Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 309 questions.
A 14-year-old girl attends a Western Australian general practice on her own for what she calls a check-up. During the consultation she tells you she has been ha…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl is brought to a regional emergency department by her mother after fainting at school. Over five months she has cut all fats from her diet and…
Psychiatry · Pre-internship · middle twist
A 22-year-old woman presents to the emergency department having cut her forearms after an argument with her flatmate. She describes two hours in which she felt…
Psychiatry · Pre-internship · middle twist
A 29-year-old woman was admitted three weeks ago unable to walk. Magnetic resonance imaging of brain and whole spine, nerve conduction studies and cerebrospinal…
Psychiatry · Pre-internship · middle twist
A 26-year-old woman has been an inpatient for three weeks with recurrent bloodstream infections through her central venous catheter, growing a different mix of…
Psychiatry · Pre-internship · middle twist
A 38-year-old labourer has been off work for nine months with back pain after a workplace lift, and his compensation claim is being contested. On examination he…
Psychiatry · Pre-internship · middle twist
A 30-year-old woman is brought to the emergency department unable to walk after a heated argument with her mother. Her right leg lies flaccid and she cannot lif…
Psychiatry · Pre-internship · middle twist
A 33-year-old woman has had five months of nightmares, flashbacks and hypervigilance since her partner strangled her. She still lives with him and was assaulted…
Psychiatry · Pre-internship · middle twist
A 24-year-old man avoids parties, will not eat in the staff cafeteria, cannot bring himself to ask a shop assistant for help, and has turned down a promotion be…
Psychiatry · Pre-internship · middle twist
A 58-year-old man is on the surgical ward on the second day after an elective inguinal hernia repair. He is anxious and sweating, his hands tremble, and he has…
Psychiatry · Pre-internship · middle twist
A 27-year-old man with obsessive compulsive disorder has checking rituals that make him two hours late for work most days. He completed 16 sessions of cognitive…
Psychiatry · Pre-internship · middle twist
A 29-year-old woman is seen at home on day 10 after an uncomplicated birth. She describes repeated images of stabbing her baby that come into her mind while she…
Psychiatry · Pre-internship · middle twist
A 29-year-old man with bipolar I disorder is reviewed in the community mental health clinic. He was admitted at 22 with a manic episode and stopped lithium thre…
Psychiatry · Pre-internship · middle twist
A 46-year-old woman has been fully well for eight months on sertraline 100 mg daily. This is her fourth depressive episode; the previous three, at 30, 34 and 39…
Psychiatry · Pre-internship · middle twist
A 79-year-old woman was started on sertraline three weeks ago for her first depressive episode. Her daughter brings her to the emergency department because over…
Psychiatry · Pre-internship · middle twist
A 64-year-old woman attends the general practice with six weeks of low mood, tearfulness, broken sleep and loss of interest in everything she used to enjoy. Fiv…
Psychiatry · Pre-internship · middle twist
A 27-year-old man is assessed in the emergency department short-stay unit with three weeks of low mood, waking at 4 am and hopelessness. He has had two similar…
Psychiatry · Pre-internship · middle twist
A 22-year-old university student had her first episode of psychosis nine months ago and has been in full remission on aripiprazole for the past seven months. Sh…
Psychiatry · Pre-internship · middle twist
A 27-year-old man with schizophrenia took risperidone 6 mg daily for ten weeks and then olanzapine 20 mg daily for twelve weeks. His case manager supervises eac…
Psychiatry · Pre-internship · middle twist
A 21-year-old man is brought to a regional emergency department at 2 am by police after he was found standing on a freeway overpass. He says a voice has been te…
Psychiatry · Pre-internship · middle twist