78y MFFD but well below baseline on HCoE ward awaiting transfer to rehabilitation unit. Prophylactic LMWH held for endoscopy few days ago but not restarted. Patient complains of chest pain, SoB and becomes hypoxic as result of a pulmonary embolism.

The participant is called to see a 69 year old patient with features of an IECOPD. The participant will need to initiate medical therapy . They are unable to contact their registrar for most of the scenario. Location: medical assessment unit.

For the Participant: as per setting and box 1. For the Facilitator: Over-oxygenated DKA. Scenario fails to deliver insulin/glucose by design. Patient develops severe hyperkalaemia and deteriorates.

For the Participant: You are the FY1 Doctor covering the acute medical wards. The nurse in charge of Ward C4 has called you to assess her patient who she feels is unwell. Please take a handover.

For the Facilitator: Cold sepsis from catheter associated UTI. Hypovolemic and slightly under oxygenated on 28%. Good SpO2 readings once on 40% Venturi and fluid resuscitated. If fluid management is not very tight, patient will be tipped into pulmonary oedema on account of CHF.