How to practise an infectious diseases viva
A viva tests whether you can make safe decisions aloud, explain why they matter and adapt when the examiner adds information. The cases below are generic practice stations, not a description of a particular licensing exam. Formats and local guidelines differ, so check the official body’s website for your exam structure and use your local antimicrobial and public health guidance for treatment decisions.
For each case, answer in a sequence that makes your reasoning easy to follow:
- State the immediate risk. Say what could harm the patient in the next minutes or hours.
- Give your first actions. Include stabilisation, urgent tests and the point at which treatment must not wait.
- Explain the differential and interpretation. Prioritise likely or dangerous causes rather than listing everything you know.
- Describe definitive management and review. Include specialist input, monitoring, complications and communication.
Speak in complete, short sentences. If you do not know a local regimen, state the principle and say you would follow the current local guideline rather than inventing a dose. A good viva answer is not a monologue: pause after your plan and let the examiner direct you to the next decision.
The examiner strip below sets a practice focus, not the criteria of any named examination. In MySummaries, the examiner persona can be matched to the subject being practised.
Choose a station and define the task
Read the opening question, then give yourself a short planning pause and answer aloud without reading a model first. A partner can play the examiner, or you can record yourself and compare the recording with the criteria below. The stations are deliberately different: one requires recognition of a time-critical opportunistic infection, one requires a diagnostic and source-control plan, and one tests a dangerous travel-related differential.
The opening prompts should lead to a management plan, not a memorised disease summary. If asked for a differential, rank it. If a new result changes the risk, say what you would do next and why. The station list keeps track of which cases you have attempted; the first one is left unsat so you can begin with it.
The scores and criteria in the worked recordings are practice feedback from the platform, not official examination marks. Use them to spot omissions: a candidate can know the diagnosis but still lose practice marks by failing to prioritise an urgent action or explain the next step.
Station 1: HIV and suspected cryptococcal meningitis
Give this answer aloud before reading the recording. The key is to avoid two unsafe shortcuts: assuming that an alert patient has no serious meningitis, and treating a suspected opportunistic infection as a reason to start antiretroviral therapy immediately. Explain how you will assess for raised intracranial pressure and obtain diagnostic samples, while not delaying urgent treatment in an unwell patient.
Examiner
A 34-year-old with newly diagnosed HIV, a CD4 count of 28 cells/µL and ten days of worsening headache is febrile but alert. Talk me through your immediate assessment and management.
You recognised advanced immunosuppression and assessed observations, mental state and signs of raised intracranial pressure.
ImproveState early that deterioration, reduced consciousness or physiological instability requires urgent escalation and stabilisation.
You included serum cryptococcal antigen and cerebrospinal fluid testing, including opening pressure, if lumbar puncture is safe.
ImproveMake the sequence explicit: assess safety for lumbar puncture, measure opening pressure, and send CSF for cryptococcal antigen, microscopy and culture.
You identified induction antifungal therapy and therapeutic lumbar punctures for raised pressure.
ImproveSay that suspected or confirmed disease needs urgent specialist-led antifungal treatment guided by local protocols, and that pressure relief may require repeat lumbar punctures.
You correctly avoided immediate ART initiation and mentioned specialist review.
ImproveExplain that ART is generally deferred for several weeks in cryptococcal meningitis because early initiation can worsen inflammatory complications; coordinate timing with the treating team.
A strong answerI am concerned about cryptococcal meningitis in a person with advanced HIV, and I would first assess airway, breathing, circulation, observations, mental state and signs of raised intracranial pressure. I would arrange urgent senior and infectious diseases input, check serum cryptococcal antigen and, if it is safe, perform lumbar puncture with opening pressure and CSF cryptococcal antigen, microscopy and culture. If the patient is unstable or has features making lumbar puncture unsafe, I would stabilise and investigate urgently rather than proceed without assessment. I would start specialist-directed induction antifungal treatment promptly when indicated and manage raised intracranial pressure with therapeutic lumbar punctures as required. I would not start ART immediately; I would agree its timing with the specialist team, alongside management of other HIV-related needs and close monitoring.
That is a MySummaries station, filled with infectious diseases material. Yours is written from your own notes. Start free
The answer earns credit for putting safety before the test list. In a real case, assess for contraindications to lumbar puncture and follow local guidance on imaging and investigation. A normal level of alertness does not rule out raised intracranial pressure. Likewise, saying “start antifungals” is not enough on its own: name the need for an appropriate induction regimen, specialist oversight and active pressure management.
ART timing is a common follow-up question. A strong response explains the risk of immune reconstitution inflammatory syndrome and says that ART is generally deferred for several weeks in cryptococcal meningitis, with the exact plan agreed by the treating team and current guidance. Avoid presenting one schedule as universal. Finish with monitoring, adherence support and coordination of HIV care, rather than ending at the first antifungal dose.
Station 2: Persistent Staphylococcus aureus bacteraemia
This station tests whether you connect positive blood cultures with a search for a source and complications. Give a prioritised plan: assess severity, clarify the microbiology, look for endocarditis and metastatic infection, and address source control. If the patient is unstable, resuscitation and timely treatment take priority over completing every investigation first.
Examiner
A 62-year-old has fever, a new murmur and two blood-culture sets growing Staphylococcus aureus. How will you investigate and manage the patient?
You assessed for sepsis and proposed prompt treatment after cultures where feasible.
ImproveSay explicitly that a patient with shock or rapid deterioration needs immediate resuscitation and antibiotics; do not wait for a complete work-up.
You linked the new murmur and S. aureus bacteraemia to endocarditis and requested echocardiography.
