Medical law and ethics

A 58-year-old interstate truck driver has had two unprovoked generalised tonic-clonic seizures in the past month and a diagnosis of epilepsy has been confirmed…

Pre-internship · middle twist

You are the intern on a Perth paediatric ward. A 6-year-old girl admitted with pneumonia tells you that a family friend does rude things to her when he babysits…

Pre-internship · middle twist

You are a resident in a Perth children's hospital and have had concerns about five children this week. Each concern is soundly based, you believe each on reason…

Pre-internship · niche

At 2 am you are the intern who admits a 2-year-old girl with a spiral fracture of the humeral shaft and bruising over the upper arm and back, for which her pare…

Pre-internship · middle twist

A 4-year-old boy is brought to a Perth emergency department with a swollen, bruised left forearm. At triage his mother said he fell from a kitchen chair. When y…

Clinical rotations · middle twist

A 3-year-old inpatient was given 15 mg of oral morphine instead of the prescribed 1.5 mg one hour ago, because a decimal point on the drug chart was misread. He…

Pre-internship · common

A 12-month audit of a paediatric ward identifies four prescriptions in which a weight-based dose was written ten times higher than intended; two of these reache…

Clinical rotations · middle twist

A 15-year-old boy with Crohn disease attends a routine clinic review with his mother. He has lost 4 kg in three months and has missed a third of school days thi…

Pre-internship · common

You are drawing a three-generation pedigree for a 7-year-old girl referred with recurrent headaches. Her mother mentions that the child's father, from whom she…

Pre-internship · middle twist

The parents of a healthy 3-day-old boy ask you to arrange his circumcision before they go home. They give family and cultural reasons. His foreskin is normal fo…

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…

Pre-internship · middle twist

A 16-year-old girl attends a Perth general practice on her own and asks for the contraceptive pill. She has been with her 17-year-old boyfriend for a year and t…

Clinical rotations · common

A 15-year-old girl is seen alone at a general practice. During the psychosocial interview she says she has been cutting her left forearm most weeks for three mo…

Pre-internship · middle twist

A medical student writes a medication order on the chart of a 3-year-old girl weighing 14 kg who has been admitted with an asthma exacerbation. The order reads:…

Clinical rotations · common

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…

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…

Pre-internship · middle twist

A 15-year-old girl is brought to a general practice by her mother, who is worried about three months of falling grades, weight loss and irritability. After the…

Clinical rotations · 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…

Pre-internship · niche

A 9-year-old boy attends a child and adolescent mental health clinic for severe attention deficit hyperactivity disorder. The psychiatrist explains the risks, b…

Clinical rotations · middle twist

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…

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,…

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…

Pre-internship · middle twist

You are the resident on a Perth adult psychiatric inpatient unit. A 41-year-old man with bipolar disorder is a voluntary inpatient and has capacity. Over one we…

Clinical rotations · 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…

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…

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…

Pre-internship · middle twist

A 79-year-old woman with mild Alzheimer disease is an inpatient with a severe depressive episode. Electroconvulsive therapy is proposed. An hour after the discu…

Clinical rotations · middle twist

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…

Pre-internship · niche

A 46-year-old woman was admitted as a voluntary patient to an authorised psychiatric hospital in Perth three days ago with a severe depressive episode. This mor…

Pre-internship · middle twist

A 24-year-old man with schizophrenia has been made an involuntary inpatient at an authorised hospital in Perth under the Mental Health Act 2014 (WA) after refus…

Clinical rotations · middle twist

A 34-year-old woman attends a Perth general practice for insomnia. On direct questioning she says her partner pushed her into a wall last week, checks her phone…

Pre-internship · middle twist

An 84-year-old woman is brought to a Perth general practice by her daughter, with whom she lives, for a third presentation this year with dehydration. She has l…

Clinical rotations · middle twist

A 16-year-old girl has been treated for a first episode of psychosis and is well on aripiprazole. She missed most of Year 11 and wants to return part time. Her…

Pre-internship · middle twist

A 58-year-old woman telephones the practice at 5 pm. She has read an online news article claiming that a medicine she has taken for three years has been linked…

Pre-internship · middle twist

A general practice registrar is deciding which antidepressant to start for a 40-year-old man with a first episode of major depression of moderate severity. She…

Clinical rotations · common

A general practice registrar reads a news report that the Australian regulator has issued a new warning about a mood stabiliser she prescribes, concerning a pos…

Clinical rotations · middle twist

A 79-year-old woman lives alone in the house she owns. She tells the general practice registrar that her grandson shouts at her when he visits and has twice sho…

Pre-internship · middle twist

An 82-year-old widow attends her general practitioner with her son, who lives in her house and answers most questions for her. Seen alone, she says he shouts at…

Clinical rotations · common

An 81-year-old woman has a severe depressive episode with nihilistic delusions. She has refused all food and fluid for four days and is dehydrated, saying that…

Pre-internship · niche

An 83-year-old man with moderate Alzheimer disease has a large symptomatic inguinal hernia and the surgeon has recommended repair. He lives in a hostel, cannot…

Clinical rotations · middle twist