Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 785 questions.
A 63-year-old woman reports several months of bone pain and difficulty climbing stairs. She has no focal neurological deficit. Serum calcium is 2.19 mmol/L (2.1…
Endocrine and Metabolic · Clinical rotations · common
A 48-year-old woman has a slowly enlarging thyroid nodule, intermittent diarrhoea and facial flushing. Her TSH is 1.6 mIU/L (0.4–4.0), and serum calcitonin is 1…
Endocrine and Metabolic · Clinical rotations · common
A 61-year-old man has a 1.5-cm thyroid nodule with a solid markedly hypoechoic appearance, irregular margins and punctate echogenic foci on ultrasound. His TSH…
Endocrine and Metabolic · Clinical rotations · common
A 52-year-old woman has progressive headaches and difficulty seeing objects to either side. MRI shows a 2.6-cm sellar mass elevating and compressing the optic c…
Endocrine and Metabolic · Clinical rotations · middle twist
A 44-year-old man has an incidental 8-mm pituitary lesion discovered during MRI for headaches. He has normal visual fields, normal pituitary hormone testing, an…
Endocrine and Metabolic · Clinical rotations · middle twist
A 58-year-old man is found to have a serum calcium concentration of 2.78 mmol/L (2.15–2.55) on two occasions. His phosphate is 0.72 mmol/L (0.80–1.50), creatini…
Endocrine and Metabolic · Clinical rotations · common
A 42-year-old woman has progressive fatigue, reduced appetite and dizziness when standing. Her serum sodium is 127 mmol/L (135–145), potassium is 5.8 mmol/L (3.…
Endocrine and Metabolic · Clinical rotations · common
A 46-year-old man notices sudden hearing loss in his left ear on waking 48 hours ago. He has no pain, discharge or recent upper respiratory infection, and otosc…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 15-year-old boy has six months of recurrent, predominantly right-sided epistaxis and progressive right nasal obstruction. He has no fever or facial pain, and…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 59-year-old man presents with eight hours of continuous vertigo, vomiting and difficulty walking. He has spontaneous right-beating nystagmus and no hearing lo…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 14-month-old child has fever and irritability after several days of coryza. The child is pulling at the right ear and wakes repeatedly overnight. Otoscopy sho…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 64-year-old woman develops sudden, profound painless loss of vision in her left eye 90 minutes before assessment. The left pupil has a relative afferent pupil…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 71-year-old man develops severe pain and blurred vision in his right eye over two hours. He reports coloured haloes around lights and nausea; examination show…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 38-year-old woman experiences brief episodes of spinning when she rolls over in bed or looks upward. Each episode lasts less than a minute, and she is well be…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 42-year-old woman presents with recurrent anterior epistaxis from the right nostril. She is haemodynamically stable, and firm compression for 15 minutes plus…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 34-year-old swimmer has had increasing right ear pain for three days. Moving the pinna and pressing the tragus markedly worsen the pain, and the external cana…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 67-year-old man notices flashes of light and a sudden increase in dark spots in his right eye. Several hours later he describes a grey curtain progressing fro…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 58-year-old woman presents with a unilateral red eye that began this morning. She reports marked discomfort and says bright light is unpleasant, but has no hi…
Eyes, Ears, Nose and Throat · Clinical rotations · common
A 29-year-old woman presents with painful genital lesions that began as small blisters 3 days ago. She describes burning on urination and has bilateral tender i…
General Practice and Population Health · Clinical rotations · common
A 31-year-old woman attends for routine care and has never had cervical screening. She has no abnormal bleeding, pelvic pain or visible cervical lesion. A self-…
Obstetrics and Gynaecology · Clinical rotations · niche