Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
You are the intern covering an orthopaedic ward at 11 pm on the third night after a 78-year-old woman's hip hemiarthroplasty. The nurse says she has not slept,…
Psychiatry · Pre-internship · middle twist
A 58-year-old man has slept poorly for three weeks since his brother died, and is now making errors at work. Sleep hygiene advice and relaxation training have n…
Psychiatry · Pre-internship · middle twist
A 17-year-old with attention deficit hyperactivity disorder has taken immediate-release methylphenidate 10 mg at 8 am and 10 mg at 1 pm for two years, sleeping…
Psychiatry · Pre-internship · middle twist
A 68-year-old retired plumber is brought by his wife, who says that for eight months, mostly in the hours before dawn, he shouts, kicks and swings his arms whil…
Psychiatry · Pre-internship · middle twist
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 16-year-old boy with anorexia nervosa weighing 39 kg was admitted three days ago and nasogastric feeding was commenced and increased daily. He has received th…
Psychiatry · Pre-internship · niche
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 26-year-old woman with a two-year eating disorder is admitted with cramps and profound weakness. She weighs 58 kg and has not lost weight. She denies vomiting…
Psychiatry · Pre-internship · niche
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 26-year-old woman with a history of childhood sexual abuse collapses in the emergency department waiting room and develops generalised shaking. Twelve minutes…
Psychiatry · Pre-internship · niche
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 36-year-old woman was abused by a relative between the ages of six and sixteen. She has nightmares about it, avoids the suburb where it happened and startles…
Psychiatry · Pre-internship · niche
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