Niche but important
Rare, but missing it harms. 109 questions.
A resident is completing the discharge summary for a woman treated for a first manic episode. The diagnosis was made at the bedside against the criteria in the…
Psychiatry · Pre-internship · niche
A 22-year-old woman is admitted with three weeks of rapidly worsening persecutory beliefs and speech that is increasingly hard to follow. In the last week her f…
Psychiatry · Pre-internship · niche
A 24-year-old man with treatment-resistant schizophrenia is on day 18 of clozapine, now 250 mg at night. He is febrile at 38.4 degrees Celsius with a pulse of 1…
Psychiatry · Pre-internship · niche
An 81-year-old woman who came to Australia from Vietnam at the age of 45 is referred because her family say she forgets appointments and repeats herself. She le…
Psychiatry · Clinical rotations · niche
A 54-year-old Aboriginal man attends his general practice in a regional town for a diabetes review. Type 2 diabetes was diagnosed four years ago. His HbA1c is 5…
Ophthalmology · Clinical rotations · niche
A 68-year-old woman arrives at 10 pm vomiting, with a painful red right eye and rings around the streetlights. The right cornea is cloudy, the pupil is mid-dila…
Ophthalmology · Pre-internship · niche
An 82-year-old woman is admitted overnight with a fractured neck of femur after a fall at home. She has had no chest pain, breathlessness or palpitations. Preop…
Acute Care · Pre-internship · niche
A 9-year-old boy is brought to a regional emergency department after a heavy tackle at football. He is alert and orientated with a Glasgow Coma Scale score of 1…
Acute Care · Clinical rotations · niche
A 24-year-old man comes off a trail bike at speed and arrives in a semi-rigid cervical collar and head blocks applied at the scene. He opens his eyes to voice,…
Acute Care · Pre-internship · niche
You are the intern covering a medical ward at 2 am. A 61-year-old woman with cirrhosis due to hepatitis C is admitted with hepatic encephalopathy; she is drowsy…
Acute Care · Pre-internship · niche
A 74-year-old man with type 2 diabetes is brought to the emergency department by his wife because he has become sweaty, tremulous and muddled at home. His capil…
Acute Care · Pre-internship · niche
A 24-year-old woman is admitted with an exacerbation of asthma. After an hour of nebulised salbutamol and ipratropium and oral prednisolone she is speaking in f…
Acute Care · Pre-internship · niche
A 70 kg man is brought to the emergency department three hours after his clothing caught fire at a campsite. He has deep burns covering 40% of his total body su…
Acute Care · Pre-internship · niche
A 71-year-old man is on day 2 after a Hartmann procedure for perforated diverticulitis. He remains nil by mouth and his nasogastric tube has drained 1400 mL in…
Acute Care · Pre-internship · niche
A 62-year-old man collapses in a hospital foyer and is found to be in ventricular fibrillation. Compressions have been continuous, adrenaline 1 mg has been give…
Acute Care · Pre-internship · niche
A 66-year-old man has had ninety minutes of central chest pain with sweating. His electrocardiogram shows 3 mm ST elevation in leads II, III and aVF with ST dep…
Acute Care · Pre-internship · niche
A 46-year-old man who came to Australia from South Sudan eight years ago is on the fourth day of treatment for community-acquired pneumonia. Asked by the nurse…
Acute Care · Pre-internship · niche
A 7-month-old infant on a children's ward is found unresponsive and making occasional gasps. You and the paediatric registrar, both trained in paediatric basic…
Acute Care · Pre-internship · niche
A 58-year-old man who works at a piggery near Griffith, New South Wales, is brought in one February with four days of fever and headache and one day of confusio…
Acute Care · Clinical rotations · niche
A 47-year-old man is reviewed in the cardiology clinic after a single episode of loss of consciousness while sitting at his desk. There was no warning and no pa…
Acute Care · Pre-internship · niche