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 primary adrenal insufficiency is scheduled for multiple dental extractions under general anaesthesia. He takes hydrocortisone 20 mg in th…
Endocrine and Metabolic · Clinical rotations · common
A 46-year-old woman taking prednisolone 7.5 mg each morning for polymyalgia rheumatica requires extraction of one mobile premolar. She is otherwise well, has ta…
Endocrine and Metabolic · Clinical rotations · middle twist
A 46-year-old woman presents with fatigue, jaundice and dark urine that began after a respiratory infection. She has mild splenomegaly but no renal or neurologi…
AMC · Clinical rotations · common
A 35-year-old woman presents with bruising, gum bleeding and increasing lethargy. Her haemoglobin is 84 g/L (115–155), platelet count 18 × 10^9/L (150–400), whi…
AMC · Clinical rotations · middle twist
A 27-year-old woman has painless enlargement of the left side of her neck and drenching night sweats. She has no sore throat, dental symptoms or recent travel.…
AMC · Clinical rotations · common
A 29-year-old man presents with fever, bruising and aching in the long bones. He has pallor, scattered petechiae and a spleen palpable 2 cm below the costal mar…
AMC · Clinical rotations · middle twist
A 74-year-old man reports several months of fatigue and burning of his feet. He has a smooth, sore tongue and impaired vibration sense at both ankles. His haemo…
AMC · Clinical rotations · common
A 31-year-old woman at 9 weeks of pregnancy presents with vaginal bleeding and cramping after passing several clots. Her pulse is 88 beats/minute, blood pressur…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 34-year-old woman is reviewed after treatment with single-dose intramuscular methotrexate for a confirmed, unruptured tubal ectopic pregnancy. She remains wel…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 24-year-old woman at 10 weeks of pregnancy has vomited repeatedly for three weeks and has lost 7 kg. She is alert, with a pulse of 104 beats/minute and blood…
Obstetrics and Gynaecology · Clinical rotations · common
A 27-year-old woman with a desired pregnancy presents at 8 weeks with mild vaginal bleeding but no pain. Transvaginal ultrasonography shows an intrauterine gest…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 29-year-old woman has 6 weeks of amenorrhoea and two days of increasing right iliac fossa pain. Transvaginal ultrasonography shows a 30-mm right tubal gestati…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 32-year-old woman presents at 7 weeks of pregnancy with left lower abdominal pain and light vaginal bleeding. The pregnancy followed in-vitro fertilisation, a…
Obstetrics and Gynaecology · Clinical rotations · common
Nine days after a vaginal birth, a woman presents with recurrent bleeding, a temperature of 38.3°C and lower abdominal pain. The uterus is tender and larger tha…
Obstetrics and Gynaecology · Clinical rotations · middle twist
Immediately after delivery, a woman becomes pale and hypotensive and reports severe pelvic pain. A smooth, dark-red mass is visible at the introitus; the placen…
Obstetrics and Gynaecology · Clinical rotations · middle twist
Thirty-five minutes after a vaginal birth, the placenta has not separated and the woman has lost 900 mL of blood. The uterus is firm, the placenta is palpable a…
Obstetrics and Gynaecology · Clinical rotations · common
A 29-year-old woman has a 1.4 L haemorrhage after an uncomplicated vaginal birth. The placenta is complete and there is no vaginal or cervical tear. Despite ute…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 72-year-old woman with severe chronic obstructive pulmonary disease is admitted with worsening breathlessness. Her pulse is irregular at 118 beats per minute.…
Cardiovascular · Clinical rotations · middle twist
A 67-year-old man with a previous anterior myocardial infarction develops palpitations while being monitored in hospital. He is alert, has a blood pressure of 1…
Cardiovascular · Clinical rotations · common
A 29-year-old man presents with palpitations and light-headedness. His pulse is irregular at 190 beats per minute and the blood pressure is 126/74 mmHg. The ECG…
Cardiovascular · Clinical rotations · niche