Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 741 questions.
A healthy boy is born at term after an uncomplicated pregnancy. His mother takes no regular medicines. She tells the midwife she does not want him to have any i…
Paediatrics · Pre-internship · middle twist
A 4-week-old exclusively breastfed boy is brought to the emergency department because he is still yellow. He feeds hungrily and has gained 900 g since birth. Hi…
Paediatrics · Pre-internship · middle twist
A girl born at 36 weeks weighing 2050 g is three hours old and has fed twice at the breast. She becomes jittery with a weak high-pitched cry, and then has an ep…
Paediatrics · Pre-internship · middle twist
A boy born at 38 weeks is 44 hours old on the postnatal ward. His mother attends a treatment program for a daily supervised dose of buprenorphine and reports no…
Paediatrics · Pre-internship · middle twist
A girl born at 38 weeks weighs 2.2 kg and her head circumference is well below the third centile. Scattered purple-red spots over the trunk do not blanch, and t…
Paediatrics · Clinical rotations · middle twist
A boy is born at 39 weeks after spontaneous labour. The membranes ruptured 26 hours before birth and his mother had a temperature of 38.4 degrees during labour;…
Paediatrics · Pre-internship · middle twist
A five-week-old exclusively breastfed boy is brought to the general practitioner because he is still yellow. He was born at term weighing 3.4 kg and now weighs…
Paediatrics · Clinical rotations · middle twist
A 32-year-old woman attends her general practitioner for the six-week postnatal check with her healthy son. She says she is coping, sleeping when he sleeps and…
Paediatrics · Pre-internship · middle twist
A woman who has had no antenatal care presents in advanced labour and gives birth to a boy weighing 2350 g. She is unsure of her dates and there has been no ult…
Paediatrics · Clinical rotations · middle twist
A boy born at 39 weeks by spontaneous vaginal birth is 60 hours old. He has a high-pitched cry, tremors when he is undressed, sneezes repeatedly and takes the b…
Paediatrics · Clinical rotations · middle twist
A woman whose vaginal-rectal swab at 36 weeks grew group B streptococcus labours spontaneously at 39 weeks and 4 days. Her membranes rupture six hours before bi…
Paediatrics · Pre-internship · middle twist
A 15-year-old boy attends the renal clinic two years after a living-donor kidney transplant. He takes tacrolimus, mycophenolate and low-dose prednisolone daily,…
Paediatrics · Pre-internship · middle twist
A 16-year-old girl attends her general practice for a routine health check required before a school leadership camp. She is well, her growth is on the 50th cent…
Paediatrics · Clinical rotations · middle twist
A 15-year-old boy is being cleared to play club rugby. He has never had chest pain, palpitations, breathlessness out of proportion to exertion or blackouts, and…
Paediatrics · Pre-internship · middle twist
A 16-year-old netballer attends for a pre-participation examination. She is asymptomatic. The femoral pulses are strong and synchronous with the radial pulses.…
Paediatrics · Clinical rotations · middle twist
A 16-year-old girl attends a Western Australian general practice alone with three days of lower abdominal pain and vaginal discharge. She is sexually active and…
Paediatrics · Pre-internship · middle twist
A 15-year-old girl in the emergency department tells you, when seen alone, that for the past month she has often thought she would be better off dead. She has n…
Paediatrics · Pre-internship · middle twist
An 11-year-old girl has just been diagnosed with type 1 diabetes and will start insulin today. She is quiet, and her only questions are whether the injections w…
Paediatrics · Pre-internship · middle twist
A 17-year-old man with cystic fibrosis has attended the same paediatric respiratory clinic since infancy and will move to the adult service next year. His mothe…
Paediatrics · Pre-internship · middle twist
A 16-year-old girl with focal epilepsy attends a general practice alone and asks for contraception. She has been seizure-free for two years on carbamazepine and…
Paediatrics · Pre-internship · middle twist