Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 741 questions.
A 13-year-old boy weighing 52 kg develops widespread urticaria, a hoarse voice and wheeze about ten minutes after eating a satay skewer at a school camp. He is…
Acute Care · Pre-internship · middle twist
A 46-year-old woman is admitted with two days of vomiting and lightheadedness. Her regular tablets are alendronate, esomeprazole and prednisolone, all of which…
Acute Care · Pre-internship · middle twist
A 24-year-old man is brought to a regional emergency department after his motorcycle struck a guard rail. The ambulance officers report that he lost his output…
Acute Care · Pre-internship · middle twist
A 68-year-old woman is admitted with fever and dysuria. Blood cultures were taken and she received gentamicin and amoxicillin within 40 minutes of arrival. She…
Acute Care · Pre-internship · middle twist
A 63-year-old man wakes at 5 am with swelling of his lower lip and the left side of his tongue. There is no rash and nothing itches. His voice is normal, his ch…
Acute Care · Clinical rotations · middle twist
A 34-year-old woman arrives 20 minutes after eating a satay skewer at a food van. She has widespread weals, a hoarse voice and expiratory wheeze. Blood pressure…
Acute Care · Pre-internship · middle twist
A 29-year-old woman, gravida 2 para 1, is 13 weeks and 2 days pregnant by a dating scan at 8 weeks. She has had six hours of moderate vaginal bleeding and cramp…
Acute Care · Pre-internship · middle twist
A 44-year-old man presents three hours after a sudden severe occipital headache that reached its worst within a minute while he was straining at stool. He vomit…
Acute Care · Pre-internship · middle twist
A 71-year-old man presents with two hours of severe left loin pain radiating into the groin, with vomiting. He has never had pain like this before. He smokes 20…
Acute Care · Clinical rotations · middle twist
A 26-year-old man is brought to a Perth emergency department by his brother. For six weeks he has slept about two hours a night, has given away his car and most…
Acute Care · Pre-internship · middle twist
An 81-year-old man is three days from a hemiarthroplasty for a fractured neck of femur. Overnight he believes he is on a fishing boat and asks his wife about tw…
Acute Care · Pre-internship · middle twist
A 23-year-old university student is reviewed after being given a salbutamol inhaler by a locum six months ago. He uses it about three times most weeks for chest…
Acute Care · Clinical rotations · middle twist
A 62-year-old man with treated hypertension develops severe pain between his shoulder blades while carrying a bag of potting mix. It was as bad in the first few…
Acute Care · Clinical rotations · middle twist
A 24-year-old motorcyclist is brought in thirty minutes after a high-speed collision. Blood is pulsing from a deep laceration on the medial aspect of his left t…
Acute Care · Pre-internship · middle twist
A 68-year-old man presents with two days of rigors and right flank pain and is confused on arrival. Temperature 38.8 °C, respiratory rate 26/min, heart rate 118…
Acute Care · Pre-internship · middle twist
A 19-year-old woman walks into a metropolitan emergency department with her sister ninety minutes after swallowing thirty modified-release paracetamol tablets.…
Acute Care · Clinical rotations · middle twist
You are the intern in a Western Australian emergency department. A 3-year-old girl was triaged two hours ago with fever and vomiting. The paediatric registrar r…
Acute Care · Pre-internship · middle twist
A 52-year-old man who lives alone is found drowsy on his kitchen floor and brought in by ambulance. He drinks heavily, is visibly thin, and his neighbour says h…
Acute Care · Pre-internship · middle twist
A 34-year-old man is brought to the emergency department six hours after his general practitioner increased his sertraline and added tramadol for back pain. He…
Acute Care · Clinical rotations · middle twist
An 18-year-old woman took 30 paracetamol tablets after her relationship ended. She has completed acetylcysteine; at 20 hours her alanine aminotransferase is nor…
Acute Care · Pre-internship · middle twist