- 37-year-old man with chronic liver failure and Gram negative sepsis who had an acute gastrointestinal haemorrhage. Clinical signs included stigmata of chronic liver disease, blood-stained airway and oliguria. Candidates were asked to examine him from the aspect of his acute GI bleed. Discussion related to the underlying causes and management of the GI bleed, coagulopathy in liver failure and hepato-renal syndrome.