Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 741 questions.
A 52-year-old man attends for a health assessment. He does not smoke, has no diabetes, chronic kidney disease or established cardiovascular disease, and his fat…
Cardiovascular · Clinical rotations · middle twist
A 46-year-old woman has a body mass index of 32 kg/m² and treated hypertension. Her mother developed type 2 diabetes at 58 years of age. She has no polyuria, po…
Endocrine and Metabolic · Clinical rotations · middle twist
A 68-year-old man taking gliclazide modified release for type 2 diabetes is found drowsy with a blood glucose concentration of 2.1 mmol/L. He improves after int…
Emergency and Toxicology · Clinical rotations · middle twist
A 24-year-old woman with type 1 diabetes presents with abdominal pain, vomiting and deep breathing. Her blood glucose concentration is 24 mmol/L, venous pH is 7…
Endocrine and Metabolic · Clinical rotations · 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 3-year-old boy who previously used short sentences has stopped speaking over the past six weeks. His parents also report that he no longer understands familia…
Paediatrics · Clinical rotations · middle twist
A 72-year-old woman with newly diagnosed multiple myeloma presents with confusion, constipation and weakness. Her serum calcium is 4.18 mmol/L (2.10–2.60), crea…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 29-year-old woman presents with headache, confusion and reduced urine output. She is pale and has scattered petechiae; investigations show haemoglobin 78 g/L…
Haematology and Oncology · Clinical rotations · middle twist
A 35-year-old primigravida at 37 weeks’ gestation is found to have blood pressure readings of 148/96 and 146/94 mmHg 4 hours apart. Urine protein is 2+, platele…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 31-year-old woman at 34 weeks’ gestation presents with a severe frontal headache and flashing lights. Her blood pressure is 176/114 mmHg on two measurements 1…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 68-year-old man with a recent transurethral resection of a bladder tumour presents with worsening suprapubic pain and inability to pass urine. He has passed b…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 29-year-old woman at 25 weeks of pregnancy presents with right flank pain, rigors and vomiting. Her temperature is 39.2°C, pulse 132/min and blood pressure 92…
Emergency and Toxicology · Clinical rotations · middle twist
A 78-year-old man presents with a lesion on the sun-exposed forearm that has enlarged from a pinpoint mark to 18 mm over seven weeks. It is a firm, smooth, red-…
Dermatology · Clinical rotations · middle twist
A 35-year-old woman is referred for a brown plaque on the upper back that has slowly enlarged over nine years. It was initially flat, but several firm reddish-b…
Dermatology · Clinical rotations · middle twist
A 63-year-old man has a brown papule on the bridge of his nose that has slowly enlarged over two years and occasionally leaves a spot of blood on his handkerchi…
Dermatology · Clinical rotations · middle twist
A 54-year-old man presents with five days of fever, dry cough, headache and diarrhoea after returning from a Mediterranean cruise. He is confused, respiratory r…
Respiratory · Clinical rotations · middle twist
A 59-year-old man develops rapidly worsening breathlessness five days after an influenza-like illness. He has a temperature of 39.8°C, respiratory rate of 38/mi…
Respiratory · Clinical rotations · 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 56-year-old man develops sharp central chest pain 36 hours after an uncomplicated inferior myocardial infarction. The pain is worse when he lies flat or takes…
Cardiovascular · Clinical rotations · middle twist
A 64-year-old man is recovering in hospital four days after an inferior ST-elevation myocardial infarction treated with primary percutaneous coronary interventi…
Cardiovascular · Clinical rotations · middle twist