Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A 71-year-old man says the vision in his right eye switched off ninety minutes ago, without pain. He can count fingers only on that side. The right pupil dilate…
Ophthalmology · Pre-internship · middle twist
A 74-year-old woman has had a new right-sided headache for three weeks and says her scalp is sore when she brushes her hair. She has begun stopping halfway thro…
Ophthalmology · Pre-internship · middle twist
A 47-year-old man was hammering a steel chisel without eye protection when he felt something strike his left eye an hour ago. Visual acuity is 6/60 on the left…
Ophthalmology · Pre-internship · common
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
A 22-year-old student attends a rural emergency department at 9 pm with a painful red left eye. She wears monthly soft contact lenses and slept in them last nig…
Ophthalmology · Pre-internship · middle twist
You are the intern on a Perth surgical ward. Overnight a 74-year-old woman received ten times the intended dose of insulin because of a prescribing error you ma…
Acute Care · Pre-internship · middle twist
An 81-year-old man had a large left middle cerebral artery infarct ten days ago. He cannot swallow safely and can neither understand nor communicate a decision.…
Acute Care · Pre-internship · middle twist
A 62-year-old Aboriginal woman from a remote Kimberley community is admitted to a Broome hospital with small bowel obstruction and listed for laparotomy on tomo…
Acute Care · Pre-internship · middle twist
You are the intern covering a paediatric ward at a Perth public hospital at 2100. The mother of a 6-year-old boy admitted this morning with fever and vomiting s…
Acute Care · Pre-internship · middle twist
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 62-year-old woman attends the emergency department after tripping on a step. She has a grazed knee, is otherwise well, takes only atorvastatin and passes urin…
Acute Care · Pre-internship · middle twist
A 6-year-old girl falls from the monkey bars onto an outstretched right hand. She holds the elbow semi-flexed with diffuse swelling over the distal humerus, and…
Acute Care · Pre-internship · middle twist
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
A 17-year-old boy returns to the emergency department 18 hours after a below-knee plaster cast was applied for an undisplaced fracture of the distal tibia. He h…
Acute Care · Pre-internship · common
A 41-year-old woman is bitten by her cat three hours ago. She has two puncture wounds over the dorsum of the right hand, one of them directly over the second me…
Acute Care · Pre-internship · middle twist
A 26-year-old man who moved to Australia two years ago stands on a nail while clearing out a chicken run. He presents 30 hours later with a deep puncture throug…
Acute Care · Pre-internship · middle twist
A 27-year-old man is brought in after his motorcycle struck a guardrail. A binder has been applied for an open-book pelvic fracture and he is haemodynamically s…
Acute Care · Pre-internship · middle twist
An 88-year-old woman in residential aged care has had an indwelling urethral catheter for eight months for a neurogenic bladder, and it will be needed indefinit…
Acute Care · Pre-internship · middle twist
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