disease stigmata, the differentiation of organomegaly, the evidence-based examination of ascites and AAA, the standard oral presentation, and the discussion questions the examiner will ask, with model answers for each probing question.

Open

Anaphylaxis — Viva Defence

Structured DCE viva for anaphylaxis: long-case defence of recurrent idiopathic anaphylaxis — trigger reconstruction, mast-cell screening, autoinjector training and safety-net building, with probing questions and first-person model answers.

Open

Cardiovascular Examination — Viva Defence

Structured DCE viva for the cardiovascular system examination: the defence of the eleven-step routine, the timing-based murmur framework, the dynamic manoeuvres, the JVP waveform interpretation, the apex beat character, the structured presentation, and the examiner discussion by finding, with a short-case station on the systematic examination of a patient with a murmur.

Open

Clinical Research AND Research Ethics — Viva Defence

DCE viva defence for Clinical Research AND Research Ethics.

Open

Confidentiality Privacy AND Mandatory Reporting — Viva Defence

DCE viva defence for Confidentiality Privacy AND Mandatory Reporting.

Open

Cranial Nerve Examination — Viva Defence

Structured DCE viva for cranial nerve examination: short-case defence of a pupil-involving third nerve palsy, a Horner syndrome and an LMN facial palsy, with the localising reasoning the examiner probes.

Open

Cultural Competence and Indigenous Health — Viva Defence

Structured DCE viva for cultural competence and Indigenous health: long-case defence of a 48-year-old Aboriginal woman from a remote community with decompensated rheumatic heart disease, type 2 diabetes, chronic kidney disease, chronic otitis media, depression, suboptimal secondary prophylaxis, and a social context of isolation and system disengagement — covering the cultural safety framework, the ARF or RHD prevention pathway, integrated disease management, the Aboriginal Health Worker role, and culturally safe discharge planning; plus a short-case discussion of a culturally safe cardiovascular examination and communication in an Indigenous patient.

Open

Drug Allergy and Desensitisation — Viva Defence

Structured DCE viva for drug allergy and desensitisation: long-case defence covering a penicillin allergy label complicating essential therapy, with the risk-stratified delabeling strategy, side-chain-based beta-lactam cross-reactivity, drug provocation testing as the gold standard, and the principles and 48-hour rule of desensitisation, plus short-case discussion of a drug eruption and the DRESS and SJS or TEN phenotypes.

Open

END OF Life Decision Making — Viva Defence

DCE viva defence for END OF Life Decision Making.

Open

Evidence-Based Medicine and Critical Appraisal — Viva Defence

Structured DCE viva for evidence-based medicine and critical appraisal: long-case defence of a 75-year-old woman with atrial fibrillation, chronic kidney disease and a recent fall in whom the evidence for a direct oral anticoagulant must be appraised, applied and shared (PICO, applicability to a patient near the renal exclusion threshold, NNT and NNH for her baseline risk, GRADE strength and quality, and the shared decision), and a short-case discussion of the interpretation of a forest plot from a meta-analysis of a new antiplatelet agent and the appraisal of a published diagnostic accuracy study using QUADAS-2.

Open

Examination OF THE Unconscious Patient — Viva Defence

DCE viva defence for Examination OF THE Unconscious Patient.

Open

Lymph Node Examination and Organomegaly — Viva Defence

Structured DCE viva for the lymph node and organomegaly short case: defence of the head-to-toe node routine, the five characteristics of every node, the interpretation of consistency, the significance of the Virchow node, the correct technique for splenomegaly, the differentiation of spleen from kidney, the grading of splenomegaly, the examination of hepatomegaly, the standard oral presentation, and the discussion questions the examiner will ask, with model answers for each probing question.

Open

Medical Errors and Open Disclosure — Viva Defence

Structured DCE viva for medical errors and open disclosure: long-case defence covering a tenfold insulin overdose and a failure to cease metformin in acute kidney injury, with the classification of the event, the Swiss cheese model analysis, the staged Australian Open Disclosure Framework, the apology that is not an admission of liability, root cause analysis with the London Protocol contributory factors, the just culture algorithm, the second victim, and the reporting and medico-legal pathways, plus short-case discussion of the classification of error types and the contributory-factor analysis.

Open

Medical Ethics Autonomy Beneficence NON Maleficence Justice — Viva Defence

DCE viva defence for Medical Ethics Autonomy Beneficence NON Maleficence Justice.

Open

Medical Ethics, Capacity and Consent — Viva Defence

Structured DCE viva for medical ethics, capacity and consent: long-case defence of a 78-year-old woman with advanced Alzheimer disease and aspiration pneumonia whose enduring guardian son demands intensive care the team considers futile — covering the capacity assessment (two-stage test, four functional abilities), the best-interests framework (substituted judgement standard), the goals-of-care conversation, the ceiling of treatment (do not resuscitate but do not abandon), and the escalation pathway to the guardianship tribunal; plus a short-case discussion of a structured bedside capacity assessment for a patient refusing a below-knee amputation.

Open

Multi-morbidity and Complex Care — Viva Defence

Structured DCE viva for multi-morbidity: long-case defence of an 82-year-old woman with heart failure with reduced ejection fraction, atrial fibrillation, type 2 diabetes, stage 3b CKD, osteoporosis and mild cognitive impairment, admitted with a fall, on 14 medications, requiring an integrated and prioritised management plan anchored to her goals of care — with discussion of the five principles of multi-morbidity management, the structured medication review with STOPP/START and Beers, the integrated cardio-renal-metabolic therapy, the deprescribing plan, the advance care planning, and the care coordination; plus a short-case discussion of the bedside medication review and the goals-of-care conversation.

Open

Neurological Examination of the Lower Limbs — Viva Defence

Structured DCE viva for the lower limb neurological examination short case: defence of the eight-step routine (gait, inspection, tone, power, reflexes, plantar, coordination, sensory, stance), the interpretation of the gait patterns, the UMN versus LMN framework, the dissociated reflex patterns (diabetic neuropathy, hypothyroidism), the Babinski sign, the heel-shin test, the Romberg test, the pes cavus syndromes (Friedreich ataxia versus Charcot-Marie-Tooth), and the common examination traps, with examiner probing questions and model answers.

Open

Neurological Examination of the Upper Limbs — Viva Defence

Structured DCE viva for the upper limb neurological examination short case: defence of the eight-step routine, the interpretation of combined UMN and LMN signs for motor neuron disease, the localisation of cerebellar and Parkinsonian findings, the inverted supinator sign for cervical myelopathy, the carpal tunnel syndrome pattern, the pronator drift, the cortical sensory deficit, and the common examination traps, with examiner probing questions and model answers.

Open

Perioperative Medicine — Viva Defence

Structured DCE viva for physician-level perioperative medicine: long-case defence of a complex elderly patient with atrial fibrillation on a DOAC, insulin-treated diabetes, COPD, and a recent coronary stent facing major cancer surgery, and short-case discussion of cardiac risk stratification, perioperative diabetes, anticoagulation bridging and reversal, and VTE prophylaxis.

Open

Physician Wellbeing Burnout AND Professional Resilience — Viva Defence

DCE viva defence for Physician Wellbeing Burnout AND Professional Resilience.

Open

Preoperative Medical Assessment AND Optimisation — Viva Defence

DCE viva defence for Preoperative Medical Assessment AND Optimisation.

Open

Primary Immunodeficiency in Adults — Viva Defence

Structured DCE viva for primary immunodeficiency in adults: long-case defence of a 34-year-old woman with newly diagnosed common variable immunodeficiency (recurrent sinopulmonary infection, Giardia, autoimmune thrombocytopenia, bronchiectasis) with discussion of the diagnostic pathway, immunoglobulin replacement, surveillance for lymphoma and autoimmunity, plus a short-case discussion of pattern recognition and the bedside clues to the four arms of the immune system.

Open

Quality AND Safety IN Medicine — Viva Defence

DCE viva defence for Quality AND Safety IN Medicine.

Open

Rapid Response Systems and MET Calls — Viva Defence

Structured DCE viva for the post-MET-call patient: long-case defence of a 68-year-old man with cellulitis who deteriorates to septic shock with multi-organ failure, with discussion of the afferent-limb failure analysis, the fluid strategy in ischaemic heart disease, the ceiling-of-care decision, the SBAR handover, and the evidence for rapid response systems, plus a short-case discussion of the post-MET bedside review.

Open

Respiratory Examination — Viva Defence

Structured DCE viva for the respiratory short case: model presentation of the systematic respiratory examination, with discussion of the eleven-step routine, the cardinal chest sign patterns (consolidation, effusion, pneumothorax, collapse), the interpretation of clubbing, the significance of fine versus coarse crackles, the tracheal deviation patterns, and the common exam traps that cost marks.

Open

Rheumatological Examination of the Hands — Viva Defence

Structured DCE viva for the rheumatological hand examination short case: defence of the six-step routine, the synovitis versus bony swelling distinction, the discriminating deformities of RA, OA, PsA, gout, SLE (Jaccoud arthropathy), SSc and dermatomyositis, the DAS28 joint count, the carpal tunnel bedside tests, and the common examination traps, with examiner probing questions and model answers.

