Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 45-year-old woman with bipolar I disorder, stable on lithium carbonate 1,000 mg nightly for six years with levels consistently 0.7–0.8 mmol/L, presents with t…
Psychiatry and Mental Health · Pre-internship · middle twist
A 5-month-old girl has had a fever of 39.2 °C for 24 hours with vomiting and irritability, and no cough, runny nose or rash. Examination is otherwise unremarkab…
Paediatrics · Clinical rotations · middle twist
A 5-week-old boy, first child, has had one week of vomiting that occurs within 30 minutes of every feed and is now forceful, landing well away from him. The vom…
Paediatrics · Pre-internship · middle twist
A 7-month-old girl has had fever above 39 °C for seven days despite paracetamol. She is irritable and difficult to console. Her eyes are red without discharge,…
Paediatrics · Clinical rotations · middle twist
A 14-year-old boy is worried that he is the shortest in his class and has no signs of puberty. His height is on the 3rd centile and his weight on the 10th; his…
Paediatrics · Clinical rotations · middle twist
A 9-year-old girl weighing 30 kg presents in diabetic ketoacidosis as the first presentation of type 1 diabetes: pH 7.02, glucose 34 mmol/L, bicarbonate 6 mmol/…
Paediatrics · Pre-internship · middle twist
A 4-year-old boy develops widespread bruising on his shins and trunk and a crop of pinpoint red spots on his legs over three days, two weeks after a cold. He is…
Paediatrics · Clinical rotations · middle twist
A 3-day-old boy, born at term and discharged well at 24 hours, is brought back because he has become grey, floppy and uninterested in feeding over six hours. Hi…
Paediatrics · Pre-internship · middle twist
An 18-month-old boy is brought by his parents because he has no words. He walked at 13 months and runs and climbs well. He does not point to show things, does n…
Paediatrics · Clinical rotations · middle twist
A 24-year-old woman with seven weeks of amenorrhoea and a positive home pregnancy test presents with two days of left-sided lower abdominal pain and light vagin…
Obstetrics and Gynaecology · Pre-internship · middle twist
A 34-year-old woman at 33 weeks in her third pregnancy, who smokes and has chronic hypertension, presents with two hours of constant severe abdominal pain that…
Obstetrics and Gynaecology · Pre-internship · middle twist
A 22-year-old man was struck on the right temple by a cricket ball three hours ago in a country town. He was briefly unconscious, then walked off the field and…
Emergency and Toxicology · Pre-internship · middle twist
A 24-year-old woman who wears soft contact lenses and often sleeps in them presents with 24 hours of an increasingly painful, red, watering right eye and marked…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 58-year-old man who smokes and drinks heavily presents with a painless lump below the angle of his left jaw that he first noticed six weeks ago and which has…
Eyes, Ears, Nose and Throat · Clinical rotations · middle twist
A 19-year-old man had a closed mid-shaft tibial fracture reduced and placed in a below-knee cast eight hours ago after a football tackle. He now has severe pain…
Rheumatology and Musculoskeletal · Pre-internship · middle twist
A 72-year-old woman with atrial fibrillation who stopped her anticoagulant six months ago after a nosebleed wakes at 3 am with sudden severe pain in her left le…
Surgery and Perioperative Care · Pre-internship · middle twist
A 34-year-old man who injects heroin presents with two weeks of fevers, sweats, a cough and pleuritic chest pain on both sides. His temperature is 39.2 °C, puls…
Cardiovascular · Clinical rotations · middle twist
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…
Ethics and Professional Practice · Pre-internship · middle twist
A 22-year-old woman is brought from a music festival by paramedics. She is agitated and confused, her temperature is 39.8 °C, pulse 132/min, blood pressure 158/…
Emergency and Toxicology · Clinical rotations · middle twist
A 34-year-old man started lamotrigine 16 days ago for newly diagnosed epilepsy. For three days he has had fever, sore eyes and painful mouth ulcers that make sw…
Dermatology · Clinical rotations · middle twist