Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A woman arrives at a remote clinic in labour, having had no antenatal care and no dating ultrasound. She gives birth to a girl weighing 1980 g who cries at birt…
Paediatrics · Pre-internship · common
A woman whose vaginal-rectal swab at 36 weeks grew group B streptococcus labours spontaneously at 39 weeks and 4 days. Her membranes rupture six hours before bi…
Paediatrics · Pre-internship · middle twist
A term boy is 32 hours old and was recorded as normal at the newborn check. He now feeds slowly and tires, is mottled and cool to the knees, and his capillary r…
Paediatrics · Pre-internship · niche
A 15-year-old boy attends the renal clinic two years after a living-donor kidney transplant. He takes tacrolimus, mycophenolate and low-dose prednisolone daily,…
Paediatrics · Pre-internship · middle twist
A 15-year-old boy is being cleared to play club rugby. He has never had chest pain, palpitations, breathlessness out of proportion to exertion or blackouts, and…
Paediatrics · Pre-internship · middle twist
A 16-year-old girl attends a Western Australian general practice alone with three days of lower abdominal pain and vaginal discharge. She is sexually active and…
Paediatrics · Pre-internship · middle twist
A 15-year-old girl in the emergency department tells you, when seen alone, that for the past month she has often thought she would be better off dead. She has n…
Paediatrics · Pre-internship · middle twist
An 11-year-old girl has just been diagnosed with type 1 diabetes and will start insulin today. She is quiet, and her only questions are whether the injections w…
Paediatrics · Pre-internship · middle twist
A 17-year-old man with cystic fibrosis has attended the same paediatric respiratory clinic since infancy and will move to the adult service next year. His mothe…
Paediatrics · Pre-internship · middle twist
A 16-year-old girl with focal epilepsy attends a general practice alone and asks for contraception. She has been seizure-free for two years on carbamazepine and…
Paediatrics · Pre-internship · middle twist
A 17-year-old boy attends a sexual health clinic alone. Five days ago he had receptive anal intercourse without a condom with a man he met online, whose HIV sta…
Paediatrics · Pre-internship · niche
A 16-year-old boy has had a moderate depressive episode for five months. He has completed eight sessions of cognitive behavioural therapy with a psychologist an…
Paediatrics · Pre-internship · middle twist
A 16-year-old girl with anorexia nervosa is reviewed in an outpatient eating disorder clinic. Over the past six weeks her weight has fallen 3 kg to 42 kg; she i…
Paediatrics · Pre-internship · niche
A 16-year-old boy is brought to a regional emergency department by his mother, who found messages in which he described wanting to die. Seen alone, he says he h…
Paediatrics · Pre-internship · middle twist
A 17-year-old girl asks for help to stop vaping. She has used a disposable device every day for two years, now wakes at night to use it, and has failed three at…
Paediatrics · Pre-internship · middle twist
A 16-year-old girl attends with three months of worsening acne. There are deep tender lumps on both cheeks and along the jaw, two of them discharging, and four…
Paediatrics · Pre-internship · middle twist
A 15-year-old girl has never had a period. Her breasts and pubic hair have been fully developed and unchanged for about a year, and she has grown 1 cm in the pa…
Paediatrics · Pre-internship · niche
A 14-year-old girl attends a Perth general practice alone and asks for emergency contraception after a condom broke last night. She tells you she has been seein…
Paediatrics · Pre-internship · middle twist
A 15-year-old boy who lives on a wheat farm 300 km from Perth is brought in by his mother after she found a note in his room. He tells you that for the past mon…
Paediatrics · Pre-internship · middle twist
A 6-year-old boy with laboratory-confirmed SARS-CoV-2 infection is admitted to a paediatric ward. Over an hour his oxygen saturation falls to 88 per cent on 6 L…
Paediatrics · Pre-internship · common