Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 371 questions.
A 32-year-old woman at 34 weeks gestation reports two weeks of intense itching that is worse at night and began on her hands and feet. She has no rash, abdomina…
Obstetrics and Gynaecology · Clinical rotations · common
A 47-year-old woman has fatigue, pruritus and intermittent jaundice. Alanine aminotransferase is 680 U/L (5–40), IgG is 31 g/L (7–16), antinuclear and smooth-mu…
Gastroenterology and Hepatology · Clinical rotations · common
A 42-year-old man presents with several months of pruritus followed by yellowing of the eyes. He has ulcerative colitis, an alkaline phosphatase of 680 U/L (30–…
Gastroenterology and Hepatology · Clinical rotations · common
A 47-year-old woman with no personal or family history of breast cancer asks whether to continue mammographic screening. She has no breast lump or nipple change…
General Practice and Population Health · Clinical rotations · common
A 61-year-old man asks about bowel cancer screening. He has no change in bowel habit, rectal bleeding or iron deficiency, and his mother was diagnosed with bowe…
Gastroenterology and Hepatology · Clinical rotations · common
A 34-year-old woman attends her general practitioner for routine preventive care. She has no symptoms, has never had cervical intraepithelial neoplasia, and her…
Obstetrics and Gynaecology · Clinical rotations · common
A 63-year-old woman with type 2 diabetes accidentally injects 60 units of insulin glargine instead of her usual 20 units. She becomes confused with a capillary…
Emergency and Toxicology · Clinical rotations · common
A 28-year-old man with type 1 diabetes uses a continuous subcutaneous insulin infusion. He develops nausea after the pump gives an occlusion alarm; his blood gl…
Endocrine and Metabolic · Clinical rotations · common
A 31-year-old woman with type 1 diabetes is being treated for diabetic ketoacidosis with intravenous insulin and 0.9% sodium chloride. Four hours later, her blo…
Endocrine and Metabolic · Clinical rotations · common
A 67-year-old woman with type 1 diabetes is admitted with community-acquired pneumonia and is not eating. She normally injects insulin glargine 24 units at nigh…
Emergency and Toxicology · Clinical rotations · common
A 74-year-old woman with severe chronic obstructive pulmonary disease presents with increasing dyspnoea and drowsiness during a respiratory infection. On room a…
Respiratory · Clinical rotations · common
A 68-year-old man with severe chronic obstructive pulmonary disease presents with increasing breathlessness and purulent sputum. He has received controlled oxyg…
Respiratory · Clinical rotations · common
A 34-year-old woman with asthma remains breathless in the emergency department after three nebulised doses of salbutamol and ipratropium and intravenous hydroco…
Respiratory · Clinical rotations · common
A 29-year-old man presents two days after running out of prescribed oxycodone, which he had been taking in increasing amounts for a year. He is yawning, restles…
Emergency and Toxicology · Clinical rotations · common
A 34-year-old woman presents with anxiety, poor sleep, nausea and a sense that people are watching her. She stopped taking alprazolam 72 hours ago after using 6…
Emergency and Toxicology · Clinical rotations · common
A 46-year-old man with longstanding alcohol dependence has eaten little during two weeks of vomiting. He is inattentive, walks with a broad-based gait and repea…
General Practice and Population Health · Clinical rotations · common
A 29-year-old man presents after completing an unusually strenuous cross-country event with severe thigh pain and dark urine. His creatinine concentration is 28…
Renal, Urology and Electrolytes · Clinical rotations · common
An 82-year-old woman becomes confused and unsteady over three days while being treated for depression and hypertension. She is euvolaemic, her serum sodium is 1…
Geriatrics and Palliative Care · Clinical rotations · common
A 74-year-old man is referred for six months of recurrent falls. He reports that his feet sometimes seem stuck to the floor when he starts walking, and he takes…
Geriatrics and Palliative Care · Clinical rotations · common
An 81-year-old man is admitted with a fractured neck of femur and becomes inattentive and disorganised over 24 hours. His level of alertness fluctuates, but he…
Geriatrics and Palliative Care · Clinical rotations · common