Liverpool Hospital

  • 47-year-old female, almost 3 months in ICU with severe ARDS and multi-organ failure secondary to influenza A pneumonia and subsequent complications including anuric renal failure, pancreatitis with pseudocyst and critical illness weakness. Clinical findings included morbid obesity, generalized weakness, bibasal crackles, significant peripheral oedema and the presence of a tracheostomy, dialysis catheter and abdominal drain. Candidates were told that she had presented with pneumonia 80 days previously and were asked to examine her with a view to determining why weaning had taken so long and how they would proceed from this point. Other points of discussion included interpretation of imaging, abnormal blood results and the management of pancreatitis