Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 398 questions.
A 79-year-old woman falls at home and develops groin pain. Pelvic and hip radiographs show no fracture, but after analgesia she still cannot take four steps and…
Surgery and Perioperative Care · Clinical rotations · middle twist
A 7-year-old boy falls from playground equipment and sustains a displaced supracondylar fracture of the humerus. His hand is warm, capillary refill is 1.5 secon…
Paediatrics · Clinical rotations · middle twist
A 42-year-old woman has a second proximal deep vein thrombosis while taking rivaroxaban as prescribed. She has no interacting medicines, normal renal function a…
Cardiovascular · Clinical rotations · middle twist
A 68-year-old man with metastatic oesophageal cancer develops a symptomatic proximal deep vein thrombosis. He completed treatment for melaena from the tumour tw…
Cardiovascular · Clinical rotations · middle twist
A 29-year-old woman at 10 weeks of pregnancy presents with sudden pleuritic chest pain and breathlessness. Her heart rate is 108/min, oxygen saturation is 98% o…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 41-year-old woman is rescued from a vehicle fire with burns encircling the chest and upper abdomen. She is intubated and ventilated, but her peak airway press…
Emergency and Toxicology · Clinical rotations · middle twist
A 28-year-old electrician receives an electrical injury while working on industrial equipment. There is a small contact mark on the palm and a larger mark at th…
Emergency and Toxicology · Clinical rotations · middle twist
A 67-year-old woman with long-standing rheumatoid arthritis reports increasing fatigue and reduced exercise tolerance. Her haemoglobin is 92 g/L (115–155), mean…
Haematology and Oncology · Clinical rotations · middle twist
A 36-year-old woman at 8 weeks of gestation has vaginal bleeding and intermittent lower abdominal cramping. Transvaginal ultrasonography shows an intrauterine g…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 3-week-old boy is brought with persistent jaundice, poor weight gain and two episodes of jitteriness before feeds. He was born at term with a small penis and…
Paediatrics · Clinical rotations · middle twist
A 7-year-old boy receiving chemotherapy for acute lymphoblastic leukaemia develops a temperature of 38.6°C at home. In hospital he is alert, has normal perfusio…
Haematology and Oncology · Clinical rotations · middle twist
An 8-month-old girl has a temperature of 39.4°C and has been unsettled for two days. She is drinking, has normal work of breathing and perfusion, and examinatio…
Paediatrics · Clinical rotations · middle twist
A 24-year-old woman presents with abrupt pounding in her neck and mild breathlessness that began while she was sitting at work. She is alert, warm and normotens…
Cardiovascular · Clinical rotations · middle twist
A 44-year-old woman develops a severe headache while lifting her young child; she says it was already unbearable before she could put the child down. She has vo…
Neurology · Clinical rotations · middle twist
An otherwise well 29-year-old woman presents eight days after an uncomplicated vaginal delivery with a headache that has gradually intensified over four days. I…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 45-year-old man presents after four days of worsening right lower quadrant pain, fever and anorexia. Examination finds a tender, relatively fixed mass in the…
Surgery and Perioperative Care · Clinical rotations · middle twist
A 76-year-old man with persistent atrial fibrillation develops sudden severe abdominal pain and vomiting. He is pale and distressed, but his abdomen is initiall…
Emergency and Toxicology · Clinical rotations · middle twist
A 67-year-old man with a previous midline laparotomy presents with colicky abdominal pain, vomiting and progressive distension. Initially the pain came in waves…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 66-year-old man is admitted with melaena from a duodenal ulcer and undergoes successful endoscopic haemostasis. He has taken aspirin 100 mg daily since a myoc…
Cardiovascular · Clinical rotations · middle twist
A 67-year-old man presents with recurrent passage of bright-red blood and clots. After initial fluid replacement, his blood pressure is 126/74 mmHg and pulse is…
Cardiovascular · Clinical rotations · middle twist