Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 785 questions.
A 31-year-old woman with type 1 diabetes is being treated for diabetic ketoacidosis with intravenous insulin and 0.9% sodium chloride. Four hours later, her blo…
Endocrine and Metabolic · Clinical rotations · common
A 67-year-old woman with type 1 diabetes is admitted with community-acquired pneumonia and is not eating. She normally injects insulin glargine 24 units at nigh…
Emergency and Toxicology · Clinical rotations · common
A 24-year-old man with type 1 diabetes presents with vomiting and abdominal pain. His blood glucose concentration is 28 mmol/L, blood ketones are 6.4 mmol/L and…
Endocrine and Metabolic · Clinical rotations · middle twist
A 74-year-old woman with severe chronic obstructive pulmonary disease presents with increasing dyspnoea and drowsiness during a respiratory infection. On room a…
Respiratory · Clinical rotations · common
A 29-year-old man with asthma is treated for an acute exacerbation with repeated nebulised salbutamol, ipratropium and corticosteroids. Initially he was agitate…
Respiratory · Clinical rotations · middle twist
A 68-year-old man with severe chronic obstructive pulmonary disease presents with increasing breathlessness and purulent sputum. He has received controlled oxyg…
Respiratory · Clinical rotations · common
A 34-year-old woman with asthma remains breathless in the emergency department after three nebulised doses of salbutamol and ipratropium and intravenous hydroco…
Respiratory · Clinical rotations · common
A 29-year-old man presents two days after running out of prescribed oxycodone, which he had been taking in increasing amounts for a year. He is yawning, restles…
Emergency and Toxicology · Clinical rotations · common
A 34-year-old woman presents with anxiety, poor sleep, nausea and a sense that people are watching her. She stopped taking alprazolam 72 hours ago after using 6…
Emergency and Toxicology · Clinical rotations · common
A 46-year-old man with longstanding alcohol dependence has eaten little during two weeks of vomiting. He is inattentive, walks with a broad-based gait and repea…
General Practice and Population Health · Clinical rotations · common
A 63-year-old man with metastatic squamous cell carcinoma has persistent thirst, vomiting and confusion. After intravenous saline, his serum calcium concentrati…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 72-year-old man with diabetic kidney disease takes perindopril and spironolactone. He has a serum potassium concentration of 6.2 mmol/L (3.5–5.2), chloride 11…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 29-year-old man presents after completing an unusually strenuous cross-country event with severe thigh pain and dark urine. His creatinine concentration is 28…
Renal, Urology and Electrolytes · Clinical rotations · common
A 54-year-old woman is treated for symptomatic hyponatraemia that has probably been present for several days. Her initial serum sodium concentration was 108 mmo…
Renal, Urology and Electrolytes · Clinical rotations · niche
A 68-year-old man with chronic kidney disease is admitted with pneumonia and has received intravenous fluids, calcium gluconate and insulin with glucose for a s…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
An 82-year-old woman becomes confused and unsteady over three days while being treated for depression and hypertension. She is euvolaemic, her serum sodium is 1…
Geriatrics and Palliative Care · Clinical rotations · common
A 74-year-old man is referred for six months of recurrent falls. He reports that his feet sometimes seem stuck to the floor when he starts walking, and he takes…
Geriatrics and Palliative Care · Clinical rotations · common
An 81-year-old man is admitted with a fractured neck of femur and becomes inattentive and disorganised over 24 hours. His level of alertness fluctuates, but he…
Geriatrics and Palliative Care · Clinical rotations · common
An 82-year-old woman is assessed after falling in her kitchen. She remembers reaching for a shelf but denies spinning, loss of consciousness, palpitations or li…
Geriatrics and Palliative Care · Clinical rotations · common
A 30-year-old woman at 30+2 weeks has hypertension controlled with oral therapy and an ultrasound-estimated fetal weight below the third centile. Umbilical arte…
Obstetrics and Gynaecology · Clinical rotations · middle twist