53-year-old female, day 7 ICU, with pneumococcal pneumonia and bacteraemia, admitted following a Medical Emergency Team call for respiratory distress. Her ICU stay had been complicated by acute kidney injury and biventricular failure. She had not required invasive ventilatory support. Clinical findings included fever, widespread septic vasculitic rash, left sided bronchial breath sounds and signs of right heart failure. Candidates were directed to examine her to determine her cardio-respiratory status and the cause of her respiratory failure.