Open

Rheumatological Examination Spine AND Lower Limbs — Viva Defence

DCE viva defence for Rheumatological Examination Spine AND Lower Limbs.

Open

Skin Examination for Systemic Disease — Viva Defence

Structured DCE viva for the skin short case: model presentation of the systematic six-step skin examination, with discussion of the morphology vocabulary and the distribution clues, the malar rash of SLE and the nasolabial fold discriminator, the heliotrope rash and the Gottron papules of dermatomyositis, the approach to palpable versus non-palpable purpura, the causes of erythema nodosum, the significance of acanthosis nigricans, and the common exam traps that cost marks.

Open

Speech and Higher Mental Function Examination — Viva Defence

Structured DCE viva for speech and higher mental function: short-case defence of an acute Wernicke aphasia, a conduction aphasia, and a progressive cognitive domain profile, with the localising and diagnostic reasoning the examiner probes.

Open

The Deteriorating Ward Patient — Viva Defence

Structured DCE viva for the deteriorating ward patient: long-case defence of a 78-year-old woman with community-acquired pneumonia who acutely deteriorates with septic shock, new atrial fibrillation, AKI with hyperkalaemia, and delirium on a background of ischaemic heart disease, CKD, diabetes, and aortic stenosis, with discussion of the ceiling-of-care decision and the evidence for rapid response systems, plus a short-case discussion of the bedside ABCDE assessment of the acutely unwell patient.

Open

The Undifferentiated Altered Mental Status — Viva Defence

Structured DCE viva for the acutely confused elderly patient: long-case defence of an 82-year-old man with multifactorial delirium (pneumonia, UTI, severe hyponatraemia, AKI, chronic subdural on apixaban, superimposed on vascular dementia), with discussion of the CAM diagnostic algorithm, the DIMTOP differential, the controlled hyponatraemia correction, the subdural management, and the delirium prevention bundle, plus a short-case discussion of the bedside cognitive assessment and the CAM application.

Open

Thyroid Status Examination — Viva Defence

Structured DCE viva for the thyroid short case: model presentation of the systematic nine-step thyroid status examination performed from behind the patient, with discussion of the Graves-specific eye signs, the Clinical Activity Score, the distinction between Graves and the other causes of thyrotoxicosis, the retrosternal goitre signs, the significance of the thyroid bruit, the delayed-relaxation reflexes, and the common exam traps that cost marks.

Open

Undifferentiated Back Pain — Viva Defence

Structured DCE viva for the undifferentiated back pain patient: long-case defence of a 34-year-old man with inflammatory back pain, psoriasis and uveitis, meeting the ASAS criteria for axial spondyloarthritis, with discussion of the inflammatory versus mechanical discrimination, the role of the HLA-B27, the X-ray and the MRI, the extra-articular surveillance, the pharmacological escalation, and the integration of the biopsychosocial management, plus a short-case discussion of the systematic spine examination.

Open

Undifferentiated Chest Pain — Viva Defence

Structured DCE viva for the undifferentiated chest pain patient: long-case defence of a 68-year-old woman with type 2 diabetes and cardiovascular risk factors presenting with an inferior STEMI, with discussion of the catheter-lab activation, the Sgarbossa criteria, the 0/1h troponin algorithm, the HEART score, the PE diagnostic algorithm, the atypical presentation, and the secondary prevention, plus a short-case discussion of the systematic cardiovascular examination.

Open

Undifferentiated Dyspnoea — Viva Defence

Structured DCE viva for the undifferentiated dyspnoeic patient: long-case defence of a 72-year-old man with COPD and ischaemic heart disease presenting with acute dyspnoea, coexisting heart failure, new atrial fibrillation and a type 2 troponin rise, with discussion of the biomarker interpretation, the oxygen strategy, the diagnostic algorithm for pulmonary embolism, and the integration of competing diagnoses, plus a short-case discussion of the systematic respiratory examination.

Open

Undifferentiated Fatigue — Viva Defence

Structured DCE viva for undifferentiated fatigue: long-case defence covering the three functional categories (physiological, psychological, physical or systemic), the Tier 1 screen and the targeted Tier 2, the management of the unexplained fatigue, and a branching scenario into ME/CFS (the 2021 NICE NG206 withdrawal of the graded exercise therapy) and a branching scenario into Addison disease (the short Synacthen test), plus a short-case discussion of the bedside discriminators (the pallor, the koilonychia, the hyperpigmentation, the postural drop).

Open

Undifferentiated Fever and Fever of Unknown Origin — Viva Defence

Structured DCE viva for fever of unknown origin: long-case defence of a 62-year-old retired park ranger with six weeks of fever, night sweats and weight loss on a background of treated tuberculosis and adalimumab for psoriatic arthritis, with discussion of the staged diagnostic protocol, the role of FDG-PET-CT, the management of the anti-TNF therapy, the threshold for empiric therapy, and the communication of diagnostic uncertainty, plus a short-case discussion of the focused examination of the FUO patient.

Open

Undifferentiated Lymphadenopathy — Viva Defence

Structured DCE viva for the undifferentiated lymphadenopathy patient: long-case defence of a 58-year-old Nigerian-born man with a six-week history of a painless left supraclavicular node, B symptoms, a raised LDH and a widened mediastinum, with discussion of the red-flag screen, the biopsy decision (excisional biopsy as the gold standard for lymphoma, FNA inadequate), the parallel tuberculosis work-up, the Lugano staging and the R-IPI prognostication, and the integration of the competing diagnoses, plus a short-case discussion of the systematic lymph node examination.

Open

Undifferentiated Oedema — Viva Defence

Structured DCE viva for the undifferentiated oedematous patient: long-case defence of a 70-year-old man with heart failure, cirrhosis, diabetes and hypertension presenting with generalised oedema, ascites and a raised NT-proBNP, with discussion of the Starling forces, the SAAG, the interpretation of the NT-proBNP in cirrhosis, the management of the competing mechanisms, and the integration of the cardiac, hepatic, renal and drug contributions, plus a short-case discussion of the examination for oedema.

Open

Undifferentiated Palpitations — Viva Defence

Structured DCE viva for the patient presenting with undifferentiated palpitations: the model presentation of the focused history and the cardiovascular examination, the four-descriptor classification (regular fast, irregular, missed beat, pounding), the mandatory 12-lead ECG interpretation (AF, SVT, VT, long QT, WPW, Brugada), the tiered ambulatory monitoring strategy, the high-risk features, the modified Valsalva manoeuvre (REVERT), the adenosine dosing and contraindications, the catheter ablation, the AF management with the anticoagulation, and the classic exam traps.

Open

Undifferentiated Presentations Abdominal Pain — Viva Defence

DCE viva defence for Undifferentiated Presentations Abdominal Pain.

Open

Undifferentiated Weight Loss — Viva Defence

Structured DCE viva for the diagnostic approach to the patient with involuntary weight loss: the long-case defence covering the 68-year-old man with the weight loss, the anorexia, the early satiety, the night sweats, and the iron deficiency anaemia with the positive FIT (the GI malignancy scenario), the Hernandez prediction score, the Tier 2 malignancy workup, and the cancer cachexia management; the branching scenario into the 58-year-old woman with the weight loss, the heat intolerance, and the atrial fibrillation (the hyperthyroidism with the preserved appetite), and the 72-year-old man with the weight loss, the postural hypotension, and the hyperpigmentation (the Addison disease); and the short-case discussion of the examination of the cachectic patient.

Open

Urticaria and Angioedema — Viva Defence

Structured DCE viva for urticaria and angioedema: long-case defence covering chronic spontaneous urticaria with the four-step EAACI treatment ladder (antihistamine up-titration, omalizumab, ciclosporin) and the thyroid autoimmunity association, plus a branching scenario into hereditary angioedema with acute laryngeal management (C1-INH concentrate, icatibant, NO adrenaline) and lanadelumab prophylaxis, and short-case discussion of the skin examination demonstrating dermographism and the histamine-versus-bradykinin branch point.

Open

Domain

renal

18

Acid-Base Disorders — Viva Defence

Structured DCE viva for physician-level acid-base interpretation: long-case defence of a complex mixed acid-base disorder in a septic, diabetic patient, and short-case discussion of the six-step algorithm, compensation rules, and toxic alcohol recognition.

Open

Acute Kidney Injury — Viva Defence

Structured DCE viva for acute kidney injury: long-case defence and short-case discussion covering KDIGO staging, pre-renal/intrinsic/post-renal classification, fluid assessment, nephrotoxicity, RRT timing, and volume status examination.

Open

Chronic Kidney Disease — Viva Defence

Structured DCE viva for chronic kidney disease: long-case defence covering progression-slowing therapy, complication management (anaemia, CKD-MBD, hyperkalaemia), dialysis planning, and the cardiorenal-metabolic patient; plus short-case discussion of dialysis access examination.

