60-year-old male, day 31 ICU, admitted to hospital, one month earlier with severe respiratory failure secondary to legionella pneumonia, mechanically ventilated since with increasing O2 requirements over the previous 36 hours. Clinical findings included fever, tachycardia with atrial flutter, peripheral oedema, palpable liver edge and hyper-reflexia.
Candidates were directed to examine him for potential causes of his ongoing ventilatory requirement and for the deterioration in the past 36 hours.
Discussion points also included the management of elevated creatinine, and the significance of a positive blood culture for candida.