Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 84 questions.
A 29-year-old woman with type 1 diabetes refuses her evening insulin after becoming convinced that the injections are being used to poison her. She can repeat t…
Ethics and Professional Practice · Pre-internship · common
A 34-year-old woman is reviewed 18 hours after an emergency caesarean section complicated by a 1.6 L postpartum haemorrhage. The bleeding has been controlled fo…
Obstetrics and Gynaecology · Pre-internship · common
A 46-year-old man with recurrent major depression tells his general practitioner that he intends to take all his prescribed medicines after his partner leaves f…
Psychiatry and Mental Health · Pre-internship · common
A 29-year-old man with schizophrenia is brought to the emergency department after threatening another patient. He is pacing, shouting and clenching his fists; h…
Psychiatry and Mental Health · Pre-internship · 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 68-year-old man is on the surgical ward 6 hours after an open appendicectomy. The nurse records a respiratory rate of 28 breaths/min, heart rate 132/min, bloo…
Nursing · Pre-internship · common
A 28-year-old woman is brought in by ambulance 90 minutes after being found drowsy next to an empty box of amitriptyline. Her Glasgow Coma Scale score is 12, he…
Emergency and Toxicology · Pre-internship · common
A 21-year-old man collapses at the 14 km mark of a city fun run on a 34°C day. In the trackside medical tent he is confused and agitated with a Glasgow Coma Sca…
Emergency and Toxicology · Pre-internship · common
A 32-year-old woman develops widespread urticaria, lip swelling and wheeze within 15 minutes of eating a satay dish at a restaurant. On arrival of paramedics he…
Emergency and Toxicology · Pre-internship · common
An 84-year-old woman who lives alone is found to have a 2.5 cm breast mass, and core biopsy shows invasive carcinoma. The surgeon has recommended wide local exc…
Ethics and Professional Practice · Pre-internship · common
A 24-year-old man presents with four days of fever, a runny nose, red watery eyes and a dry cough, ten days after returning from Bali. This morning a blotchy re…
Ethics and Professional Practice · Pre-internship · common
A 19-year-old man is brought to a rural general practice, 45 minutes from the nearest hospital, with six hours of fever, vomiting and severe pain in his legs. H…
Emergency and Toxicology · Pre-internship · common
A 35-year-old man is admitted six hours after a house fire with burns to 25% of his body surface area, including a burn encircling the entire right forearm wher…
Emergency and Toxicology · Pre-internship · common
A 25-year-old motorcyclist is brought to the emergency department after a high-speed crash, complaining of left-sided chest pain and severe breathlessness; he c…
Emergency and Toxicology · Pre-internship · common
A 58-year-old man with chronic kidney disease presents with weakness. Serum potassium is 7.1 mmol/L, and the laboratory result has been confirmed on a repeat no…
Emergency and Toxicology · Pre-internship · common
A 45-year-old man becomes acutely unwell after receiving approximately 20 mL of an incompatible red-cell unit. He develops fever, severe flank pain, hypotension…
Emergency and Toxicology · Pre-internship · common
A 67-year-old woman develops a temperature of 38.3°C and rigors 30 minutes after a red-cell transfusion begins. She is haemodynamically stable and has no dyspno…
Haematology and Oncology · Pre-internship · common
A 74-year-old woman with advanced dementia is unable to make decisions and has no advance care directive. Her husband is the recognised substitute decision-make…
Ethics and Professional Practice · Pre-internship · common
A 90-year-old man is dying from advanced heart failure and is no longer able to swallow. His breathing is noisy because of pooled respiratory secretions, but he…
Ethics and Professional Practice · Pre-internship · common
A 72-year-old woman with metastatic breast cancer has decision-making capacity and asks that cardiopulmonary resuscitation not be attempted if she becomes unabl…
Ethics and Professional Practice · Pre-internship · common