Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 382 questions.
A 76-year-old man with persistent atrial fibrillation develops sudden severe abdominal pain and vomiting. He is pale and distressed, but his abdomen is initiall…
Emergency and Toxicology · Clinical rotations · middle twist
A 67-year-old man with a previous midline laparotomy presents with colicky abdominal pain, vomiting and progressive distension. Initially the pain came in waves…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 66-year-old man is admitted with melaena from a duodenal ulcer and undergoes successful endoscopic haemostasis. He has taken aspirin 100 mg daily since a myoc…
Cardiovascular · Clinical rotations · middle twist
A 67-year-old man presents with recurrent passage of bright-red blood and clots. After initial fluid replacement, his blood pressure is 126/74 mmHg and pulse is…
Cardiovascular · Clinical rotations · middle twist
A 64-year-old woman with cirrhosis presents with fresh haematemesis and melaena. After intravenous access, cautious crystalloid and cross-matched blood have bee…
Cardiovascular · Clinical rotations · middle twist
A 26-year-old woman is identified as a household contact of a patient with invasive meningococcal disease caused by Neisseria meningitidis serogroup B. She is 2…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 4-year-old child in a childcare centre has had paroxysmal coughing with post-tussive vomiting for 12 days, and PCR has detected Bordetella pertussis. He is ot…
Paediatrics · Clinical rotations · middle twist
A 34-year-old man with established primary sclerosing cholangitis develops worsening pruritus and jaundice over six weeks, with a 5 kg weight loss. His bilirubi…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 29-year-old woman is admitted with nausea, jaundice and right upper-quadrant discomfort. Her alanine aminotransferase is 9200 U/L (5–40), aspartate aminotrans…
Cardiovascular · Clinical rotations · middle twist
A 45-year-old man attends a health assessment. He has a sedentary occupation, a waist circumference of 108 cm and a first-degree relative with type 2 diabetes,…
Endocrine and Metabolic · Clinical rotations · middle twist
A 68-year-old man undergoes an abdominal ultrasound arranged during assessment of nonspecific back discomfort. He has no abdominal pain, vascular symptoms or kn…
Cardiovascular · Clinical rotations · middle twist
A 24-year-old man with type 1 diabetes presents with vomiting and abdominal pain. His blood glucose concentration is 28 mmol/L, blood ketones are 6.4 mmol/L and…
Endocrine and Metabolic · Clinical rotations · middle twist
A 29-year-old man with asthma is treated for an acute exacerbation with repeated nebulised salbutamol, ipratropium and corticosteroids. Initially he was agitate…
Respiratory · Clinical rotations · middle twist
A 63-year-old man with metastatic squamous cell carcinoma has persistent thirst, vomiting and confusion. After intravenous saline, his serum calcium concentrati…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 72-year-old man with diabetic kidney disease takes perindopril and spironolactone. He has a serum potassium concentration of 6.2 mmol/L (3.5–5.2), chloride 11…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 68-year-old man with chronic kidney disease is admitted with pneumonia and has received intravenous fluids, calcium gluconate and insulin with glucose for a s…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 30-year-old woman at 30+2 weeks has hypertension controlled with oral therapy and an ultrasound-estimated fetal weight below the third centile. Umbilical arte…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 35-year-old woman at 35+2 weeks has had two episodes of painless vaginal bleeding, each settling with bed rest. Ultrasound shows placental tissue covering the…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 29-year-old woman at 29 weeks has gestational diabetes managed with dietary advice and exercise. For the past 2 weeks, her fasting capillary glucose concentra…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 33-year-old woman at 33+5 weeks has a blood pressure of 168/112 mmHg on two occasions despite oral treatment. She has persistent right upper quadrant pain; pl…
Obstetrics and Gynaecology · Clinical rotations · middle twist