Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 456 questions.
A 4-month-old boy attends for his scheduled immunisations. He was born at term and is thriving. The right hemiscrotum is empty and underdeveloped. The right tes…
Paediatrics · Pre-internship · middle twist
A 10-day-old girl is reviewed before discharge from the special care nursery, where she was admitted for feeding support. She was born at 38 weeks in a frank br…
Paediatrics · Pre-internship · middle twist
An 8-year-old boy is referred to the paediatric clinic after a school nursing screen recorded a blood pressure of 132/84 mmHg, above the 95th centile for his ag…
Paediatrics · Pre-internship · common
You are the intern on the postnatal ward. A healthy term boy was born two hours ago weighing 3400 g. After a full discussion of the risks, both parents decline…
Paediatrics · Pre-internship · middle twist
A 34-year-old man who came to Australia from Somalia six years ago is reviewed by his general practitioner for a depressive episode. After eight weeks of sertra…
Psychiatry · Pre-internship · niche
A 71-year-old woman who migrated from Hong Kong 40 years ago is admitted to a psychiatric ward with a severe depressive episode. She speaks Cantonese and almost…
Psychiatry · Pre-internship · middle twist
A 52-year-old man born in Vietnam, who has had schizophrenia for 25 years, comes to an emergency department with six hours of epigastric pain. He speaks limited…
Psychiatry · Pre-internship · niche
A 38-year-old Aboriginal woman is on the caseload of a metropolitan community mental health team after her third admission this year for a depressive episode wi…
Psychiatry · Pre-internship · middle twist
A 74-year-old man is reviewed in a memory clinic. Over the past year he has twice been brought home by police after becoming lost while driving to familiar plac…
Psychiatry · Pre-internship · middle twist
A 16-year-old girl is seen alone at a youth health service, where she has been attending for low mood. Today she tells you that for the past fortnight she has b…
Psychiatry · Pre-internship · middle twist
A 15-year-old girl with profound intellectual disability and cerebral palsy attends a gynaecology clinic with both parents and her treating psychiatrist. She is…
Psychiatry · Pre-internship · niche
A psychiatry registrar in Perth tells you, a fellow registrar, that since his father died four months ago he has had low mood, waking at 4 am and poor concentra…
Psychiatry · Pre-internship · common
You are an intern on a Perth psychiatry ward. At handover for the evening shift the other intern smells strongly of alcohol, is unsteady and slurring slightly,…
Psychiatry · Pre-internship · middle twist
You are a final-year medical student on a Perth psychiatry ward. During the ward round the registrar tells a nursing student, in front of the patient and the wh…
Psychiatry · Pre-internship · middle twist
A 19-year-old man is an inpatient with a first episode of psychosis. He has capacity and told the team yesterday, without being asked, that his family are not t…
Psychiatry · Pre-internship · middle twist
You are a psychiatry registrar in a country town in Western Australia. A close friend from your football club telephones you at home. He has slept badly for thr…
Psychiatry · Pre-internship · middle twist
A psychiatry registrar treated a 29-year-old woman for a depressive episode in a Perth outpatient clinic, seeing her weekly for eight months. She was discharged…
Psychiatry · Pre-internship · middle twist
A 38-year-old man with bipolar I disorder has been well on lithium for two years. At review he says he has decided to stop it because of tremor and a 9 kg weigh…
Psychiatry · Pre-internship · middle twist
A 68-year-old woman is an involuntary inpatient at an authorised hospital in Perth with a severe depressive episode with psychotic features. She has not respond…
Psychiatry · Pre-internship · niche
A 31-year-old man with schizophrenia stopped his aripiprazole six weeks ago because of restlessness. His mother brings him to a Perth community mental health cl…
Psychiatry · Pre-internship · niche