© James Austin 2002
Last updated 9 April 2004
For what it's worth, this is the list of cases I submitted with my ETR. The examiners seemed to like them! The cases are now (really) downloadable as Word .docs.
1. Ethics: Patient autonomy in unsuccessful suicide (a lady who made a rational attempt at suicide, with an advance directive, in whom we withdrew treatment on the grounds of presumed patient refusal).
2. Respiratory/Paediatric: Paediatric tracheomalacia causing failure of extubation (an infant with 'recurrent bronchiolitis' found to have a pulmonary vascular sling, with tracheomalacia diagnosed post-op. Tracheomalacia is probably under-recognised).
3. Obstetric/Endocrine: Diabetic keto-acidosis in pregnancy (DKA causing still-birth in an undiagnosed pregnancy, undiagnosed diabetic).
4. Trauma/GIT: Abdominal compartment syndrome (retroperitoneal crush injury causing the classical triad of ACS, relieved by decompression).
5. Cardiac: False aneurysm following pulmonary artery catheterisation (haemoptysis following PA wedging; undiagnosed PA false aneurysm resulting in fatal haemoptysis several days later).
6. Cardiorespiratory: Episodic hypoxia due to extrapulmonary shunting (hypoxic pulmonary vasoconstriction causing reverse shunting in a patent foramen ovale).
7. Neurology: Critical illness polyneuropathy (a typical case following multiple trauma, extended use of neuromuscular blockers and Gram-negative sepsis).
8. Metabolism: Anti-oxidant therapy in acute severe pancreatitis (an unproven therapy with a sound pathophysiological rationale).
9. GIT: Pre-operative nutrition (a young lady who underwent semi-elective colectomy for UC while severely malnourished, with no attempt at pre-operative nutrition - serial septic complications left her severely disabled).
10. Cytokines: Haemofiltration and high-dose FFP in meningococcal septicaemia (a young lady who survived despite profoundly poor prognosis, using an anecdotally highly-promising therapy that has never been subjected to controlled trials).