Open

Diabetic Kidney Disease — Viva Defence

Structured DCE viva for diabetic kidney disease: long-case defence covering progression-slowing therapy with SGLT2 inhibitors and finerenone, RAAS blockade, multifactorial intervention, complication management (anaemia, CKD-MBD, hyperkalaemia), dialysis and transplant planning, and biopsy decision-making; plus short-case discussion of examination in the cardiorenal-metabolic patient.

Open

Electrolyte Disorders (Calcium, Magnesium, Phosphate) — Viva Defence

Structured DCE viva for divalent ion disorders: long-case defence of asymptomatic hypercalcaemia with inappropriately normal PTH on a thiazide — the operate-or-monitor discussion in primary hyperparathyroidism, with the thiazide and FHH confounders.

Open

Glomerulonephritis (Nephritic Spectrum) — Viva Defence

Structured DCE viva for glomerulonephritis: long-case defence covering pulmonary-renal syndrome from ANCA vasculitis, complement interpretation, biopsy classification, induction immunosuppression, plasma exchange evidence, and short-case examination of a nephrology patient.

Open

Hypertensive Nephrosclerosis and Renovascular Disease — Viva Defence

Structured DCE viva: long-case defence of a 66-year-old with resistant hypertension, GFR decline on dual therapy and a 70% renal artery stenosis — the CORAL defence of medical therapy, with probing first-person answers.

Open

Kidney Transplantation — Viva Defence

Structured DCE viva for kidney transplantation: long-case defence of a complex transplant recipient 6 months post-transplant with a rising creatinine and BK viraemia (the biopsy and the trade-off between BK nephropathy and rejection, immunosuppression reduction, surveillance) plus a short-case discussion of the abdominal examination of a transplant recipient (the iliac fossa scar, the palpable graft, the AV fistula, the immunosuppression side-effects) and the systematic presentation routine.

Open

Nephrolithiasis — Viva Defence

Structured DCE viva for nephrolithiasis: long-case defence of a 48-year-old man with Crohn disease and recurrent calcium oxalate stones from enteric hyperoxaluria, covering the pathophysiology of enteric hyperoxaluria, the metabolic evaluation, the prevention strategy (normal calcium with meals, potassium citrate, low-oxalate low-fat diet, cholestyramine), and the acute management of renal colic and obstructive pyelonephritis. Plus branching scenarios into primary hyperparathyroidism, cystinuria, and struvite staghorn calculus.

Open

Nephrotic Syndrome — Viva Defence

Structured DCE viva for nephrotic syndrome: long-case defence covering cause-specific immunosuppression (rituximab for membranous — MENTOR/GEMRITUX), renal vein thrombosis and anticoagulation, hepatitis B reactivation risk, and the older patient with possible malignancy-associated membranous; plus short-case discussion of oedema examination.

Open

Polycystic Kidney Disease (ADPKD) — Viva Defence

Structured DCE viva: long-case defence of a 40-year-old woman with Mayo 1D ADPKD, eGFR 52 and a sister with a cerebral aneurysm — the tolvaptan decision, selective aneurysm screening and family implications, with probing first-person answers.

Open

Potassium Disorders — Viva Defence

Structured DCE viva for potassium disorders: long-case defence of severe hyperkalaemia in a CKD patient on RAAS inhibitors covering the four-pillar emergency management, the calcium-insulin-salbutamol-bicarbonate-dialysis sequence, hypoglycaemia surveillance, the cardiorenal trade-off and the role of binders, and a short-case discussion of the ECG patterns and the hypokalaemia workup including the magnesium-first principle and the Gitelman versus Bartter discriminator.

Open

Renal Cell Carcinoma AND Urothelial Malignancy — Viva Defence

DCE viva defence for Renal Cell Carcinoma AND Urothelial Malignancy.

Open

Renal Replacement Therapy (Haemodialysis, Peritoneal Dialysis) — Viva Defence

Structured DCE viva: long-case defence of a 67-year-old woman with cardiac disease and frailty approaching end-stage kidney disease — modality reasoning, access timing, the cardiovascular burden and the goals-of-care defence, with probing first-person answers.

Open

Renal Tubular Acidoses AND Inherited Tubular Disorders — Viva Defence

DCE viva defence for Renal Tubular Acidoses AND Inherited Tubular Disorders.

Open

Sodium Disorders — Viva Defence

Structured DCE viva for sodium disorders: long-case defence covering the competing risks of cerebral oedema and osmotic demyelination in severe hyponatraemia, the 3% saline bolus regimen, the correction ceiling, SIADH and its mimics, and the hypernatraemia free water deficit; plus short-case discussion of volume status assessment and signs of hyponatraemia aetiology.

Open

Tubulointerstitial Disease — Viva Defence

Structured DCE viva for acute interstitial nephritis: long-case defence of biopsy-proven PPI-induced AIN in a polypharmacy patient — deprescribing, the steroid decision with observational evidence, and recovery counselling.

Open

Urinary Tract Infection AND Complicated UTI Pyelonephritis — Viva Defence

DCE viva defence for Urinary Tract Infection AND Complicated UTI Pyelonephritis.

Open

Domain

haematological

15

Acute Leukaemia — Viva Defence

Structured DCE viva for acute leukaemia: long-case defence of newly diagnosed acute myeloid leukaemia in a fit older adult (intensive versus lower-intensity induction, ELN 2022 risk stratification, midostaurin for FLT3, transplant decision, neutropenic sepsis) plus a short-case haematology examination discussion covering pallor, bruising, gum hypertrophy, organomegaly and the systematic presentation routine.

Open

Anaemia — Systematic Workup: Viva Defence

Structured DCE viva for physician-level anaemia investigation: long-case defence of iron deficiency anaemia in a complex patient with possible GI malignancy, and short-case discussion of the MCV classification, iron-studies interpretation, reticulocyte count, and haemolytic anaemia classification.

Open

Bleeding Disorders AND Thrombocytopenia — Viva Defence

DCE viva defence for Bleeding Disorders AND Thrombocytopenia.

Open

Chronic Leukaemia and Myeloid Neoplasms — Viva Defence

Structured DCE viva for chronic leukaemia: a long-case defence of symptomatic chronic lymphocytic leukaemia with TP53 disruption in a 62-year-old fit man (the iwCLL active-disease criteria, the fitness-and-biology treatment ladder, the decision to use a novel agent over chemoimmunotherapy, tumour lysis syndrome precautions on venetoclax, and the complications of Richter transformation and autoimmune cytopenia), plus a short-case discussion covering the examination of lymphadenopathy and splenomegaly and the differential of massive splenomegaly.

Open

Coagulation Disorders: Viva Defence

Structured DCE viva for physician-level coagulation disorders: long-case defence of antiphospholipid syndrome with acute thrombosis in a patient with SLE, and short-case discussion of the abnormal coagulation screen, mixing study interpretation, and the inherited bleeding disorders.

Open

Haematological Investigation Blood Film Marrow Coagulation Tests — Viva Defence

DCE viva defence for Haematological Investigation Blood Film Marrow Coagulation Tests.

Open

Haematopoietic Stem Cell Transplantation — Viva Defence

Branching oral examination for stem cell transplantation — a transplant survivor with chronic graft-versus-host disease and late effects, modelling the DCE long-case viva defence and short-case skin examination.

Open

Haemolytic Anaemia — Viva Defence

DCE viva defence for Haemolytic Anaemia.

Open

Iron Deficiency — Viva Defence

Structured DCE viva for iron deficiency: long-case defence of a postmenopausal woman with iron-deficiency anaemia — malignancy workup, iron replacement strategy, and the ferritin-in-inflammation and treatment-failure probes.

Open

Lymphoma — Viva Defence

Structured DCE viva for lymphoma: long-case defence of newly diagnosed bulky stage IIB classical Hodgkin lymphoma in a young man with asthma (PET-adapted ABVD versus A+AVD, fertility, bleomycin pulmonary toxicity, IPS, survivorship), plus a short-case lymphadenopathy examination discussion covering cervical, axillary, inguinal nodes and spleen, the systematic presentation routine, and the discrimination between Hodgkin, NHL, TB, and metastatic carcinoma.

Open

Multiple Myeloma — Viva Defence

Structured DCE viva for multiple myeloma: long-case defence of newly diagnosed symptomatic myeloma in a fit 66-year-old presenting with cast nephropathy and hypercalcaemia (transplant-eligible VRd induction, the bortezomib-first principle in renal failure, lenalidomide maintenance, cord-compression emergencies) plus a short-case skeletal and general examination discussion covering vertebral collapse, pallor, recurrent infection and the systematic presentation routine.

Open

Myelodysplastic Syndromes — Viva Defence

DCE viva defence for Myelodysplastic Syndromes.

Open

Myeloproliferative Neoplasms — Viva Defence

DCE viva defence for Myeloproliferative Neoplasms.

Open

Thrombophilia and VTE — Viva Defence

Structured DCE viva for thrombophilia and VTE: long-case defence of recurrent VTE with triple-positive antiphospholipid syndrome and cancer-associated thrombosis (warfarin vs DOAC, TRAPS trial, Caravaggio, Hokusai-CANVAS, indefinite duration, pregnancy planning) plus a short-case haematology examination discussion covering leg swelling, livedo reticularis, post-thrombotic syndrome, and the systematic presentation routine.

