Doctor Instruction: Mrs Smith, 73-year-old lady with a background of COPD, presented with perforated vicus and has now gone into acute renal failure. Blood results showed: K 2.5 (3.5), and Creatinine 200 (65). Her ABG showed metabolic acidosis with a high lactate with a negative base excess. Hb also dropped by 2 units. She was brought in by her daughter in the emergency department for being 'under the weather', unremarkable until she ate food and suddenly developed severe abd

Doctor Instruction: Mrs Smith, a 52-year-old lady, underwent laparoscopic cholecystectomy. Post-operative day 4, the operation was uneventful - 2 clips were applied to the common bile duct and 2 clips were applied to the cystic artery. Since yesterday, Mrs Smith complained of worsening generalised abdominal pain. Ultrasound showed free fluid in the abdomen with no common bile duct dilatation. She has tachycardia, jaundice and pyrexia. Today there is bile in the abdominal drai

Doctor Instruction: A 78-year-old woman, called Mrs Jane Smith, with a history of COPD and mild LVF, underwent mastectomy and axillary lymph node clearance for breast cancer. On postoperative day 2, she experienced axillary discomfort, swelling, and shortness of breath. Despite the planned discharge for the next day, her daughter, who has just arrived at the hospital, is adamant about taking her home this afternoon to a house 60 miles away. The patient, although eager to retu

Doctor Instruction: During a road traffic accident, a 21-year-old male motorbiker was injured during a hit-and-run incident. He was unconscious initially with a GCS of 15 on arrival. Ultrasound showed free fluid in the paracolic gutter. X-ray and examination showed left open tibia and fibula fracture. His left limb has gone cold and pulseless. Blood investigations on admission were all normal, except for raised CRP and WBC. You are given a preparation station prior to this st