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A 28-year-old man with type 1 diabetes uses a continuous subcutaneous insulin infusion. He develops nausea after the pump gives an occlusion alarm; his blood gl…
Endocrine and Metabolic · Clinical rotations · common
A 31-year-old woman with type 1 diabetes is being treated for diabetic ketoacidosis with intravenous insulin and 0.9% sodium chloride. Four hours later, her blo…
Endocrine and Metabolic · Clinical rotations · common
A 74-year-old woman with severe chronic obstructive pulmonary disease presents with increasing dyspnoea and drowsiness during a respiratory infection. On room a…
Respiratory · Clinical rotations · common
A 34-year-old woman with asthma remains breathless in the emergency department after three nebulised doses of salbutamol and ipratropium and intravenous hydroco…
Respiratory · Clinical rotations · common
A 67-year-old man with alcohol dependence has mild withdrawal 10 hours after his last drink, with anxiety, tremor and nausea but no hallucinations or seizure. H…
Gastroenterology and Hepatology · Mechanisms of disease · middle twist
A 46-year-old man with longstanding alcohol dependence has eaten little during two weeks of vomiting. He is inattentive, walks with a broad-based gait and repea…
General Practice and Population Health · Clinical rotations · common
A 33-year-old woman at 33+5 weeks has a blood pressure of 168/112 mmHg on two occasions despite oral treatment. She has persistent right upper quadrant pain; pl…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 24-year-old woman presents 30 hours after taking repeated doses of paracetamol for a dental infection. She estimates taking 10–12 g daily for four days; her p…
Emergency and Toxicology · Clinical rotations · common
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 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 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 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
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 32-year-old woman presents seven days after an uncomplicated delivery with five sudden, severe headaches over 48 hours. Each begins abruptly during bathing or…
AMC · Clinical rotations · middle twist
A 35-year-old woman at 31 weeks’ gestation has six weeks of low mood, guilt and early-morning waking. During the past week she has stopped eating, believes her…
Psychiatry and Mental Health · Clinical rotations · common
A 29-year-old woman has a plasma bicarbonate concentration of 15 mmol/L (reference 22–29 mmol/L) and a normal anion gap. Her urine pH is 6.2 during bicarbonate…
Biomedical Science · Mechanisms of disease · middle twist
A healthy adult receives an intravenous glucose load. Plasma glucose is 12 mmol/L (reference 3.5–7.8 mmol/L), the measured glomerular filtration rate is 120 mL/…
Biomedical Science · Mechanisms of disease · common
A 62-year-old woman is receiving her first unit of packed red blood cells for symptomatic anaemia. Fifteen minutes after commencement her temperature rises from…
Nursing · Pre-internship · common
A registered nurse is preparing to administer flucloxacillin 1 g in 100 mL of sodium chloride 0.9% intravenously over 30 minutes. No infusion pump is available,…
Nursing · Clinical rotations · common