MLA Domain 5 · Presentation

Deteriorating patient

8 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 2

Extradural haemorrhage

Deteriorating GCS after a lucid interval, fixed dilated pupil, Cushing reflex → herniation; neurosurgical emergency

Influenza

Deterioration with new consolidation → secondary bacterial pneumonia (esp. Staph. aureus) → antibiotics

recognised feature · 4

Gastrointestinal perforation

Generalised peritonitis with free gas → emergency resuscitation + surgery

Intraventricular haemorrhage (IVH)

Post-haemorrhagic ventricular dilatation/hydrocephalus (expanding head, bulging fontanelle) → neurosurgical input

Sepsis & septic shock

Red-flag sepsis / septic shock → SEPSIS SIX within 1 hour; lactate >2 (and especially >4) signals hypoperfusion

Vascular dementia

Acute decline = new vascular event; manage stroke risk aggressively

differential of the above · 2

COVID-19

Hypoxia / respiratory failure → oxygen + escalation (cross-ref respiratory failure); VTE risk → thromboprophylaxis

Subdural haematoma

Reduced/fluctuating GCS, anticoagulation, large collection with midline shift