Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A 63-year-old man collapses in an emergency department waiting room. He is shocked once for ventricular fibrillation and a palpable pulse returns after four min…
Acute Care · Pre-internship · middle twist
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 13-year-old boy weighing 52 kg develops widespread urticaria, a hoarse voice and wheeze about ten minutes after eating a satay skewer at a school camp. He is…
Acute Care · Pre-internship · middle twist
A 46-year-old woman is admitted with two days of vomiting and lightheadedness. Her regular tablets are alendronate, esomeprazole and prednisolone, all of which…
Acute Care · Pre-internship · middle twist
A 24-year-old man is brought to a regional emergency department after his motorcycle struck a guard rail. The ambulance officers report that he lost his output…
Acute Care · Pre-internship · middle twist
A 68-year-old woman is admitted with fever and dysuria. Blood cultures were taken and she received gentamicin and amoxicillin within 40 minutes of arrival. She…
Acute Care · Pre-internship · middle twist
A 34-year-old woman arrives 20 minutes after eating a satay skewer at a food van. She has widespread weals, a hoarse voice and expiratory wheeze. Blood pressure…
Acute Care · Pre-internship · middle twist
A 29-year-old woman, gravida 2 para 1, is 13 weeks and 2 days pregnant by a dating scan at 8 weeks. She has had six hours of moderate vaginal bleeding and cramp…
Acute Care · Pre-internship · middle twist
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
A 44-year-old man presents three hours after a sudden severe occipital headache that reached its worst within a minute while he was straining at stool. He vomit…
Acute Care · Pre-internship · middle twist
A 74-year-old woman describes losing the sight of her right eye over a few seconds while watching television 90 minutes ago. It has not come back and she now se…
Acute Care · Pre-internship · niche
A 26-year-old man is brought to a Perth emergency department by his brother. For six weeks he has slept about two hours a night, has given away his car and most…
Acute Care · Pre-internship · middle twist
An 81-year-old man is three days from a hemiarthroplasty for a fractured neck of femur. Overnight he believes he is on a fishing boat and asks his wife about tw…
Acute Care · Pre-internship · middle twist
A 26-year-old woman weighing 60 kg presents five hours after swallowing an unknown number of immediate-release paracetamol tablets. She is alert with normal obs…
Acute Care · Pre-internship · niche
A 24-year-old motorcyclist is brought in thirty minutes after a high-speed collision. Blood is pulsing from a deep laceration on the medial aspect of his left t…
Acute Care · Pre-internship · middle twist
A 68-year-old man presents with two days of rigors and right flank pain and is confused on arrival. Temperature 38.8 °C, respiratory rate 26/min, heart rate 118…
Acute Care · Pre-internship · middle twist
You are the intern in a Western Australian emergency department. A 3-year-old girl was triaged two hours ago with fever and vomiting. The paediatric registrar r…
Acute Care · Pre-internship · middle twist
A 52-year-old man who lives alone is found drowsy on his kitchen floor and brought in by ambulance. He drinks heavily, is visibly thin, and his neighbour says h…
Acute Care · Pre-internship · middle twist
A 26-year-old woman is brought in three hours after taking about 40 alprazolam tablets with wine. She sleeps but rouses to a loud voice, gags on an oropharyngea…
Acute Care · Pre-internship · niche
An 18-year-old woman took 30 paracetamol tablets after her relationship ended. She has completed acetylcysteine; at 20 hours her alanine aminotransferase is nor…
Acute Care · Pre-internship · middle twist