Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 785 questions.
A 78-year-old man presents with an anterior ST-elevation myocardial infarction at a hospital where primary percutaneous coronary intervention cannot be delivere…
Cardiovascular · Clinical rotations · middle twist
A 64-year-old man becomes hypotensive shortly after reperfusion of an inferior ST-elevation myocardial infarction. He is distressed but has clear breath sounds,…
Cardiovascular · Clinical rotations · common
A 67-year-old man is recovering on the fourth day after an inferior myocardial infarction treated with primary percutaneous coronary intervention. He suddenly d…
Cardiovascular · Clinical rotations · common
A 41-year-old woman has been stable on clozapine for 18 months but presents with fever, painful swallowing and malaise. Her temperature is 38.5°C and her absolu…
Haematology and Oncology · Clinical rotations · common
A 48-year-old man presents with severe persecutory psychosis and requires medication after verbal de-escalation has failed. He has no history of cardiac disease…
Psychiatry and Mental Health · Clinical rotations · middle twist
A 26-year-old man with schizophrenia stopped taking lorazepam prescribed for recurrent episodes of immobility and mutism. Two days later he is mute, alternates…
Psychiatry and Mental Health · Clinical rotations · niche
A 72-year-old man with Parkinson disease has developed distressing visual experiences over the past month. His wife reports that he sets places at the table for…
Psychiatry and Mental Health · Clinical rotations · niche
A 58-year-old man is being treated with unfractionated heparin for a proximal deep vein thrombosis. On day 7, his platelet count has fallen from 224 to 86 × 10⁹…
Cardiovascular · Clinical rotations · common
A 31-year-old woman developed a proximal deep vein thrombosis at 32 weeks gestation and has received therapeutic low-molecular-weight heparin since diagnosis. S…
Obstetrics and Gynaecology · Clinical rotations · common
A 42-year-old woman has a second proximal deep vein thrombosis while taking rivaroxaban regularly for a previous unprovoked event. Her renal function is normal…
Cardiovascular · Clinical rotations · middle twist
A 66-year-old man with metastatic gastric adenocarcinoma develops a symptomatic proximal deep vein thrombosis. He has a friable gastric lesion with recent occul…
Cardiovascular · Clinical rotations · middle twist
A 29-year-old woman at 28 weeks gestation presents with sudden pleuritic chest pain and breathlessness. Her pulse is 108/min, oxygen saturation is 97% on room a…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 25-year-old woman had a levonorgestrel-releasing intrauterine device inserted six months ago. She now has a missed period, lower abdominal pain worse on the r…
Obstetrics and Gynaecology · Clinical rotations · common
A 39-year-old woman wants reliable contraception and has heavy, painful periods. She is taking rifampicin for tuberculosis and has no uterine abnormality on exa…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 47-year-old woman has developed bleeding between otherwise irregular periods over the past four months. She has a body mass index of 36 kg/m² and polycystic o…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 34-year-old woman who is breastfeeding at four weeks after birth requests contraception. She has migraine with visual aura and reports that her periods were p…
Obstetrics and Gynaecology · Clinical rotations · common
A 38-year-old woman presents with two days of very heavy bleeding during an otherwise predictable menstrual cycle. Her blood pressure is 118/72 mmHg, she is not…
Obstetrics and Gynaecology · Clinical rotations · common
A 42-year-old man was treated with radioactive iodine for Graves disease three days ago. He now reports dry mouth and painful swelling in front of both ears, wo…
Geriatrics and Palliative Care · Clinical rotations · common
A 34-year-old woman taking carbimazole for Graves disease presents with fever, malaise and two painful oral ulcers. She has a temperature of 38.7°C and mild cer…
Endocrine and Metabolic · Clinical rotations · common
A 49-year-old woman with a recently diagnosed adrenal pheochromocytoma requires drainage of a painful dental abscess before definitive tumour surgery. Her blood…
Emergency and Toxicology · Clinical rotations · niche