Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 398 questions.
A 46-year-old woman has a body mass index of 32 kg/m² and treated hypertension. Her mother developed type 2 diabetes at 58 years of age. She has no polyuria, po…
Endocrine and Metabolic · Clinical rotations · middle twist
A 68-year-old man taking gliclazide modified release for type 2 diabetes is found drowsy with a blood glucose concentration of 2.1 mmol/L. He improves after int…
Emergency and Toxicology · Clinical rotations · middle twist
A 24-year-old woman with type 1 diabetes presents with abdominal pain, vomiting and deep breathing. Her blood glucose concentration is 24 mmol/L, venous pH is 7…
Endocrine and Metabolic · Clinical rotations · middle twist
A 3-year-old boy who previously used short sentences has stopped speaking over the past six weeks. His parents also report that he no longer understands familia…
Paediatrics · Clinical rotations · middle twist
A 72-year-old woman with newly diagnosed multiple myeloma presents with confusion, constipation and weakness. Her serum calcium is 4.18 mmol/L (2.10–2.60), crea…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 29-year-old woman presents with headache, confusion and reduced urine output. She is pale and has scattered petechiae; investigations show haemoglobin 78 g/L…
Haematology and Oncology · Clinical rotations · middle twist
A 35-year-old primigravida at 37 weeks’ gestation is found to have blood pressure readings of 148/96 and 146/94 mmHg 4 hours apart. Urine protein is 2+, platele…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 31-year-old woman at 34 weeks’ gestation presents with a severe frontal headache and flashing lights. Her blood pressure is 176/114 mmHg on two measurements 1…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 68-year-old man with a recent transurethral resection of a bladder tumour presents with worsening suprapubic pain and inability to pass urine. He has passed b…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 29-year-old woman at 25 weeks of pregnancy presents with right flank pain, rigors and vomiting. Her temperature is 39.2°C, pulse 132/min and blood pressure 92…
Emergency and Toxicology · Clinical rotations · middle twist
A 78-year-old man presents with a lesion on the sun-exposed forearm that has enlarged from a pinpoint mark to 18 mm over seven weeks. It is a firm, smooth, red-…
Dermatology · Clinical rotations · middle twist
A 35-year-old woman is referred for a brown plaque on the upper back that has slowly enlarged over nine years. It was initially flat, but several firm reddish-b…
Dermatology · Clinical rotations · middle twist
A 63-year-old man has a brown papule on the bridge of his nose that has slowly enlarged over two years and occasionally leaves a spot of blood on his handkerchi…
Dermatology · Clinical rotations · middle twist
A 54-year-old man presents with five days of fever, dry cough, headache and diarrhoea after returning from a Mediterranean cruise. He is confused, respiratory r…
Respiratory · Clinical rotations · middle twist
A 59-year-old man develops rapidly worsening breathlessness five days after an influenza-like illness. He has a temperature of 39.8°C, respiratory rate of 38/mi…
Respiratory · Clinical rotations · middle twist
A 56-year-old man develops sharp central chest pain 36 hours after an uncomplicated inferior myocardial infarction. The pain is worse when he lies flat or takes…
Cardiovascular · Clinical rotations · middle twist
A 64-year-old man is recovering in hospital four days after an inferior ST-elevation myocardial infarction treated with primary percutaneous coronary interventi…
Cardiovascular · Clinical rotations · middle twist
A 72-year-old man with Parkinson disease is brought by his wife because he has begun speaking to people who are not present and has become suspicious of her. He…
Psychiatry and Mental Health · Clinical rotations · middle twist
A 16-year-old female long-distance runner develops gradually worsening right groin pain over six weeks. She has recently increased her training volume and repor…
Rheumatology and Musculoskeletal · Clinical rotations · middle twist
A 3-year-old boy is brought to the emergency department because he has stopped walking and cries when lifted. He has a temperature of 38.8°C, a heart rate of 13…
Paediatrics · Clinical rotations · middle twist