Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 382 questions.
A 13-year-old boy is brought by his father because of daily shouting matches at home over the past 18 months. He argues with every request, swears at his parent…
Psychiatry · Clinical rotations · middle twist
An 11-year-old girl has missed 14 days of school this term. On school mornings she has stomach ache and vomits, and settles completely once she is told she may…
Psychiatry · Clinical rotations · middle twist
A 15-year-old boy is referred by the Children's Court after a series of thefts. His mother reports that from the age of eight he lit fires in the backyard and r…
Psychiatry · Clinical rotations · middle twist
A 19-year-old university student is seen the morning after taking twelve paracetamol tablets and scratching her forearm, three weeks after her parents separated…
Psychiatry · Clinical rotations · middle twist
A 56-year-old man is referred by his employer after lodging a third complaint alleging that colleagues are conspiring to have him dismissed. He keeps a dated fo…
Psychiatry · Clinical rotations · middle twist
A 29-year-old woman has been treated for "depression" for six years and has now been referred for electroconvulsive therapy after adequate trials of three antid…
Psychiatry · Clinical rotations · middle twist
A 44-year-old accountant has had trouble getting to sleep for eight months. She goes to bed at 9.30 pm hoping to catch up, then lies awake for two or three hour…
Psychiatry · Clinical rotations · middle twist
A 45-year-old man with major depressive disorder has been treated for seven weeks and his mood has clearly improved. He now reports intensely vivid, unpleasant…
Psychiatry · Clinical rotations · middle twist
A 24-year-old primary school teacher is referred because of painless swelling at the angles of both jaws over four months. She is 165 cm tall and weighs 61 kg,…
Psychiatry · Clinical rotations · middle twist
A 34-year-old operating theatre nurse has had eight admissions in a year with episodes of sweating and confusion. Today her blood glucose is 1.6 mmol/L (3.0 to…
Psychiatry · Clinical rotations · middle twist
A 46-year-old man has consulted five doctors in two years convinced he has bowel cancer. He has had three colonoscopies, all normal, and inspects his stool ever…
Psychiatry · Clinical rotations · middle twist
A 20-year-old warehouse worker has spent five hours a day washing since he handled a leaking drum of solvent three months ago. He is certain he will poison his…
Psychiatry · Clinical rotations · middle twist
A 24-year-old woman is referred because of mood swings since her late teens. Twice in two years she has had six-day spells of sleeping three hours a night, talk…
Psychiatry · Clinical rotations · middle twist
A 71-year-old man is three months into rehabilitation after a left middle cerebral artery infarct. He eats little and has lost 4 kg. He wakes at 4 am and cannot…
Psychiatry · Clinical rotations · middle twist
A 24-year-old man has recovered from his first episode of schizophrenia and has been well on aripiprazole for four months. He has moved back in with his parents…
Psychiatry · Clinical rotations · middle twist
A 19-year-old man is brought to the emergency department by police after being found shouting at parked cars. He is guarded, gives his name and little else, and…
Psychiatry · Clinical rotations · middle twist
A 25-year-old man has taken risperidone 4 mg at night for six months for schizophrenia, and his voices and persecutory beliefs have gone. His mother says he now…
Psychiatry · Clinical rotations · middle twist
A 47-year-old woman, whose mother died six weeks ago, tells her general practitioner that she has three times seen and spoken with her mother in the family home…
Psychiatry · Clinical rotations · middle twist
A 29-year-old man is seen by the consultation-liaison team. Over the past twelve months he has needed steadily more alcohol for the same effect, has twice tried…
Psychiatry · Clinical rotations · middle twist
A 68-year-old woman is admitted after a fall at home. She says she takes 'a sleeping tablet now and then' and drinks 'a small sherry before bed'. Her speech is…
Psychiatry · Clinical rotations · middle twist