Westmead Hospital

  • 39-year-old male, day 3 ICU, following presentation with uncontrolled hypertension and subsequent right parietal bleed, and pulmonary oedema (now resolved), on a background of obesity, type 2 diabetes and chronic renal failure. Clinical findings included altered conscious state with no localising signs, reduced breath sounds at both bases, elevated CVP, pericardial rub and a gallop rhythm, generalised anasarca and the presence of a right femoral venous vascath. Candidates were told that he had presented 3 days earlier with altered sensorium and shortness of breath on the background of diabetic nephropathy and were asked to examine him and to identify the reason for his presentation. Discussion points included interpretation of imaging and investigations, contributing factors for his presentation and reasons for the elevated CVP.