Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 30-year-old woman, three weeks after giving birth, has had 24 hours of pain in the left breast. There is a tender, red, wedge-shaped area in the upper outer q…
Paediatrics · Pre-internship · middle twist
A 14-year-old girl has lost 9 kg over five months, restricts herself to about 800 kilojoules a day and exercises for two hours daily. Her heart rate is 58 beats…
Paediatrics · Pre-internship · middle twist
A 15-year-old girl is seen alone at a general practice. During the psychosocial interview she says she has been cutting her left forearm most weeks for three mo…
Paediatrics · Pre-internship · middle twist
A 14-year-old girl has had daily tiredness and central abdominal pain for eight months and has attended school on only nine days this term. Full blood count, in…
Paediatrics · Pre-internship · middle twist
A 14-year-old girl is brought by her mother because her marks have dropped over three months, she has quit netball, and she is irritable and withdrawn. Her pare…
Paediatrics · Pre-internship · middle twist
A 9-year-old boy has primary nocturnal enuresis with no daytime urinary symptoms, normal growth, normal blood pressure and a normal urinalysis. An eight-week al…
Paediatrics · Pre-internship · middle twist
A 2-year-old boy attends with his mother after his childcare educator commented that he "plays on his own". He walks and runs well, uses about sixty single word…
Paediatrics · Pre-internship · middle twist
A 14-year-old boy attends the general practice with his mother because his school marks have collapsed over two terms and he has begun refusing to go on Monday…
Paediatrics · Pre-internship · middle twist
An 18-month-old boy is brought back to the general practice by his father. At his 15-month check he was walking, waving goodbye, using eight words and handing h…
Paediatrics · Pre-internship · middle twist
A boy born at 28 weeks gestation is brought to the general practice at 20 months of age because he is not yet walking. He was discharged home at term with no in…
Paediatrics · Pre-internship · middle twist
A 30-month-old boy is reviewed after the practice nurse completed an Ages and Stages Questionnaire with his mother. He scores below the cut-off for communicatio…
Paediatrics · Pre-internship · middle twist
A 7-month-old girl is brought to a rural general practice. Her weight has fallen from the 50th centile to below the 0.4th centile over three months; her length…
Paediatrics · Pre-internship · middle twist
A 7-month-old boy is brought to the emergency department by his 19-year-old mother because of a cold. His weight has crossed from the 50th percentile at 4 month…
Paediatrics · Pre-internship · middle twist
A 12-year-old boy attends with his mother. His body mass index for age is above the 99.7th percentile on his growth chart, having been on the 92nd percentile at…
Paediatrics · Pre-internship · middle twist
A 13-year-old boy who received a deceased-donor kidney transplant eighteen months ago attends the general practice with his mother. He takes tacrolimus, mycophe…
Paediatrics · Pre-internship · middle twist
You are the resident in a paediatric outpatient clinic. A 15-year-old boy attends for review of his asthma, which is well controlled. At the start you explained…
Paediatrics · Pre-internship · middle twist
You are asked to chart regular paracetamol for a 14-year-old boy on the first day after an open appendicectomy. He weighs 68 kg and is 174 cm tall. He has no li…
Paediatrics · Pre-internship · middle twist
A 4-month-old boy attends for his scheduled immunisations. He was born at term and is thriving. The right hemiscrotum is empty and underdeveloped. The right tes…
Paediatrics · Pre-internship · middle twist
A 10-day-old girl is reviewed before discharge from the special care nursery, where she was admitted for feeding support. She was born at 38 weeks in a frank br…
Paediatrics · Pre-internship · middle twist
You are the intern on the postnatal ward. A healthy term boy was born two hours ago weighing 3400 g. After a full discussion of the risks, both parents decline…
Paediatrics · Pre-internship · middle twist