Unspecified hospital in Adelaide

59-year-old male admitted to ICU 2 weeks earlier with cardiorespiratory failure secondary to unknown bronchial adenocarcinoma causing obstruction of right upper lobe bronchus and pleural and pericardial effusions with tamponade. He had been extubated 10 days earlier but readmitted 2 days later for respiratory failure and started chemotherapy whilst ventilated. Past history included liver transplantation for cirrhosis one year ago. Findings on examination included left cervical lymphandenopathy, LLL collapse, liver transplant surgery scar, indications of chemotherapy in progress and minimal respiratory support.

Candidates were asked to assess his suitability for extubation.

Discussion points also included interpretation of imaging including the initial echo findings and the issues surrounding chemotherapy in a ventilated patient.