Open

Transfusion Medicine — Viva Defence

Structured DCE viva for transfusion medicine: long-case defence of a transfusion-dependent myelodysplasia patient plus short-case anaemia discussion, covering thresholds, reactions, chelation and consent.

Open

Domain

hepatic

6

Acute Liver Failure — Viva Defence

Structured DCE viva for acute liver failure: long-case defence of Wilson disease ALF in a young woman (urgent transplant referral, chelation, cerebral oedema prophylaxis, no routine INR correction, genetic counselling) plus a short-case discussion covering encephalopathy grading, the abdominal examination distinguishing ALF from chronic liver disease, and the systematic presentation routine.

Open

Autoimmune Liver Disease — Viva Defence

Structured DCE viva for autoimmune liver disease: long-case defence of an AIH-PBC overlap syndrome in a 54-year-old woman (UDCA plus prednisolone and azathioprine, TPMT check, bone and pruritus management, surveillance, transplant assessment) plus a short-case discussion covering the abdominal examination of chronic cholestasis (xanthelasma, xanthomata, hepatosplenomegaly), the three-disease differential, and the simplified score and Paris criteria.

Open

Chronic Liver Disease and Cirrhosis — Viva Defence

Structured DCE viva for cirrhosis: long-case defence and short-case discussion covering decompensation prevention, variceal prophylaxis, SBP and albumin, hepatorenal syndrome, hepatic encephalopathy, and abdominal examination findings.

Open

Hepatocellular Carcinoma — Viva Defence

Structured DCE viva for hepatocellular carcinoma: long-case defence of a BCLC A HCC in a 62-year-old man with HCV cirrhosis (post-SVR) found on surveillance (LI-RADS 5, curative treatment decision between resection, ablation and transplant, portal pressure assessment, management of underlying liver disease) plus a short-case discussion covering the abdominal examination of chronic liver disease with a hepatocellular carcinoma, the BCLC staging system, and the LI-RADS diagnostic pathway.

Open

Portal Hypertension — Viva Defence

Structured DCE viva for portal hypertension: long-case defence covering acute variceal bleeding management, hepatorenal syndrome, refractory ascites, and hepatic encephalopathy, plus short-case abdominal examination discussion.

Open

Viral Hepatitis — Viva Defence

Structured DCE viva for viral hepatitis: long-case defence and short-case discussion covering HBV serology, phases of chronic infection, antiviral selection, HCV DAA therapy, HDV superinfection, perinatal transmission prevention, and abdominal examination in chronic liver disease.

Open

Domain

gastrointestinal

13

Acute Pancreatitis — Viva Defence

Structured DCE viva for acute pancreatitis: long-case defence of a 58-year-old man with severe alcohol-related necrotising pancreatitis complicated by infected walled-off necrosis, organ failure, new-onset diabetes, and malnutrition, covering the Revised Atlanta Classification severity, goal-directed Ringer lactate fluids after WATERFALL, early enteral nutrition, the step-up approach for infected necrosis after PANTER, and same-admission considerations. Plus branching scenarios into autoimmune pancreatitis (IgG4-related, steroid-responsive), hypertriglyceridaemic pancreatitis, and the abdominal examination short case.

Open

Chronic Pancreatitis — Viva Defence

Structured DCE viva for chronic pancreatitis: long-case defence of a 49-year-old man with alcohol-related chronic pancreatitis, chronic pain on opioids, severe exocrine insufficiency with steatorrhoea, brittle type 3c diabetes, and malnutrition, covering the TIGAR-O aetiology, the analgesic ladder, pancreatic enzyme replacement with a PPI, type 3c diabetes management, the endoscopic-versus-surgical decision after Cahen, and pancreatic cancer surveillance. Plus branching scenarios into autoimmune pancreatitis (IgG4-related, steroid-responsive), tropical calcific pancreatitis, and splenic vein thrombosis.

Open

Colorectal Cancer — Viva Defence

DCE viva defence for Colorectal Cancer.

Open

Functional GI Disorders — Viva Defence

DCE viva defence for Functional GI Disorders.

Open

Gallstone Disease AND Biliary Pathology — Viva Defence

DCE viva defence for Gallstone Disease AND Biliary Pathology.

Open

Gastrointestinal Bleeding — Viva Defence

Structured DCE viva for acute gastrointestinal bleeding: long-case defence covering resuscitation, risk stratification, restrictive transfusion, variceal versus non-variceal pathways, anticoagulation, and short-case abdominal examination and signs of chronic liver disease.

Open

GI Investigation Endoscopy Capsule Liver Biopsy Elastography — Viva Defence

DCE viva defence for GI Investigation Endoscopy Capsule Liver Biopsy Elastography.

Open

Inflammatory Bowel Disease — Viva Defence

Structured DCE viva for IBD: long-case defence and short-case discussion covering acute severe UC rescue therapy, biologic selection, perianal Crohn's management, extraintestinal manifestation classification, and abdominal and skin examination findings.

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Liver Transplantation — Viva Defence

DCE viva defence for Liver Transplantation.

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Malabsorption and Small Bowel Disease — Viva Defence

Structured DCE viva for malabsorption and small bowel disease: long-case defence of a 42-year-old woman with coeliac disease presenting with iron deficiency anaemia, weight loss, and dermatitis herpetiformis (Marsh 3c), covering the three-level pathophysiology, the immunopathogenesis (HLA-DQ2/DQ8, tTG deamidation), the gluten-free diet, complications (osteoporosis, hyposplenism, EATL), and refractory disease. Plus branching scenarios into tropical sprue, Whipple disease, short bowel syndrome with teduglutide, and bile salt malabsorption after Crohn resection.

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Nutrition IN Liver AND GI Disease — Viva Defence

DCE viva defence for Nutrition IN Liver AND GI Disease.

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Obstructive Jaundice — Viva Defence

Structured DCE viva for obstructive jaundice: long-case defence of a 68-year-old man with painless progressive jaundice, a pancreatic head mass, Courvoisier sign, and an elevated CA 19-9, covering the differential diagnosis, the staged imaging strategy (ultrasound, MRCP, CT, EUS-FNA), the staging for resectability, the integrated management plan (Whipple, adjuvant chemotherapy), the van der Gaag evidence on preoperative biliary drainage, and palliative care. Plus branching scenarios into acute ascending cholangitis (Tokyo Guidelines 2018), choledocholithiasis (ASGE risk stratification), and primary sclerosing cholangitis.

Open

Oesophageal Disorders — Viva Defence

Structured DCE viva for oesophageal disorders: long-case defence of a 70-year-old with Barrett's oesophagus and confirmed low-grade dysplasia against a background of cardiac comorbidity — the ablate-versus-survey decision.

Open

Domain

endocrine

14

Adrenal Disorders — Viva Defence

Structured DCE viva for adrenal disorders: long-case defence covering Cushing syndrome diagnostic strategy and management, primary aldosteronism workup, and phaeochromocytoma preoperative preparation, plus short-case face-and-hands examination discussion.

Open

Adrenal Incidentaloma AND Workup — Viva Defence

DCE viva defence for Adrenal Incidentaloma AND Workup.

Open

Calcium and Bone Disorders — Viva Defence

Structured DCE viva for calcium and bone disorders: long-case defence of primary hyperparathyroidism with osteoporosis and CKD (PTH-based differential, parathyroidectomy criteria, cinacalcet, osteoporosis treatment with renal constraints, hungry bone syndrome), plus a short-case DEXA interpretation and osteoporosis discussion covering T-score, FRAX, secondary causes, bisphosphonate selection, and the drug-holiday decision.

Open

Diabetes Mellitus — Viva Defence

Structured DCE viva for diabetes mellitus: long-case defence and short-case discussion covering the modern pharmacological hierarchy, organ-protective agents, glycaemic target individualisation, diabetic foot examination, and cardiovascular risk reduction.

Open

Disorders OF Sodium AND Water Homeostasis — Viva Defence

DCE viva defence for Disorders OF Sodium AND Water Homeostasis.

Open

DKA and HHS — Viva Defence

Structured DCE viva for physician-level hyperglycaemic emergency management: long-case defence of a complex patient with severe DKA precipitated by insulin omission and pneumonia, and short-case discussion of the diagnostic criteria, the JBDS protocol, euglycaemic DKA, cerebral oedema, and the differences between DKA and HHS.

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Hypoglycaemia — Viva Defence

DCE viva defence for Hypoglycaemia.

Open

Metabolic Bone Disease AND Vitamin D Disorders — Viva Defence

DCE viva defence for Metabolic Bone Disease AND Vitamin D Disorders.

Open

Multiple Endocrine Neoplasia — Viva Defence

DCE viva defence for Multiple Endocrine Neoplasia.

Open

Pituitary Disease — Viva Defence

Structured DCE viva for pituitary disease: long-case defence covering acromegaly with complications, biochemical diagnosis, surgical and medical management, and short-case examination of the acromegalic face and visual fields.

