Liverpool Hospital

  • 75-year-old female with MSSA mitral valve endocarditis admitted to ICU 5 days earlier following a MET call for a sudden fall in conscious state to GCS 4 and intubation in the ward Clinical findings included signs of left lower lobe consolidation, pansystolic murmur at the apex and marked oedema. Candidates were told that she presented with fever, delirium and hypotension and were asked to examine her with a view to establishing the diagnosis. Discussion points included the differential diagnosis, interpretation of investigations, treatment of endocarditis and drug dosing with CRRT.