Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A 63-year-old man with renal colic is receiving morphine 2.5 mg intravenously every 5 minutes on your instruction. He has now had 12.5 mg and says the pain has…
Acute Care · Pre-internship · middle twist
A 5-year-old boy is pulled from a backyard swimming pool in Mandurah after an unknown time under the water. He is limp and blue and is not breathing normally. H…
Acute Care · Pre-internship · middle twist
A 34-year-old bushwalker is winched out of a gully in the Stirling Range after a night in cold rain. He is unresponsive and pulseless. Cardiopulmonary resuscita…
Acute Care · Pre-internship · middle twist
A 19-year-old man walks into a small country hospital 40 minutes after being bitten on the right calf by a snake he disturbed while moving hay bales. A bystande…
Acute Care · Pre-internship · middle twist
A 68-year-old woman having a computed tomography scan develops flushing, wheeze and hypotension eight minutes after the intravenous contrast injection. She take…
Acute Care · Pre-internship · niche
A 22-year-old man is brought in 20 minutes after eating a satay skewer at a food van. On arrival he had widespread welts, audible wheeze and a blood pressure of…
Acute Care · Pre-internship · middle twist
An 81-year-old woman was brought from a residential aged care facility two hours ago with fever and dysuria; her observations were normal at triage and she was…
Acute Care · Pre-internship · middle twist
You are the intern on an evening shift at a public hospital in Perth. A 3-year-old boy was admitted this morning with a febrile illness. His mother has told the…
Acute Care · Pre-internship · middle twist
A 79-year-old woman is brought in drowsy and clammy after two episodes of collapse at home. The monitor shows complete heart block with a ventricular rate of 34…
Acute Care · Pre-internship · middle twist
A 58-year-old man had a witnessed collapse at a shopping centre. Bystanders started compressions, ambulance officers delivered one shock, and spontaneous circul…
Acute Care · Pre-internship · middle twist
A 4-year-old boy weighing 16 kg has had profuse watery diarrhoea and vomiting for three days and has not passed urine since yesterday. In the emergency departme…
Acute Care · Pre-internship · middle twist
A 63-year-old man with two hours of chest pain has 3 mm of ST elevation in leads II, III and aVF. He is alert but cold and clammy. Pulse is 52 beats per minute…
Acute Care · Pre-internship · middle twist
A 5-year-old girl weighing 20 kg is admitted with right lower lobe pneumonia. She is febrile at 38.9 degrees Celsius, saturating 93% on 2 litres per minute of o…
Acute Care · Pre-internship · middle twist
A 71-year-old man noticed slurred speech 90 minutes ago while watching television and his wife drove him straight in. He speaks with a mild slur that is fully i…
Acute Care · Pre-internship · niche
A 79-year-old woman is admitted with ongoing lower gastrointestinal bleeding and a haemoglobin concentration of 72 g/L (reference range 115–155). She is receivi…
Cardiovascular · Pre-internship · middle twist
A 74-year-old woman presents with sudden passage of a large volume of dark red blood per rectum. After two litres of intravenous crystalloid her blood pressure…
Emergency and Toxicology · Pre-internship · middle twist
A 24-year-old man presents with two days of sore throat, fever and increasing difficulty swallowing. He has muffled speech, tender cervical nodes and a grey-whi…
Infectious Diseases · Pre-internship · middle twist
A 26-year-old woman with asthma is reviewed after three hours of emergency department treatment with inhaled salbutamol and ipratropium, systemic corticosteroid…
Respiratory · Pre-internship · middle twist
An 82-year-old woman has fallen twice since her medicines were changed. She is slower when walking and has recently complained of constipation, blurred vision a…
Geriatrics and Palliative Care · Pre-internship · common
A 46-year-old man wakes with markedly reduced hearing in his right ear and a continuous high-pitched noise. He has no pain, discharge or recent infection, and t…
Emergency and Toxicology · Pre-internship · middle twist