- 70-year-old female day 2 post laparotomy for repair of obstructed ventral hernia and division of adhesions with a background of severe COPD. Clinical findings included kyphosis, wheeze and bronchial breathing, atrial fibrillation, right ventricular impulse, obstructed pattern on ETCO2 trace and presence of intra-abdominal pressure monitor. Candidates were asked to examine her with a view to planning further management. Other discussion points included interpretation of investigations, management of AF and COPD, ventilation weaning strategies, timing of tracheostomy, intra-abdominal hypertension and nutritional support.