Open

Reproductive Endocrinology — Viva Defence

DCE viva defence for Reproductive Endocrinology.

Open

Thyroid Disorders — Viva Defence

Structured DCE viva for thyroid disorders: long-case defence of Graves disease with atrial fibrillation and orbitopathy (cause discrimination, antithyroid drugs vs radioiodine vs surgery, Graves orbitopathy management, shared decision-making), plus a short-case thyroid examination discussion covering goitre, eye signs, and the systematic presentation routine.

Open

Thyroid Nodules AND Thyroid Cancer — Viva Defence

DCE viva defence for Thyroid Nodules AND Thyroid Cancer.

Open

Transgender Medicine AND Hormone Therapy — Viva Defence

DCE viva defence for Transgender Medicine AND Hormone Therapy.

Open

Domain

cardiovascular

20

Adult Congenital Heart Disease — Viva Defence

DCE viva defence for Adult Congenital Heart Disease.

Open

Anticoagulation and Antiplatelet Therapy — Viva Defence

Structured DCE viva: defending anticoagulation in an elderly patient with atrial fibrillation, recurrent falls and chronic kidney disease — risk quantification, agent choice, and the probing questions examiners actually ask.

Open

Aortic Disease — Viva Defence

DCE viva defence for Aortic Disease.

Open

Arrhythmias and Conduction Disease — Viva Defence

Structured DCE viva for arrhythmias: long-case defence of an elderly patient with persistent AF, CKD and fall risk — anticoagulation, rate/rhythm strategy, and monitoring — with probing questions and model answers.

Open

Atrial Fibrillation — Viva Defence

Structured DCE viva for atrial fibrillation: long-case defence and short-case discussion covering rate versus rhythm reasoning, CHA₂DS₂-VASc decision-making, DOAC selection, ablation, and cardiovascular examination of an irregular pulse.

Open

Cardiac Investigations — Viva Defence

Structured DCE viva for cardiac investigations: long-case defence covering investigation pathway in a complex cardiology patient and short-case discussion covering echocardiogram report interpretation and cardiac MRI LGE pattern analysis.

Open

Cardiac Tumours AND Systemic Manifestations OF Cardiac Disease — Viva Defence

DCE viva defence for Cardiac Tumours AND Systemic Manifestations OF Cardiac Disease.

Open

Cardiomyopathies — Viva Defence

Structured DCE viva for the cardiomyopathies: long-case defence covering a young man with dilated cardiomyopathy and a probable LMNA mutation — the ICD decision informed by DANISH, GDMT optimisation, and transplant pathway — and short-case discussion covering the HCM murmur with dynamic manoeuvres and SCD risk stratification.

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Cardiovascular Prevention and Rehabilitation — Viva Defence

Structured DCE viva for cardiovascular prevention: long-case defence of a 62-year-old post-NSTEMI patient with statin-associated muscle symptoms — the secondary prevention bundle defended, the SAMS protocol, and rehabilitation adherence.

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Coronary Artery Disease — Viva Defence

Structured DCE viva for coronary artery disease: long-case defence covering NSTEMI risk stratification, antiplatelet selection, CABG vs PCI decision-making, and post-MI complications; plus short-case cardiovascular examination discussion.

Open

ECG Interpretation — Viva Defence

Structured DCE viva for physician-level ECG interpretation: long-case defence of a complex ECG and short-case discussion of acute ischaemia, conduction disease, and arrhythmia patterns.

Open

Heart Failure — Viva Defence

Structured DCE viva for heart failure: long-case defence and short-case discussion covering GDMT reasoning, device therapy, cardiorenal syndrome, and examination findings.

Open

Hypertension — Viva Defence

Structured DCE viva for hypertension: long-case defence and short-case discussion covering resistant hypertension reasoning, secondary cause workup, target organ damage, and cardiovascular examination findings.

Open

Infective Endocarditis — Viva Defence

Structured DCE viva for infective endocarditis: long-case defence covering Duke criteria, prosthetic valve IE, surgical decision-making, embolic complications, and antibiotic therapy; and short-case discussion covering peripheral stigmata and murmur interpretation.

Open

Pericardial Disease — Viva Defence

Structured DCE viva for pericardial disease: long-case defence covering constrictive pericarditis in a complex patient and short-case discussion covering JVP interpretation, pericardial knock, and the constriction vs restriction discriminator.

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Pulmonary Hypertension — Viva Defence

Structured DCE viva for pulmonary hypertension: long-case defence covering a young woman with idiopathic pulmonary arterial hypertension — the mandatory right heart catheterisation, the ESC/ERS 2022 three-strata risk stratification, and the evidence-based combination therapy informed by AMBITION, GRIPHON, and STELLAR — and a short-case discussion of chronic thromboembolic pulmonary hypertension, V/Q versus CTPA, and operability.

Open

Rheumatic Fever AND Rheumatic Heart Disease — Viva Defence

DCE viva defence for Rheumatic Fever AND Rheumatic Heart Disease.

Open

Sudden Cardiac Death AND ICD CRT Therapy — Viva Defence

DCE viva defence for Sudden Cardiac Death AND ICD CRT Therapy.

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Syncope — Viva Defence

Structured DCE viva for syncope: long-case defence covering a middle-aged man with recurrent unexplained syncope and bifascicular block — the ESC 2018 directed investigation pathway, the role of the implantable loop recorder, and the ISSUE-3 evidence for pacing in asystolic neurally mediated syncope — and a short-case discussion of carotid sinus hypersensitivity, the three response types, and the evidence for pacing.

Open

Valvular Heart Disease — Viva Defence

Structured DCE viva for valvular heart disease: long-case defence (severe AS with comorbidity — SAVR vs TAVI) and short-case discussion (cardiovascular examination and murmurs).

Open

Domain

pharmacological

15

Adverse Drug Reactions — Viva Defence

Structured DCE viva for adverse drug reactions: a long-case defence of a complex patient with DRESS to allopurinol superimposed on multimorbidity and renal impairment, and a DCE short-case discussion of a bedside skin examination of a patient with a drug eruption, covering the ABCDEF classification, causality assessment, the severe Type B reactions, and ADR reporting.

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Australian Envenomation — Viva Defence

Structured DCE viva for Australian envenomation: long-case defence of a brown snake bite with VICC and thrombotic microangiopathy in a 42-year-old farmer (pressure immobilisation first aid, monovalent antivenom selection, the VICC-versus-DIC distinction, FFP role, TMA and AKI management) plus a short-case discussion covering the neurological examination of a descending flaccid paralysis from snake bite, the five clinical syndromes, and the marine envenomation first-aid rules.

Open

Beta Blocker AND Calcium Channel Blocker Toxicity — Viva Defence

DCE viva defence for Beta Blocker AND Calcium Channel Blocker Toxicity.

Open

Cardiac Glycoside — Viva Defence

DCE viva defence for Cardiac Glycoside.

Open

Iron Toxicity — Viva Defence

DCE viva defence for Iron Toxicity.

Open

Lithium Toxicity — Viva Defence

Structured DCE viva for lithium toxicity: long-case defence covering a complex elderly patient with chronic lithium toxicity precipitated by drug interactions, with acute kidney injury and chronic end-organ effects, plus a DCE short-case focused neurological examination of the toxic patient and discussion of the EXTRIP criteria, the pharmacology of lithium, and the chronic complications.

Open

Opioid Benzodiazepine AND Alcohol Withdrawal — Viva Defence

DCE viva defence for Opioid Benzodiazepine AND Alcohol Withdrawal.

Open

Paracetamol Toxicity — Viva Defence

Structured DCE viva for paracetamol toxicity: long-case defence of a single acute paracetamol overdose with established hepatotoxicity in a high-risk patient (N-acetylcysteine regimen, adverse reactions, King's College Criteria and lactate adjunct, transplant decision, alcohol withdrawal) plus a short-case discussion covering encephalopathy grading, abdominal examination in hepatotoxicity and the systematic presentation routine.

Open

Pharmacokinetics in Organ Failure — Viva Defence

Structured DCE viva for physician-level clinical pharmacology: long-case defence of a complex elderly patient with CKD, AF, diabetes and polypharmacy needing a medication review, and short-case discussion of renal/hepatic dose adjustment, therapeutic drug monitoring, and the Beers/STOPP-START framework.

Open

Poisoning — Viva Defence

Structured DCE viva for physician-level toxicology: long-case defence of a complex mixed overdose (tricyclic antidepressant plus paracetamol plus alcohol) covering toxidrome identification, the decontamination and airway decision, the antidote table, and the integration of cardiotoxicity management with hepatotoxicity prevention; and short-case discussion of bedside toxidrome recognition and antidote selection.

Open

Salicylate Toxicity — Viva Defence

DCE viva defence for Salicylate Toxicity.

Open

Serotonin Syndrome and NMS — Viva Defence

Structured DCE viva for serotonin syndrome and neuroleptic malignant syndrome: long-case defence covering recognition, the Hunter criteria, the SS-versus-NMS distinction, cyproheptadine and dantrolene pharmacology, and post-recovery psychiatric planning, plus short-case discussion of bedside neurological examination of the febrile rigid patient.