ImproveName transthoracic echocardiography first where appropriate, with transoesophageal echocardiography if suspicion remains high or the initial study is inadequate.
You planned repeat cultures and a search for an infected device or other removable focus.
ImproveState that susceptibility results guide definitive antibiotics and that any removable infected line or drain should be assessed for prompt source control.
You mentioned embolic complications and specialist involvement.
ImproveAdd focused assessment for heart failure, neurological or other embolic features, and persistent bacteraemia; involve infectious diseases and cardiology or cardiac surgery when indicated.
A strong answerI would first assess observations, perfusion and organ dysfunction, and resuscitate and give timely antibiotics if the patient is unstable. Staphylococcus aureus in blood cultures is clinically significant here, and the new murmur makes infective endocarditis a major concern. I would review the culture identification and susceptibilities, obtain repeat blood cultures to assess clearance, and arrange echocardiography, escalating to transoesophageal imaging if suspicion remains high or transthoracic views are inadequate. I would examine for a source, including vascular devices, skin, joints and focal spinal or neurological symptoms, and assess for heart failure and embolic complications. I would tailor antimicrobial treatment to susceptibility results and current local guidance, pursue source control, and coordinate care with infectious diseases and the relevant procedural or cardiac team.
Notice the distinction between collecting cultures and delaying treatment. In a stable patient, obtain appropriate blood cultures before antibiotics where feasible; in shock or serious deterioration, do not hold up urgent treatment to complete the investigation. State that antibiotic choice depends on susceptibility results, allergies, renal function and local guidance rather than guessing a regimen.
A new murmur is not the only reason to investigate for endocarditis: persistent S. aureus bacteraemia, prosthetic material or embolic features can also raise concern. Explain that echocardiography is part of the work-up, not the whole work-up. Repeat cultures help establish whether bacteraemia is clearing, while examination and imaging guided by symptoms look for metastatic infection. A vague “search for a source” becomes a useful viva answer when you name likely sites and explain that an infected removable device may need removal.
Station 3: Fever after travel and an initially negative malaria test
The central decision is that one negative initial test does not safely exclude malaria when the clinical suspicion remains. Answer as though the patient is in front of you: assess severity, arrange urgent repeat testing and involve the appropriate laboratory and specialist team. Do not let a travel history narrow your differential so much that you miss sepsis or another immediately dangerous diagnosis.
Examiner
A 29-year-old returns from a malaria-endemic region with fever, rigors and vomiting. The first malaria test is negative. What do you do next?
You checked for altered consciousness, shock and other features of severe disease.
ImproveLead with observations, glucose and urgent escalation if there is organ dysfunction or clinical deterioration.
You understood that an initial negative test does not exclude malaria and planned further testing.
ImproveSpecify urgent repeat thick and thin blood films, or the locally available diagnostic pathway, with timing guided by local protocols and the laboratory.
You recognised that severe suspected malaria is an emergency.
ImproveSay that if severe malaria is strongly suspected, urgent specialist-led treatment should not be delayed while waiting for repeated results.
You considered other travel-related infections and requested specialist support.
ImproveMention sepsis and other locally relevant travel-associated infections, and involve infectious diseases, microbiology and travel or public health services as appropriate.
A strong answerI would assess the patient immediately for shock, altered consciousness, respiratory distress, jaundice, hypoglycaemia and other evidence of severe illness, and arrange urgent escalation if any are present. Malaria remains a concern despite one negative test, so I would contact the laboratory and arrange urgent repeat testing with thick and thin films or the locally recommended method. I would not wait for serial testing if the patient has severe features and malaria is strongly suspected; I would seek urgent specialist advice and start treatment according to local guidance. I would also assess for sepsis and other infections related to the itinerary, exposures and symptoms, and take appropriate cultures and tests without delaying emergency care. I would establish the exact travel route, dates, prophylaxis and prior treatment, and coordinate ongoing review with infectious diseases and the relevant laboratory or public health team.
The point to make explicit is the action after a negative result: keep malaria in the differential and arrange repeat testing urgently if suspicion remains. The precise repeat-testing schedule varies by local protocol and laboratory practice, so do not memorise a universal interval for an international viva. A strong answer says whom you will contact and how you will keep the patient under review while testing continues.
Ask about itinerary, dates, prophylaxis, accommodation, mosquito exposure and any treatment already taken. These details change the differential and help interpret tests. Consider other causes of fever and sepsis based on the patient’s route, exposures and symptoms; avoid naming an exhaustive list without connecting it to the case. If severe malaria is suspected, emphasise urgent specialist-led care and treatment according to local guidance rather than waiting for a reassuring repeat test.
Review the answer, not just the score
After each recording, identify one omission that could change safety or management. Turn it into a sentence you can use in the next attempt: “If the patient is unstable, I will stabilise and treat without waiting for the complete investigation.” Then repeat the station later with the case details changed. For example, add a focal neurological symptom to the travel case, a prosthetic valve to the endocarditis case, or reduced consciousness to the meningitis case. The aim is to practise adapting the plan, not reciting the same script.
Listen for three common weaknesses: delaying an urgent intervention while listing tests; naming a diagnosis without describing how you will confirm and manage it; and using a broad phrase such as “start treatment” without stating what determines the choice. Improve one weakness at a time. When you review a recording, note the exact point where you would ask for help, which finding changes the plan, and what needs follow-up after initial treatment.
How MySummaries helps
Build a board from your infectious diseases notes, then use it to generate recorded oral practice from the cases and topics you are revising. Review the marked response, identify missed points and repeat the station to check whether your answer has become clearer and safer. Open MySummaries.