Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 382 questions.
A 42-year-old man presents with haemoptysis, fatigue and rapidly worsening renal function. Creatinine is 486 micromol/L, urine microscopy shows dysmorphic red c…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 59-year-old man has an eGFR of 52 mL/min/1.73 m² on repeated testing over 4 months. His urine albumin:creatinine ratio is 12 mg/mmol, and there is no haematur…
Haematology and Oncology · Clinical rotations · middle twist
A 31-year-old woman at 18 weeks' gestation presents with sudden left flank pain and microscopic haematuria. She is afebrile, her blood pressure is 126/74 mmHg a…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 26-year-old woman who is 9 weeks pregnant is planning a 3-week trip to rural areas of Papua New Guinea. She will stay in local villages and has no psychiatric…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 52-year-old woman has progressive headaches and difficulty seeing objects to either side. MRI shows a 2.6-cm sellar mass elevating and compressing the optic c…
Endocrine and Metabolic · Clinical rotations · middle twist
A 44-year-old man has an incidental 8-mm pituitary lesion discovered during MRI for headaches. He has normal visual fields, normal pituitary hormone testing, an…
Endocrine and Metabolic · Clinical rotations · middle twist
A 59-year-old man presents with eight hours of continuous vertigo, vomiting and difficulty walking. He has spontaneous right-beating nystagmus and no hearing lo…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 34-year-old swimmer has had increasing right ear pain for three days. Moving the pinna and pressing the tragus markedly worsen the pain, and the external cana…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A healthy 55-year-old man with no family history of prostate cancer asks for a PSA test after seeing an online advertisement. He has no urinary symptoms, haemat…
General Practice and Population Health · Clinical rotations · middle twist
A 52-year-old man reports a 9-month history of gradually worsening erectile difficulty and reduced sexual desire. He has obesity, hypertension and type 2 diabet…
Cardiovascular · Clinical rotations · middle twist
A 32-year-old woman wants highly effective contraception and would prefer predictable light bleeding. She does not want a method requiring daily action and has…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 66-year-old man with diffuse large B-cell lymphoma is receiving chemotherapy through a tunnelled central venous catheter. On day 8 he develops fever of 38.6°C…
Haematology and Oncology · Clinical rotations · middle twist
A 54-year-old woman has a symptomatic isolated posterior calf-vein thrombosis found on ultrasound. She has no cancer, previous venous thromboembolism, marked sw…
Cardiovascular · Clinical rotations · middle twist
A 59-year-old man has a painless left cervical mass that has enlarged over 6 weeks. He reports drenching night sweats and has no dental infection, pharyngitis o…
Haematology and Oncology · Clinical rotations · middle twist
A 76-year-old man with probable dementia with Lewy bodies has recurrent visual hallucinations that are frightening but not associated with aggression or immedia…
Geriatrics and Palliative Care · Clinical rotations · middle twist
A 24-year-old man has 9 months of low back pain that began gradually and improves after exercise but not with rest. He wakes in the second half of the night and…
Rheumatology and Musculoskeletal · Clinical rotations · middle twist
A 67-year-old man has recurrent sinusitis, otitis and a persistent cough with occasional blood-streaked sputum. Urinalysis shows dysmorphic red cells and red-ce…
Rheumatology and Musculoskeletal · Clinical rotations · middle twist
A 74-year-old woman has 3 weeks of a new unilateral temporal headache and pain in her jaw when chewing. She has no visual symptoms, limb weakness or constitutio…
Rheumatology and Musculoskeletal · Clinical rotations · middle twist
A 54-year-old man with no family history of prostate cancer attends his GP for a routine check-up. He is asymptomatic and has no significant past medical histor…
Year 4 · Clinical rotations · middle twist
A 58-year-old man with no symptoms attends your clinic for a general health check. He is concerned because his uncle and cousin both died of pancreatic cancer.…
Year 4 · Clinical rotations · middle twist