Open

Therapeutic Drug Monitoring — Viva Defence

DCE viva defence for Therapeutic Drug Monitoring.

Open

Toxic Alcohols — Viva Defence

DCE viva defence for Toxic Alcohols.

Open

Tricyclic Antidepressant AND Sodium Channel Blocker Toxicity — Viva Defence

DCE viva defence for Tricyclic Antidepressant AND Sodium Channel Blocker Toxicity.

Open

Domain

rheumatological

18

Allergic Rhinitis AND Asthma — Viva Defence

DCE viva defence for Allergic Rhinitis AND Asthma.

Open

Antiphospholipid Syndrome — Viva Defence

DCE viva defence for Antiphospholipid Syndrome.

Open

Complement Deficiencies AND Recurrent Infections — Viva Defence

DCE viva defence for Complement Deficiencies AND Recurrent Infections.

Open

Crystal Arthropathies — Viva Defence

DCE viva defence for Crystal Arthropathies.

Open

Drug Induced Rheumatological Disease AND Biologics Safety — Viva Defence

DCE viva defence for Drug Induced Rheumatological Disease AND Biologics Safety.

Open

Eosinophilic Disorders — Viva Defence

DCE viva defence for Eosinophilic Disorders.

Open

Fibromyalgia and Chronic Widespread Pain — Viva Defence

Structured DCE viva for the fibromyalgia patient with comorbid inflammatory disease: long-case defence of a 48-year-old woman with rheumatoid arthritis and secondary fibromyalgia, with discussion of the central sensitisation mechanism, the 2016 ACR criteria, the discordance between the normal inflammatory markers and the elevated DAS28, the non-pharmacological-first management, the opioid deprescribing, and the communication of a shared plan, plus a short-case discussion of the widespread pain assessment and the distinction from inflammatory arthritis.

Open

IgG4-Related Disease — Viva Defence

Structured DCE viva for IgG4-related disease: long-case defence of a 62-year-old retired engineer with painless jaundice, bilateral submandibular gland enlargement and renal impairment from multi-organ IgG4-RD (type 1 autoimmune pancreatitis, IgG4-related sclerosing cholangitis, Mikulicz syndrome, IgG4-related kidney disease and early retroperitoneal fibrosis), with discussion of the clinicopathological diagnosis, the histopathology triad, the correct use and limits of serum IgG4, the exclusion of pancreatobiliary malignancy and Sjogren syndrome, the 2019 ACR and EULAR classification criteria, the treatment ladder of glucocorticoids and rituximab, and the decompress-first principle for ureteric obstruction, plus a short-case discussion of the salivary and lacrimal gland examination for Mikulicz syndrome.

Open

Immunological Investigation Immunoglobulins Complement Flow Cytometry — Viva Defence

DCE viva defence for Immunological Investigation Immunoglobulins Complement Flow Cytometry.

Open

Osteoarthritis — Viva Defence

DCE viva defence for Osteoarthritis.

Open

Rheumatoid Arthritis — Viva Defence

Structured DCE viva for rheumatoid arthritis: long-case defence covering treat-to-target management of newly diagnosed seropositive erosive RA with methotrexate, escalation principles, pre-biologic screening, and comorbidity management, plus short-case discussion of the rheumatoid hand examination.

Open

Rheumatological Investigation Autoantibodies Imaging Synovial Fluid — Viva Defence

DCE viva defence for Rheumatological Investigation Autoantibodies Imaging Synovial Fluid.

Open

SJ Gren S Syndrome AND Inflammatory Myopathies — Viva Defence

DCE viva defence for SJ Gren S Syndrome AND Inflammatory Myopathies.

Open

Spondyloarthropathies — Viva Defence

Structured DCE viva for the spondyloarthropathies: long-case defence covering the treatment ladder for newly diagnosed ankylosing spondylitis (NSAIDs, physiotherapy, biologic escalation with TNFi or IL-17i), pre-biologic screening, uveitis management, and the psoriatic arthritis treatment framework (CASPAR, DAPSA, DMARDs, biologics), plus short-case discussion of the spine examination for reduced spinal mobility.

Open

Systemic Autoinflammatory Syndromes — Viva Defence

Structured DCE viva for the systemic autoinflammatory syndromes: long-case defence covering undiagnosed familial Mediterranean fever complicated by AA amyloidosis, with colchicine initiation, genetic confirmation, family testing and the cytokine-directed rescue strategy, plus short-case discussion of the chronic urticarial rash and the autoinflammatory-versus-autoimmune distinction.

Open

Systemic Lupus Erythematosus — Viva Defence

Structured DCE viva for systemic lupus erythematosus: long-case defence covering induction of class IV proliferative lupus nephritis with mycophenolate versus cyclophosphamide, pregnancy-compatible drug selection, hydroxychloroquine rationale, antiphospholipid syndrome management, and steroid-sparing strategy, plus short-case discussion of the hand and face examination.

Open

Systemic Sclerosis — Viva Defence

Structured DCE viva for systemic sclerosis: long-case defence covering a woman with limited cutaneous SSc presenting with pulmonary arterial hypertension and interstitial lung disease, including the ACE-inhibitor-first principle in renal crisis contingency planning, the antibody-subtype framework, organ-based surveillance, and PAH combination therapy, plus short-case discussion of hand examination for sclerodactyly, digital ulcers and Raynaud phenomenon.

Open

The Systemic Vasculitides — Viva Defence

Structured DCE viva for the systemic vasculitides: long-case defence covering newly diagnosed granulomatosis with polyangiitis presenting as a pulmonary-renal syndrome, with rituximab-based induction, exclusion of mimics, plasma exchange decision-making, and maintenance strategy, plus short-case discussion of the palpable purpura and mononeuritis multiplex examination.

Open

Domain

infectious

16

Antimicrobial Stewardship and Resistance — Viva Defence

Structured DCE viva for antimicrobial stewardship and resistance: long-case defence of a 72-year-old woman who develops severe Clostridioides difficile infection (NAP1/027 strain) during a course of ceftriaxone for healthcare-associated pneumonia, with discussion of severity stratification, the fidaxomicin-versus-vancomycin decision, bezlotoxumab and faecal microbiota transplantation, and the stewardship lessons of the inciting antibiotic; plus a short-case discussion of bedside assessment of a patient with a resistant organism and the infection-control response.

Open

Bloodstream Infections and Infective Endocarditis — Viva Defence

Structured DCE viva for bloodstream infection and endocarditis: long-case defence of prosthetic-valve endocarditis with an embolic stroke — treatment duration, the surgery decision, and the anticoagulation dilemma.

Open

Bone AND Joint Infections — Viva Defence

DCE viva defence for Bone AND Joint Infections.

Open

CNS Infections — Viva Defence

Structured DCE viva for CNS infections: long-case defence of post-pneumococcal meningitis follow-up plus probing questions on sequencing, steroids, and special populations.

Open

Fungal Infections — Viva Defence

Structured DCE viva for invasive fungal infection: long-case defence of a 60-year-old man with AML on induction who develops invasive pulmonary aspergillosis, with discussion of the diagnostic strategy (chest CT, galactomannan), voriconazole first-line therapy and therapeutic drug monitoring, isavuconazole as an alternative, the role of immune recovery, and secondary prophylaxis through subsequent chemotherapy and transplant — plus a short-case discussion of bedside assessment of the diabetic patient with suspected rhinocerebral mucormycosis.

Open

Healthcare-Associated Infections — Viva Defence

Structured DCE viva for healthcare-associated infections: long-case defence of a 68-year-old man post-emergency laparotomy who develops Pseudomonas aeruginosa catheter-related bloodstream infection and concurrent ventilator-associated pneumonia on ICU day 7, with discussion of the diagnostic strategy (paired blood cultures and differential time to positivity, VAP prevention bundle), the central line bundle, the stewardship review, and the prevention of recurrence; plus a short-case discussion of bedside assessment of a patient with a device in situ and the infection control response.

Open

HIV and AIDS — Viva Defence

Structured DCE viva for HIV: long-case defence covering ART initiation in a complex patient with TB and hepatitis B co-infection, drug-interaction management, IRIS, opportunistic infection prophylaxis, and the U equals U framework, plus short-case discussion of generalised lymphadenopathy and oral findings in advanced HIV.

Open

Infections in the Immunocompromised Host — Viva Defence

Structured DCE viva for the immunocompromised host: long-case defence of a 62-year-old man with AML on induction who develops febrile neutropenia complicated by invasive pulmonary aspergillosis, with discussion of the door-to-antibiotic protocol, empiric therapy, escalation, and the role of G-CSF, plus a short-case discussion of bedside assessment of the febrile neutropenic patient and the opportunistic infection timeline in transplantation.

Open

Sepsis and Septic Shock — Viva Defence

Structured DCE viva for sepsis and septic shock: long-case defence covering the Hour-1 Bundle in septic shock with multiple comorbidities, vasopressor escalation, and post-sepsis survivorship, plus short-case discussion of bedside assessment of the critically ill septic patient.

