Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 76-year-old woman was admitted five days ago with a severe depressive episode. Her general practitioner started amitriptyline 75 mg at night three weeks ago a…
Psychiatry · Pre-internship · middle twist
You are the intern covering the orthopaedic ward at 2 am. A 79-year-old man, two days after hemiarthroplasty for a fractured neck of femur, is climbing over the…
Psychiatry · Pre-internship · middle twist
A 46-year-old accountant is brought in by his wife. Over five weeks he has become convinced that his neighbours are broadcasting his thoughts to the street, and…
Psychiatry · Pre-internship · middle twist
An intern reviews a 47-year-old man in the emergency department twelve hours after he swallowed twenty paracetamol tablets on the night his wife left him. He is…
Psychiatry · Pre-internship · middle twist
A 39-year-old man is brought to a regional Western Australian emergency department by police after climbing onto a shop roof shouting that transmitters have bee…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl attends the adolescent mental health clinic alone. She has moderate depression and, after discussion, wants to start an antidepressant. She d…
Psychiatry · Pre-internship · middle twist
A 61-year-old man was admitted with severe depression and pervasive hopelessness after a near-fatal overdose. Twelve days after starting an antidepressant the n…
Psychiatry · Pre-internship · middle twist
A 78-year-old woman is three days after a hemiarthroplasty for a fractured neck of femur. The night nurse reports that she was pulling at her drip at 2 am and c…
Psychiatry · Pre-internship · middle twist
A 62-year-old woman brought to the emergency department after a fall at home tells the registrar that her recent illness was sent by an ancestor spirit, and tha…
Psychiatry · Pre-internship · middle twist
A 28-year-old man brought in by police is pacing the ward corridor, clenching his fists and shouting that he will not be locked up again. He has not struck anyo…
Psychiatry · Pre-internship · middle twist
A 47-year-old man is admitted for elective inguinal hernia repair. Taking the substance use history, the intern records 12 standard drinks a day for the past 20…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl attends a general practice with her mother, who says her daughter has become withdrawn and is failing subjects at school. The doctor has aske…
Psychiatry · Pre-internship · middle twist
A 19-year-old man received his first ever dose of an antipsychotic 14 hours ago, having been admitted with psychosis. He calls the nurse because his neck has pu…
Psychiatry · Pre-internship · middle twist
A 79-year-old woman is brought to the emergency department at 2 am by police, having been found walking along a main road in her nightdress. She is pleasant and…
Psychiatry · Pre-internship · middle twist
A 24-year-old man was admitted yesterday to the psychiatric unit as a voluntary patient with a first episode of psychosis. He has told the team he does not want…
Psychiatry · Pre-internship · middle twist
A 68-year-old woman comes to the emergency department at 10 pm with four hours of severe right-sided headache and vomiting that began while she was watching a f…
Ophthalmology · Pre-internship · middle twist
A 74-year-old man attends for a repeat prescription. He drives himself and his wife to the shops and to church each week. He has had dry age-related macular deg…
Ophthalmology · Pre-internship · middle twist
A 43-year-old woman has had two days of boring pain behind the right eye and, since this morning, double vision. Her right upper lid now covers the pupil and sh…
Ophthalmology · Pre-internship · middle twist
A 79-year-old woman lives alone and has stopped driving after dark because oncoming headlights spread into a glare she cannot see through. She has given up the…
Ophthalmology · Pre-internship · middle twist
A 71-year-old man says the vision in his right eye switched off ninety minutes ago, without pain. He can count fingers only on that side. The right pupil dilate…
Ophthalmology · Pre-internship · middle twist