A 65 year old man admitted with sepsis and multi-organ dysfunction 3 weeks previously.. Diagnosis of staph bacteremia and C5-6 discitis requiring surgery and is now in the recovery phase. Re-intubated within a few hours of extubation yesterday. Please assess and make a plan for the next week.
Awake patient with clear weakness in upper limb, proximal more than distal.
Long tract UMN signs
Raised a-a gradient
Long term management issues regarding tracheostomy
Areas of weakness identified by examiners:
Performing a superficial PNS examination and failing to recognise that neurological exam was a core part of formulating a management plan.
Several candidates failed to identify UMN signs in the lower limbs including clonus, upgoing plantars and pathologically brisk reflexes. Several candidates, despite demonstrating brisk reflexes suggested CIPN as a diagnosis.
Several candidates missed a drug rash
Candidates were not able to come out and clearly say that patient needs a tracheostomy,
When shown a CXR with bilateral infiltrates, inability to comment on the possibility of aspiration or sputum retention as possible cause of readmission