Open

Sexually Transmitted Infections — Viva Defence

DCE viva defence for Sexually Transmitted Infections.

Open

Tropical and Travel-Related Infections — Viva Defence

Structured DCE viva for tropical infections: long-case defence of a returning traveller with severe falciparum malaria complicated by cerebral malaria, AKI, and ARDS, with discussion of post-artesunate delayed haemolysis and post-malaria sequelae, plus a short-case discussion of bedside assessment of the febrile returning traveller.

Open

Tuberculosis — Viva Defence

Structured DCE viva for tuberculosis: long-case defence covering smear-positive cavitary pulmonary TB with comorbidities (diabetes, CKD, hepatitis B, atrial fibrillation on warfarin), the standard RIPE regimen, rifampicin drug interactions, public health responsibilities; and short-case discussion covering cervical lymphadenopathy (scrofula) and apical consolidation.

Open

Tuberculosis — Viva Defence

Structured DCE viva for tuberculosis: long-case defence of a migrant patient with smear-positive pulmonary TB and a new HIV diagnosis — regimen construction, ART timing, IRIS, contact tracing and adherence architecture.

Open

Vaccine-Preventable Diseases — Viva Defence

Structured DCE viva for adult immunisation decisions in the immunocompromised patient: long-case defence of a 58-year-old veterinary surgeon with rheumatoid arthritis and resolved hepatitis B about to start rituximab, with a prior splenectomy and incomplete vaccination history, with discussion of the pre-immunosuppression window, the hepatitis B reactivation risk, the asplenic vaccination bundle, the live vaccine considerations, the travel advice, and the re-vaccination plan, plus a short-case discussion of vaccine adverse events and contraindications.

Open

Viral Hepatitis — Viva Defence

Structured DCE viva for infectious-diseases viral hepatitis: long-case defence of a 45-year-old with chronic hepatitis B and fluctuating ALT — phase assignment, treat-versus-watch, antiviral selection, HCC surveillance, family screening and stigma.

Open

Zoonotic and Vector-Borne Infections — Viva Defence

Structured DCE viva for the zoonotic infection patient: long-case defence of a 58-year-old abattoir worker with culture-negative prosthetic valve endocarditis (chronic Q fever), with discussion of the exposure history, the phase I and II serology, the doxycycline plus hydroxychloroquine regimen and its rationale, the Q-VAX vaccine, and the integration of the competing diagnoses, plus a short-case discussion of the systematic examination for fever with eschar.

Open

Domain

respiratory

16

Asthma and Severe Asthma — Viva Defence

Structured DCE viva for severe asthma: long-case defence covering phenotyping, biologic selection, oral-steroid-sparing strategy, comorbidity integration, and acute severe asthma escalation, plus short-case respiratory examination discussion.

Open

Bronchiectasis AND Suppurative Lung Disease — Viva Defence

DCE viva defence for Bronchiectasis AND Suppurative Lung Disease.

Open

COPD — Viva Defence

Structured DCE viva for COPD: long-case defence covering exacerbation management, NIV reasoning, eosinophil-guided ICS decisions, cor pulmonale, and comorbidity integration, plus short-case respiratory examination discussion.

Open

Diffuse Alveolar Haemorrhage — Viva Defence

Structured DCE viva for diffuse alveolar haemorrhage: long-case defence of granulomatosis with polyangiitis presenting with alveolar haemorrhage and dialysis-dependent renal disease — induction, plasma exchange reasoning, maintenance and relapse monitoring.

Open

Interstitial Lung Disease — Viva Defence

Structured DCE viva for interstitial lung disease: long-case defence and short-case discussion covering diagnostic reasoning, antifibrotic therapy, CTD-ILD management, acute exacerbation, and examination findings.

Open

Lung Cancer — Viva Defence

Structured DCE viva for lung cancer: long-case defence of a never-smoker with stage IV EGFR-mutant NSCLC — targeted-therapy sequencing, resistance management, and the conversations that evolve as options narrow.

Open

Lung Transplantation — Viva Defence

DCE viva defence for Lung Transplantation.

Open

Obstructive Sleep Apnoea — Viva Defence

Structured DCE viva for obstructive sleep apnoea: long-case defence covering severe OSA with excessive daytime sleepiness, resistant hypertension, atrial fibrillation, and a commercial driving licence — including diagnosis, the treatment ladder, CPAP adherence, the SAVE and Marin cardiovascular evidence, and the medico-legal duty regarding driving.

Open

Occupational AND Environmental Lung Disease — Viva Defence

DCE viva defence for Occupational AND Environmental Lung Disease.

Open

Pleural Disease — Viva Defence

Structured DCE viva for pleural disease: long-case defence covering malignant pleural mesothelioma with asbestos exposure (diagnosis, pleural control, chemotherapy, compensation), plus short-case respiratory examination discussion of pleural effusion versus consolidation.

Open

Pneumonia — Viva Defence

Structured DCE viva for pneumonia: long-case defence covering severe CAP with septic shock, empiric therapy, corticosteroid adjunct, parapneumonic effusion, and ICU severity scoring, plus short-case respiratory examination discussion of consolidation.

Open

Pulmonary Embolism — Viva Defence

Structured DCE viva for pulmonary embolism: long-case defence covering diagnostic algorithm reasoning, risk stratification (sPESI, biomarkers, echo), DOAC dosing in renal impairment, rescue thrombolysis decision-making, anticoagulation duration by provokability, and CTEPH surveillance, plus short-case discussion of right heart strain signs.

Open

Pulmonary Vascular Disease AND COR Pulmonale — Viva Defence

DCE viva defence for Pulmonary Vascular Disease AND COR Pulmonale.

Open

Respiratory Failure and Non-Invasive Ventilation — Viva Defence

Structured DCE viva for respiratory failure and NIV: long-case defence of severe COPD with a second acidotic exacerbation this year — acute NIV, ceilings of care, domiciliary oxygen/NIV selection and advance care planning.

Open

Respiratory Investigation — Viva Defence

Structured DCE viva for respiratory investigation: defending the investigation chain in progressive dyspnoea with crackles — HRCT, pulmonary function tests, and the BAL/biopsy decision in suspected interstitial lung disease.

Open

Solitary Pulmonary Nodule — Viva Defence

Structured DCE viva for the solitary pulmonary nodule: defence of an incidental 11 mm spiculated nodule in an ex-smoker with emphysema and cardiac comorbidity — surveillance versus biopsy, fitness for surgery, and the multidisciplinary decision.

Open

Domain

oncological

8

Breakthrough Cancer Pain AND Opioid Titration — Viva Defence

DCE viva defence for Breakthrough Cancer Pain AND Opioid Titration.

Open

Breast Cancer — Viva Defence

Structured DCE viva for breast cancer: long-case defence of a HER2-positive breast cancer in a 52-year-old woman managed with neoadjuvant TCHP (the receptor subtype framework, the dual HER2 blockade rationale, the KATHERINE response-adapted strategy, trastuzumab cardiotoxicity monitoring, and the HERA-derived 1-year duration) plus a short-case discussion covering the breast examination of a woman with a palpable lump, the receptor subtypes, and the treatment algorithm by subtype and stage.

Open

Cancer Cachexia AND Nutritional Support — Viva Defence

DCE viva defence for Cancer Cachexia AND Nutritional Support.

Open

Immune Checkpoint Inhibitor Toxicity — Viva Defence

Structured DCE viva for immune checkpoint inhibitor toxicity: long-case defence covering a patient on combination ipilimumab-nivolumab who develops multisystem irAEs (grade 3 colitis, hypophysitis with adrenal crisis, hepatitis, pneumonitis), with grading, steroid dosing, second-line infliximab and mycophenolate, the restart decision, and a short-case discussion of the general-examination routine and the troponin-for-chest-pain rule.

Open

Oncologic Emergencies — Viva Defence

Structured DCE viva for oncologic emergencies: long-case defence of a patient with lung cancer presenting with multiple simultaneous oncologic emergencies (superior vena cava obstruction, SIADH and hypercalcaemia), plus a short-case discussion covering the focused neurological examination of suspected malignant spinal cord compression and the systematic presentation routine.

Open

Pain Management IN Cancer AND Chronic Disease — Viva Defence

DCE viva defence for Pain Management IN Cancer AND Chronic Disease.

Open

Palliative Care — Viva Defence

Structured DCE viva for palliative care and symptom management: a long-case defence covering a complex patient with metastatic cancer and multiple uncontrolled symptoms, goals-of-care and advance care planning, plus a DCE short-case symptom-assessment discussion covering pain assessment, the WHO analgesic ladder, and the management of refractory breathlessness.

Open

Prostate Cancer — Viva Defence

DCE viva defence for Prostate Cancer.

Open

Domain

geriatric

12

Comprehensive Geriatric Assessment and Frailty — Viva Defence

Structured DCE viva for CGA and frailty: long-case defence covering a complex frail older woman with functional decline, falls, polypharmacy, malnutrition, and cognitive impairment, plus a DCE short-case functional assessment and discussion of the Katz ADL, the Lawton IADL, the Timed Up and Go, the Clinical Frailty Scale, and the Fried phenotype.

