Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 84 questions.
A 47-year-old man was hammering a steel chisel without eye protection when he felt something strike his left eye an hour ago. Visual acuity is 6/60 on the left…
Ophthalmology · Pre-internship · common
A 17-year-old boy returns to the emergency department 18 hours after a below-knee plaster cast was applied for an undisplaced fracture of the distal tibia. He h…
Acute Care · Pre-internship · common
A 74-year-old woman is on day 4 after an open right hemicolectomy. Sodium chloride 0.9% 1 L eight-hourly, charted in the emergency department before her operati…
Acute Care · Pre-internship · common
You are the intern asked to collect a group and hold sample from a 68-year-old man before an elective hip replacement. When you arrive the ward clerk hands you…
Acute Care · Pre-internship · common
A 78-year-old woman is admitted overnight for observation after a mechanical fall. She is eating and drinking, takes only oral medications, and no intravenous t…
Acute Care · Pre-internship · common
A 24-year-old man is brought in by ambulance after his motorcycle struck a guardrail. His left leg is partly amputated below the knee and bright blood is wellin…
Acute Care · Pre-internship · common
A 71-year-old woman who speaks only Vietnamese is ready to leave the emergency department after chest pain with normal troponin results. She is to start a new m…
Acute Care · Pre-internship · common
A 76-year-old man taking ramipril and spironolactone attends with three days of vomiting and increasing lethargy. He is drowsy but rousable. Pulse is 42/min and…
Acute Care · Pre-internship · common
An 82-year-old woman has fallen twice since her medicines were changed. She is slower when walking and has recently complained of constipation, blurred vision a…
Geriatrics and Palliative Care · Pre-internship · common
A 62-year-old man has a regular broad-complex tachycardia at 190 beats per minute three hours after treatment for an acute myocardial infarction. He is consciou…
Emergency and Toxicology · Pre-internship · common
A 39-year-old man with bipolar disorder is brought to the emergency department one hour after becoming agitated and incoherent. His medicines are sertraline, tr…
Emergency and Toxicology · Pre-internship · common
A 46-year-old man with schizophrenia becomes restless and confused two days after his haloperidol dose was increased. He is febrile at 39.8°C, has widespread mu…
Emergency and Toxicology · Pre-internship · common
A 55-year-old man with severe depression is admitted after refusing food and fluids for several days. He understands that electroconvulsive therapy has been rec…
Ethics and Professional Practice · Pre-internship · common
A 36-year-old man with schizophrenia attends with his sister after stopping risperidone. He hears a voice commenting on his actions but is calm, has no thoughts…
Ethics and Professional Practice · Pre-internship · common
A 74-year-old man with type 2 diabetes presents with several days of lethargy and increasing confusion. His blood glucose concentration is 42 mmol/L, calculated…
Emergency and Toxicology · Pre-internship · common
A 52-year-old man with alcohol dependence is brought to the emergency department after being found confused at home. He has had several days of vomiting and is…
Emergency and Toxicology · Pre-internship · common
A 79-year-old man has fallen three times in two months, usually when walking to the toilet at night. He has slowed reactions and feels unsteady for several hour…
Geriatrics and Palliative Care · Pre-internship · common
A 20-year-old university student with bipolar disorder is admitted voluntarily during a manic episode. She has capacity and agrees that her sister may be told t…
Ethics and Professional Practice · Pre-internship · common
A 56-year-old man with severe depression has decision-making capacity and agrees that electroconvulsive therapy may be appropriate. Before signing consent, he a…
Ethics and Professional Practice · Pre-internship · common
A 34-year-old man with major depression tells his general practitioner that he has thought about dying and has imagined taking an overdose. He has no tablets at…
Ethics and Professional Practice · Pre-internship · common