Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 4-year-old boy weighing 16 kg has had profuse watery diarrhoea and vomiting for three days and has not passed urine since yesterday. In the emergency departme…
Acute Care · Pre-internship · middle twist
A 63-year-old man with two hours of chest pain has 3 mm of ST elevation in leads II, III and aVF. He is alert but cold and clammy. Pulse is 52 beats per minute…
Acute Care · Pre-internship · middle twist
A 5-year-old girl weighing 20 kg is admitted with right lower lobe pneumonia. She is febrile at 38.9 degrees Celsius, saturating 93% on 2 litres per minute of o…
Acute Care · Pre-internship · middle twist
A 79-year-old woman is admitted with ongoing lower gastrointestinal bleeding and a haemoglobin concentration of 72 g/L (reference range 115–155). She is receivi…
Cardiovascular · Pre-internship · middle twist
A 74-year-old woman presents with sudden passage of a large volume of dark red blood per rectum. After two litres of intravenous crystalloid her blood pressure…
Emergency and Toxicology · Pre-internship · middle twist
A 24-year-old man presents with two days of sore throat, fever and increasing difficulty swallowing. He has muffled speech, tender cervical nodes and a grey-whi…
Infectious Diseases · Pre-internship · middle twist
A 26-year-old woman with asthma is reviewed after three hours of emergency department treatment with inhaled salbutamol and ipratropium, systemic corticosteroid…
Respiratory · Pre-internship · middle twist
A 46-year-old man wakes with markedly reduced hearing in his right ear and a continuous high-pitched noise. He has no pain, discharge or recent infection, and t…
Emergency and Toxicology · Pre-internship · middle twist
A 32-year-old man is rescued from a burning warehouse. He is confused, hypotensive and tachypnoeic, with soot on his face but no wheeze. His pulse oximeter read…
Emergency and Toxicology · Pre-internship · middle twist
A 9-year-old refugee presents with a sore throat and neck swelling after arriving in Australia from a region with limited vaccination coverage. He is febrile bu…
Infectious Diseases · Pre-internship · middle twist
A 29-year-old Aboriginal man attends an annual health assessment. He injects methamphetamine intermittently and reports sharing a needle once four months ago; h…
Infectious Diseases · Pre-internship · middle twist
A 42-year-old woman with recurrent bipolar disorder has made a written advance statement saying that she would want lithium during a future manic relapse. She i…
Ethics and Professional Practice · Pre-internship · middle twist
A woman develops ongoing haemorrhage during an emergency caesarean section for uterine atony. After 3 units of red blood cells and 2 units of fresh frozen plasm…
Obstetrics and Gynaecology · Pre-internship · middle twist
A 19-year-old man presents six hours after an acute ingestion of an unknown number of immediate-release paracetamol tablets in a suicide attempt. He is alert, w…
Emergency and Toxicology · Pre-internship · middle twist
A 24-year-old woman presents to the emergency department two hours after impulsively swallowing 32 tablets of 500 mg immediate-release paracetamol (16 g) follow…
Emergency and Toxicology · Pre-internship · middle twist
A 79-year-old retired farmer was diagnosed with Alzheimer disease eight months ago. At that time you advised him and his family that he should stop driving, and…
Ethics and Professional Practice · Pre-internship · middle twist
A 15-year-old girl attends alone requesting the combined oral contraceptive pill. She has recently become sexually active with her 16-year-old boyfriend and the…
Ethics and Professional Practice · Pre-internship · middle twist
A 35-year-old man with a known diagnosis of schizophrenia is brought to the emergency department by police after neighbours reported him shouting in the street…
Psychiatry and Mental Health · Pre-internship · middle twist
An 8-week-old boy is brought to a general practice for his scheduled immunisations. While preparing the injections the practice nurse notices a 1.5 cm oval brui…
Paediatrics · Pre-internship · middle twist
A 24-year-old man sustains a closed fracture of the midshaft of the left tibia playing football. A plaster backslab with encircling crepe bandage is applied and…
Emergency and Toxicology · Pre-internship · middle twist