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Delirium — Viva Defence

Structured DCE viva for delirium: long-case defence covering a complex elderly patient with postoperative delirium superimposed on dementia, plus a DCE short-case cognitive assessment and discussion of the CAM, hypoactive delirium, and the differentiation from dementia and depression.

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Dementia — Viva Defence

Structured DCE viva for dementia: long-case defence covering a complex elderly patient with mixed Alzheimer and vascular dementia, polypharmacy, BPSD, driving and capacity, plus a DCE short-case cognitive assessment and discussion of the MoCA, the dementia subtypes, and the differentiation from delirium and depression.

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Elder Abuse and Safeguarding — Viva Defence

Structured DCE viva for elder abuse and safeguarding: long-case defence of an 82-year-old woman with moderate Alzheimer disease admitted with dehydration, malnutrition and a pressure injury whose daughter (her enduring power of attorney) is displaying controlling behaviour and may be financially and psychologically abusing her — covering the recognition of abuse types, the immediate safety plan, the capacity assessment, the safeguarding referral and tribunal pathway, mandatory reporting, and the ethical balance of autonomy versus protection; plus a short-case discussion of the structured assessment of suspected elder abuse at the bedside (the interview-alone principle, the EASI, red flags, documentation).

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End-of-Life Care and Advance Care Planning — Viva Defence

Structured DCE viva for end-of-life care and advance care planning: long-case defence of an 82-year-old man with end-stage heart failure and chronic kidney disease admitted with a decompensation, who triggers the Surprise Question and requires an advance care planning conversation, a documented goals-of-care plan, a ceiling of treatment and a prognosis discussion — covering the evidence for advance care planning (Detering, Wright, Brinkman-Stoppelenburg), the SPIKES protocol, the substituted judgement standard, the ethical equivalence of withholding and withdrawing treatment, and the dying patient care bundle; plus a short-case discussion of a structured goals-of-care conversation at the bedside.

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Falls and Syncope in Older Adults — Viva Defence

Structured DCE viva for falls and syncope: long-case defence covering a complex older patient with multifactorial falls, drug-induced orthostatic hypotension, diabetic neuropathy and polypharmacy, plus a DCE short-case gait and Timed Up and Go assessment with discussion of the multifactorial intervention bundle and the ESC 2018 syncope classification.

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Nutrition AND Hydration IN Older Adults — Viva Defence

DCE viva defence for Nutrition AND Hydration IN Older Adults.

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Orthogeriatrics AND Perioperative Medicine IN Older Adults — Viva Defence

DCE viva defence for Orthogeriatrics AND Perioperative Medicine IN Older Adults.

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Parkinson S Disease IN Older Adults — Viva Defence

DCE viva defence for Parkinson S Disease IN Older Adults.

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Polypharmacy and Deprescribing — Viva Defence

Structured DCE viva for polypharmacy and deprescribing: long-case defence covering a complex elderly patient with polypharmacy, frailty, falls and multiple inappropriate medications, plus a DCE short-case bedside medication review and discussion of the prescribing cascade, the Beers and STOPP/START criteria, and the deprescribing process.

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Pressure Injuries AND Wound Care — Viva Defence

DCE viva defence for Pressure Injuries AND Wound Care.

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Urinary Incontinence IN Older Adults — Viva Defence

DCE viva defence for Urinary Incontinence IN Older Adults.

Open

Domain

dermatological

8

Cutaneous Manifestations of Systemic Disease — Viva Defence

Structured DCE viva for cutaneous manifestations of systemic disease: long-case defence covering the paraneoplastic approach to adult-onset dermatomyositis with malignancy search, the recognition and management of calciphylaxis in a dialysis patient, the gluten-free diet and dapsone strategy in dermatitis herpetiformis, and short-case discussion of skin examination.

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Drug Eruptions AND Severe Cutaneous Adverse Reactions — Viva Defence

DCE viva defence for Drug Eruptions AND Severe Cutaneous Adverse Reactions.

Open

Erythema Nodosum AND Panniculitis — Viva Defence

DCE viva defence for Erythema Nodosum AND Panniculitis.

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Genodermatoses with Systemic Significance — Viva Defence

DCE viva defence for Genodermatoses with Systemic Significance.

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Malignant Skin Lesions — Viva Defence

DCE viva defence for Malignant Skin Lesions.

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Pyoderma Gangrenosum AND Neutrophilic Dermatoses — Viva Defence

DCE viva defence for Pyoderma Gangrenosum AND Neutrophilic Dermatoses.

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Skin Signs OF Internal Malignancy — Viva Defence

DCE viva defence for Skin Signs OF Internal Malignancy.

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Vasculitic Skin Lesions — Viva Defence

DCE viva defence for Vasculitic Skin Lesions.

Open

Domain

neurological

17

Epilepsy — Viva Defence

Structured DCE viva for epilepsy: long-case defence (drug-resistant focal epilepsy and surgery) and short-case discussion (women with epilepsy and status epilepticus decision-making).

Open

Guillain-Barre Syndrome — Viva Defence

Structured DCE viva for Guillain-Barre syndrome: long-case defence covering respiratory decision-making, disease-modifying therapy, the steroid trap, autonomic monitoring and prognosis, and short-case discussion of the areflexic-weakness neurological examination.

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Headache — Viva Defence

Structured DCE viva for headache: long-case defence covering chronic migraine with medication overuse and giant cell arteritis in a complex patient, and short-case discussion of cranial nerve and fundoscopic examination in a headache patient.

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Meningitis and Encephalitis — Viva Defence

Structured DCE viva for CNS infections: long-case defence covering empiric therapy in immunocompromised bacterial meningitis, HSV encephalitis diagnostic reasoning, and short-case discussion of neurological examination in suspected meningitis.

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Motor Neuron Disease — Viva Defence

Structured DCE viva for motor neuron disease: long-case defence (bulbar-onset ALS with respiratory failure and nutritional decline) and short-case discussion (combined UMN and LMN sign examination and the ALS-versus-cervical-myelopathy and ALS-versus-MMN discriminators).

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Movement Disorders — Viva Defence

Structured DCE viva for movement disorders: long-case defence covering advanced Parkinson's disease with motor complications and psychosis, plus a DCE short-case parkinsonian examination and discussion of atypical parkinsonism.

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Multiple Sclerosis — Viva Defence

Structured DCE viva for multiple sclerosis: long-case defence of a 29-year-old woman with highly active relapsing-remitting MS failing interferon, with residual disability, JC virus positivity, and pregnancy plans. Covers the McDonald 2017 criteria, DMT escalation (ocrelizumab, natalizumab, alemtuzumab), PML risk stratification, acute relapse management (steroids, plasma exchange), symptom management, and pregnancy planning (PRIMS data, washout periods). Plus branching scenarios into NMOSD, primary progressive MS, and natalizumab-associated PML.

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Myasthenia Gravis — Viva Defence

Structured DCE viva for myasthenia gravis: long-case defence (AChR-positive generalized MG with a thymoma) and short-case discussion (fatigable weakness examination and the MG-versus-LEMS discriminator).

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Neurocutaneous Syndromes — Viva Defence

DCE viva defence for Neurocutaneous Syndromes.

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Neurological Investigation LP EMG NCS EEG Neuroimaging — Viva Defence

DCE viva defence for Neurological Investigation LP EMG NCS EEG Neuroimaging.

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Peripheral Neuropathy — Viva Defence

Structured DCE viva for peripheral neuropathy: long-case defence of a 62-year-old man with diabetic distal symmetric polyneuropathy, a painless foot ulcer, and a superimposed subacute vasculitic mononeuritis multiplex with an IgM paraprotein. Covers the four classification axes, the NCS axonal-versus-demyelinating discriminator, the investigation pathway including sural nerve biopsy, the role of immunosuppression, neuropathic pain management, and foot care. Plus branching scenarios into GBS, CIDP, CMT, and critical illness polyneuropathy.

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Raised Intracranial Pressure AND Brain Tumours — Viva Defence

DCE viva defence for Raised Intracranial Pressure AND Brain Tumours.

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Spinal Cord Disease — Viva Defence

Structured DCE viva for spinal cord disease: long-case defence covering the emergency management of metastatic spinal cord compression, the Patchell decision, corticosteroid dosing, and prognosis, and short-case discussion of the sensory-level neurological examination and cord syndrome identification.

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Stroke — Viva Defence

Structured DCE viva for stroke: long-case defence and short-case discussion covering reperfusion decision-making, vascular territory localisation, secondary prevention, and neurological examination findings.

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Subarachnoid Haemorrhage AND Intracranial Haemorrhage — Viva Defence

DCE viva defence for Subarachnoid Haemorrhage AND Intracranial Haemorrhage.

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TIA and Carotid Disease — Viva Defence

DCE viva for high-risk TIA and symptomatic carotid stenosis: definition, urgent pathway, DAPT, and revascularisation.

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Vestibular Disorders — Viva Defence

DCE viva defence for Vestibular Disorders.

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