Case 6: 76yr old woman admitted with sepsis of unknown source
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Observations & Interpretations
CT: Previous sternotomy and aortic valve replacement. Enhancing fluid collection around aortic root. No significant pericardial effusion. Right sided central venous catheter appropriately sited, with no obvious line thrombus. Multiple wedge shaped lesions in spleen and kidneys. No clear thrombus in left ventricle or atrial appendage (though this is an undated study).Principal Diagnosis
Aortic root abscess around artificial valve. Subsequent thromboembolism to spleen and kidneys.Differential Diagnosis
None.Management
Consider gated Cardiac CT to better assess valve anatomy and root abscess involvement Urgent Cardiothoracic surgeon referral| Marking Scheme | ||
|---|---|---|
| 3 | Nothing | Nothing Written |
| 4 | Fail | Significant Observations Missed. No Mention of Correct Diagnosis |
| 5 | Borderline | Some Observations Missed. Only 1 of the main diagnoses suggested |
| 6 | Pass | Most observations made. The main diagnoses are made (at least in differential) |
| 7 | Good Pass | Observations made. Principal Diagnoses are all correct, and there is good reasoning. |
| 8 | Perfect Answer | Clear, Concise & Confident. Good Reasoning, and no unrealistic differentials |
You should mark yourself realistically. Some cases will be hard, and just making the relevant observations and sensible observations will give you a pass. Some cases will seem easy, and it is these cases you need to be scoring 7 or 8. In the exam if you write something very incorrect, or if you put down too many obscure differentials, then half marks can be deducted from your score. Make sure you include relevant negatives. If you think there is only 1 differential then be confident, and don't put down unlikely diagnoses. Make sure your handwriting is clear, and use bullet-points to make it more readable. Timing is crucial, and don't spend too long on a single case. As you will note from the mark scheme, if you put nothing down you get a 3. So simply writing a single observation gives you a point
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