Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 785 questions.
A 58-year-old man with established alcohol-related cirrhosis presents with two episodes of black, offensive stool and light-headedness. His blood pressure is 10…
Infectious Diseases · Clinical rotations · middle twist
A 32-year-old woman shares a bedroom with her partner, who has been admitted with laboratory-confirmed meningococcal meningitis. She has no fever or rash and fe…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 41-year-old man undergoes urgent debridement for a necrotising infection of the calf. Initial broad-spectrum treatment has been given, and deep tissue culture…
Emergency and Toxicology · Clinical rotations · middle twist
A 63-year-old man is admitted with fever, hypotension and rapidly progressive cellulitis of the forearm. He had been licked on an excoriated hand by his daughte…
Emergency and Toxicology · Clinical rotations · common
A 35-year-old woman at 35 weeks of pregnancy presents with vomiting, malaise and jaundice. She is normotensive, has no proteinuria and has mild right upper quad…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 21-year-old university student notices yellowing of his eyes after several days of restricted food intake during examinations. He is otherwise well and has no…
Gastroenterology and Hepatology · Clinical rotations · common
A 42-year-old woman has 18 months of fatigue, pruritus and intermittent discomfort beneath the right costal margin. Alkaline phosphatase is 410 U/L (30–110), al…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 52-year-old man attends for a health assessment. He does not smoke, has no diabetes, chronic kidney disease or established cardiovascular disease, and his fat…
Cardiovascular · Clinical rotations · middle twist
A 46-year-old woman has a body mass index of 32 kg/m² and treated hypertension. Her mother developed type 2 diabetes at 58 years of age. She has no polyuria, po…
Endocrine and Metabolic · Clinical rotations · middle twist
A 68-year-old man taking gliclazide modified release for type 2 diabetes is found drowsy with a blood glucose concentration of 2.1 mmol/L. He improves after int…
Emergency and Toxicology · Clinical rotations · middle twist
A 24-year-old woman with type 1 diabetes presents with abdominal pain, vomiting and deep breathing. Her blood glucose concentration is 24 mmol/L, venous pH is 7…
Endocrine and Metabolic · Clinical rotations · middle twist
A 24-year-old woman with asthma remains breathless after repeated nebulised salbutamol and ipratropium, intravenous hydrocortisone and oxygen. She can speak onl…
Respiratory · Clinical rotations · common
A 3-year-old boy who previously used short sentences has stopped speaking over the past six weeks. His parents also report that he no longer understands familia…
Paediatrics · Clinical rotations · middle twist
A 78-year-old woman becomes agitated and repeatedly pulls at her intravenous line on the second night after hip surgery. She alternates between asking where she…
Geriatrics and Palliative Care · Clinical rotations · common
A 29-year-old man is brought in shortly after his partner administered naloxone for suspected heroin overdose. He is yawning repeatedly, has abdominal cramps, d…
Emergency and Toxicology · Clinical rotations · common
A 72-year-old woman with newly diagnosed multiple myeloma presents with confusion, constipation and weakness. Her serum calcium is 4.18 mmol/L (2.10–2.60), crea…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 46-year-old man is found vomiting beside an open container of an automotive fluid. He has tachypnoea, flank pain and oliguria; arterial blood gas analysis sho…
Emergency and Toxicology · Clinical rotations · common
A 29-year-old woman presents with headache, confusion and reduced urine output. She is pale and has scattered petechiae; investigations show haemoglobin 78 g/L…
Haematology and Oncology · Clinical rotations · middle twist
A 24-year-old woman is brought to the emergency department after drinking approximately 8 L of water during a long-distance event. She is drowsy and has a serum…
Neurology · Clinical rotations · common
A 68-year-old man with chronic kidney disease presents with weakness after spironolactone was added to his medicines. His serum potassium is 7.0 mmol/L (3.5–5.2…
Cardiovascular · Clinical rotations · common