Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 382 questions.
A 15-month-old boy presents with two days of vomiting and frequent watery stools. He is alert but subdued, with dry lips, mildly sunken eyes, heart rate 148/min…
Paediatrics · Clinical rotations · middle twist
A 78-year-old woman presents with sudden painless loss of vision in her right eye on waking this morning. For the past three weeks she has had a right-sided hea…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 48-year-old man who migrated from southern China ten years ago presents with six weeks of a blocked sensation and reduced hearing in the right ear. On several…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 72-year-old woman presents with an ulcer above her left medial malleolus that has been present for eight weeks. She has type 2 diabetes and smoked a packet of…
Cardiovascular · Clinical rotations · middle twist
A 45-year-old woman presents because a mole on her calf has become darker and larger over three months. It is 8 mm across with an irregular edge and several sha…
Dermatology · Clinical rotations · middle twist
A 34-year-old man presents with five days of fever, drenching sweats, severe headache behind the eyes and aching muscles. He started work at a rural Queensland…
General Practice and Population Health · Clinical rotations · middle twist
A 76-year-old woman taking warfarin for atrial fibrillation attends for a routine INR check, which returns at 11.0 (target 2.0–3.0). She recently completed a co…
Cardiovascular · Clinical rotations · middle twist
A 41-year-old woman presents nine hours after the onset of a severe headache that struck like a blow to the back of the head while she was lifting weights and r…
Neurology · Clinical rotations · middle twist
A 29-year-old woman presents ten days after an uncomplicated vaginal delivery under epidural analgesia with four days of worsening headache, which she says is w…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 45-year-old woman is admitted with epigastric pain radiating to the back and a serum lipase of 2400 U/L (<60). Ultrasound shows multiple small stones in the g…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 22-year-old woman presents to the emergency department with 24 hours of lower abdominal pain that began around the umbilicus and is now most marked on the rig…
Surgery and Perioperative Care · Clinical rotations · middle twist
A 71-year-old woman with chronic obstructive pulmonary disease presents with two days of worsening breathlessness and purulent sputum. She is treated with 28% o…
Respiratory · Clinical rotations · middle twist
A 24-year-old woman with asthma since childhood attends for review. Her only treatment is a salbutamol inhaler, which she now uses three to four times a week fo…
Respiratory · Clinical rotations · middle twist
A 59-year-old man presents 90 minutes after onset of severe central chest pain with sweating and nausea. The ECG shows 3 mm ST-segment elevation in leads II, II…
Cardiovascular · Clinical rotations · middle twist
A 64-year-old man with type 2 diabetes has an HbA1c of 62 mmol/mol (7.8%) despite maximal-dose metformin and attention to diet and activity. He had a myocardial…
Endocrine and Metabolic · Clinical rotations · middle twist
A 52-year-old man has a blood pressure of 162/98 mmHg despite adequate doses of perindopril, amlodipine and hydrochlorothiazide, with good adherence confirmed.…
Endocrine and Metabolic · Clinical rotations · middle twist
A 54-year-old man with cirrhosis secondary to chronic hepatitis C presents with two episodes of haematemesis over the past hour. On arrival his blood pressure i…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 45-year-old woman has a 7-mm calculus in the distal ureter on non-contrast CT. Her pain is controlled with oral analgesia, creatinine is normal, and she is af…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 47-year-old man with chronic kidney disease presents with palpitations and proximal muscle weakness. Serum potassium is 6.8 mmol/L, the sample is non-haemolys…
Cardiovascular · Clinical rotations · middle twist
A 70-year-old man with diabetic kidney disease takes ramipril and spironolactone. Routine testing shows potassium 6.4 mmol/L, confirmed on a non-haemolysed samp…
Renal, Urology and Electrolytes · Clinical rotations · middle twist