Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 382 questions.
A 64-year-old man is recovering in hospital four days after an inferior ST-elevation myocardial infarction treated with primary percutaneous coronary interventi…
Cardiovascular · Clinical rotations · middle twist
A 72-year-old man with Parkinson disease is brought by his wife because he has begun speaking to people who are not present and has become suspicious of her. He…
Psychiatry and Mental Health · Clinical rotations · middle twist
A 16-year-old female long-distance runner develops gradually worsening right groin pain over six weeks. She has recently increased her training volume and repor…
Rheumatology and Musculoskeletal · Clinical rotations · middle twist
A 3-year-old boy is brought to the emergency department because he has stopped walking and cries when lifted. He has a temperature of 38.8°C, a heart rate of 13…
Paediatrics · Clinical rotations · middle twist
A 79-year-old woman falls at home and develops groin pain. Pelvic and hip radiographs show no fracture, but after analgesia she still cannot take four steps and…
Surgery and Perioperative Care · Clinical rotations · middle twist
A 7-year-old boy falls from playground equipment and sustains a displaced supracondylar fracture of the humerus. His hand is warm, capillary refill is 1.5 secon…
Paediatrics · Clinical rotations · middle twist
A 42-year-old woman has a second proximal deep vein thrombosis while taking rivaroxaban as prescribed. She has no interacting medicines, normal renal function a…
Cardiovascular · Clinical rotations · middle twist
A 68-year-old man with metastatic oesophageal cancer develops a symptomatic proximal deep vein thrombosis. He completed treatment for melaena from the tumour tw…
Cardiovascular · Clinical rotations · middle twist
A 29-year-old woman at 10 weeks of pregnancy presents with sudden pleuritic chest pain and breathlessness. Her heart rate is 108/min, oxygen saturation is 98% o…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 41-year-old woman is rescued from a vehicle fire with burns encircling the chest and upper abdomen. She is intubated and ventilated, but her peak airway press…
Emergency and Toxicology · Clinical rotations · middle twist
A 28-year-old electrician receives an electrical injury while working on industrial equipment. There is a small contact mark on the palm and a larger mark at th…
Emergency and Toxicology · Clinical rotations · middle twist
A 67-year-old woman with long-standing rheumatoid arthritis reports increasing fatigue and reduced exercise tolerance. Her haemoglobin is 92 g/L (115–155), mean…
Haematology and Oncology · Clinical rotations · middle twist
A 36-year-old woman at 8 weeks of gestation has vaginal bleeding and intermittent lower abdominal cramping. Transvaginal ultrasonography shows an intrauterine g…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 3-week-old boy is brought with persistent jaundice, poor weight gain and two episodes of jitteriness before feeds. He was born at term with a small penis and…
Paediatrics · Clinical rotations · middle twist
A 7-year-old boy receiving chemotherapy for acute lymphoblastic leukaemia develops a temperature of 38.6°C at home. In hospital he is alert, has normal perfusio…
Haematology and Oncology · Clinical rotations · middle twist
An 8-month-old girl has a temperature of 39.4°C and has been unsettled for two days. She is drinking, has normal work of breathing and perfusion, and examinatio…
Paediatrics · Clinical rotations · middle twist
A 24-year-old woman presents with abrupt pounding in her neck and mild breathlessness that began while she was sitting at work. She is alert, warm and normotens…
Cardiovascular · Clinical rotations · middle twist
A 44-year-old woman develops a severe headache while lifting her young child; she says it was already unbearable before she could put the child down. She has vo…
Neurology · Clinical rotations · middle twist
An otherwise well 29-year-old woman presents eight days after an uncomplicated vaginal delivery with a headache that has gradually intensified over four days. I…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 45-year-old man presents after four days of worsening right lower quadrant pain, fever and anorexia. Examination finds a tender, relatively fixed mass in the…
Surgery and Perioperative Care · Clinical rotations · middle twist