Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 74-year-old woman has had a new right-sided headache for three weeks and says her scalp is sore when she brushes her hair. She has begun stopping halfway thro…
Ophthalmology · Pre-internship · middle twist
A 22-year-old student attends a rural emergency department at 9 pm with a painful red left eye. She wears monthly soft contact lenses and slept in them last nig…
Ophthalmology · Pre-internship · middle twist
You are the intern on a Perth surgical ward. Overnight a 74-year-old woman received ten times the intended dose of insulin because of a prescribing error you ma…
Acute Care · Pre-internship · middle twist
An 81-year-old man had a large left middle cerebral artery infarct ten days ago. He cannot swallow safely and can neither understand nor communicate a decision.…
Acute Care · Pre-internship · middle twist
A 62-year-old Aboriginal woman from a remote Kimberley community is admitted to a Broome hospital with small bowel obstruction and listed for laparotomy on tomo…
Acute Care · Pre-internship · middle twist
You are the intern covering a paediatric ward at a Perth public hospital at 2100. The mother of a 6-year-old boy admitted this morning with fever and vomiting s…
Acute Care · Pre-internship · middle twist
A 62-year-old woman attends the emergency department after tripping on a step. She has a grazed knee, is otherwise well, takes only atorvastatin and passes urin…
Acute Care · Pre-internship · middle twist
A 6-year-old girl falls from the monkey bars onto an outstretched right hand. She holds the elbow semi-flexed with diffuse swelling over the distal humerus, and…
Acute Care · Pre-internship · middle twist
A 41-year-old woman is bitten by her cat three hours ago. She has two puncture wounds over the dorsum of the right hand, one of them directly over the second me…
Acute Care · Pre-internship · middle twist
A 26-year-old man who moved to Australia two years ago stands on a nail while clearing out a chicken run. He presents 30 hours later with a deep puncture throug…
Acute Care · Pre-internship · middle twist
A 27-year-old man is brought in after his motorcycle struck a guardrail. A binder has been applied for an open-book pelvic fracture and he is haemodynamically s…
Acute Care · Pre-internship · middle twist
An 88-year-old woman in residential aged care has had an indwelling urethral catheter for eight months for a neurogenic bladder, and it will be needed indefinit…
Acute Care · Pre-internship · middle twist
A 31-year-old man is intubated in the emergency department after falling from a roof and is transferred to the intensive care unit. Sedation has been withheld f…
Acute Care · Pre-internship · middle twist
A 68-year-old woman weighing 65 kg is in the emergency department with urinary sepsis. Intravenous antibiotics were given within 30 minutes of arrival and she h…
Acute Care · Pre-internship · middle twist
A 54-year-old man presents to a metropolitan hospital with a catheter laboratory after seventy minutes of central chest pain, which is continuing. His blood pre…
Acute Care · Pre-internship · middle twist
A 68-year-old woman is brought in from a residential aged care facility with fever and new confusion. Her temperature is 38.9 degrees Celsius, blood pressure 82…
Acute Care · Pre-internship · middle twist
A 28-year-old man is stung by a bee in a hospital car park. In the emergency department he has generalised urticaria, audible wheeze and a blood pressure of 84/…
Acute Care · Pre-internship · middle twist
A 71-year-old man collapses in the radiology department and is apnoeic with a palpable carotid pulse. You are first to arrive with a self-inflating bag, mask an…
Acute Care · Pre-internship · middle twist
You are the intern on night cover. At 02:00 the nurse asks you to see a 68-year-old man on the second night after a right hemicolectomy. His respiratory rate is…
Acute Care · Pre-internship · middle twist
A 58-year-old man is admitted with three days of fever and a productive cough. He weighs 138 kg, uses continuous positive airway pressure at home for witnessed…
Acute Care · Pre-internship · middle twist