Middle twist

A 45-year-old man presents after four days of worsening right lower quadrant pain, fever and anorexia. Examination finds a tender, relatively fixed mass in the…

Surgery and Perioperative Care · Clinical rotations · middle twist

A 76-year-old man with persistent atrial fibrillation develops sudden severe abdominal pain and vomiting. He is pale and distressed, but his abdomen is initiall…

Emergency and Toxicology · Clinical rotations · middle twist

A 67-year-old man with a previous midline laparotomy presents with colicky abdominal pain, vomiting and progressive distension. Initially the pain came in waves…

Gastroenterology and Hepatology · Clinical rotations · middle twist

A 66-year-old man is admitted with melaena from a duodenal ulcer and undergoes successful endoscopic haemostasis. He has taken aspirin 100 mg daily since a myoc…

Cardiovascular · Clinical rotations · middle twist

A 67-year-old man presents with recurrent passage of bright-red blood and clots. After initial fluid replacement, his blood pressure is 126/74 mmHg and pulse is…

Cardiovascular · Clinical rotations · middle twist

A 64-year-old woman with cirrhosis presents with fresh haematemesis and melaena. After intravenous access, cautious crystalloid and cross-matched blood have bee…

Cardiovascular · Clinical rotations · middle twist

A 26-year-old woman is identified as a household contact of a patient with invasive meningococcal disease caused by Neisseria meningitidis serogroup B. She is 2…

Obstetrics and Gynaecology · Clinical rotations · middle twist

A 4-year-old child in a childcare centre has had paroxysmal coughing with post-tussive vomiting for 12 days, and PCR has detected Bordetella pertussis. He is ot…

Paediatrics · Clinical rotations · 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 34-year-old man with established primary sclerosing cholangitis develops worsening pruritus and jaundice over six weeks, with a 5 kg weight loss. His bilirubi…

Gastroenterology and Hepatology · Clinical rotations · middle twist

A 29-year-old woman is admitted with nausea, jaundice and right upper-quadrant discomfort. Her alanine aminotransferase is 9200 U/L (5–40), aspartate aminotrans…

Cardiovascular · Clinical rotations · 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 45-year-old man attends a health assessment. He has a sedentary occupation, a waist circumference of 108 cm and a first-degree relative with type 2 diabetes,…

Endocrine and Metabolic · Clinical rotations · middle twist

A 68-year-old man undergoes an abdominal ultrasound arranged during assessment of nonspecific back discomfort. He has no abdominal pain, vascular symptoms or kn…

Cardiovascular · Clinical rotations · middle twist

A 24-year-old man with type 1 diabetes presents with vomiting and abdominal pain. His blood glucose concentration is 28 mmol/L, blood ketones are 6.4 mmol/L and…

Endocrine and Metabolic · Clinical rotations · middle twist

A 29-year-old man with asthma is treated for an acute exacerbation with repeated nebulised salbutamol, ipratropium and corticosteroids. Initially he was agitate…

Respiratory · Clinical rotations · middle twist

A 67-year-old man with alcohol dependence has mild withdrawal 10 hours after his last drink, with anxiety, tremor and nausea but no hallucinations or seizure. H…

Gastroenterology and Hepatology · Mechanisms of disease · middle twist

A 63-year-old man with metastatic squamous cell carcinoma has persistent thirst, vomiting and confusion. After intravenous saline, his serum calcium concentrati…

Renal, Urology and Electrolytes · Clinical rotations · middle twist

A 72-year-old man with diabetic kidney disease takes perindopril and spironolactone. He has a serum potassium concentration of 6.2 mmol/L (3.5–5.2), chloride 11…

Renal, Urology and Electrolytes · Clinical rotations · middle twist

A 68-year-old man with chronic kidney disease is admitted with pneumonia and has received intravenous fluids, calcium gluconate and insulin with glucose for a s…

Renal, Urology and Electrolytes · Clinical rotations · middle twist