Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 398 questions.
A 78-year-old man presents with an anterior ST-elevation myocardial infarction at a hospital where primary percutaneous coronary intervention cannot be delivere…
Cardiovascular · Clinical rotations · middle twist
A 48-year-old man presents with severe persecutory psychosis and requires medication after verbal de-escalation has failed. He has no history of cardiac disease…
Psychiatry and Mental Health · Clinical rotations · middle twist
A 42-year-old woman has a second proximal deep vein thrombosis while taking rivaroxaban regularly for a previous unprovoked event. Her renal function is normal…
Cardiovascular · Clinical rotations · middle twist
A 66-year-old man with metastatic gastric adenocarcinoma develops a symptomatic proximal deep vein thrombosis. He has a friable gastric lesion with recent occul…
Cardiovascular · Clinical rotations · middle twist
A 29-year-old woman at 28 weeks gestation presents with sudden pleuritic chest pain and breathlessness. Her pulse is 108/min, oxygen saturation is 97% on room a…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 39-year-old woman wants reliable contraception and has heavy, painful periods. She is taking rifampicin for tuberculosis and has no uterine abnormality on exa…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 47-year-old woman has developed bleeding between otherwise irregular periods over the past four months. She has a body mass index of 36 kg/m² and polycystic o…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 46-year-old woman taking prednisolone 7.5 mg each morning for polymyalgia rheumatica requires extraction of one mobile premolar. She is otherwise well, has ta…
Endocrine and Metabolic · Clinical rotations · middle twist
A 35-year-old woman presents with bruising, gum bleeding and increasing lethargy. Her haemoglobin is 84 g/L (115–155), platelet count 18 × 10^9/L (150–400), whi…
AMC · Clinical rotations · middle twist
A 29-year-old man presents with fever, bruising and aching in the long bones. He has pallor, scattered petechiae and a spleen palpable 2 cm below the costal mar…
AMC · Clinical rotations · middle twist
A 31-year-old woman at 9 weeks of pregnancy presents with vaginal bleeding and cramping after passing several clots. Her pulse is 88 beats/minute, blood pressur…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 34-year-old woman is reviewed after treatment with single-dose intramuscular methotrexate for a confirmed, unruptured tubal ectopic pregnancy. She remains wel…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 27-year-old woman with a desired pregnancy presents at 8 weeks with mild vaginal bleeding but no pain. Transvaginal ultrasonography shows an intrauterine gest…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 29-year-old woman has 6 weeks of amenorrhoea and two days of increasing right iliac fossa pain. Transvaginal ultrasonography shows a 30-mm right tubal gestati…
Obstetrics and Gynaecology · Clinical rotations · middle twist
Nine days after a vaginal birth, a woman presents with recurrent bleeding, a temperature of 38.3°C and lower abdominal pain. The uterus is tender and larger tha…
Obstetrics and Gynaecology · Clinical rotations · middle twist
Immediately after delivery, a woman becomes pale and hypotensive and reports severe pelvic pain. A smooth, dark-red mass is visible at the introitus; the placen…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 29-year-old woman has a 1.4 L haemorrhage after an uncomplicated vaginal birth. The placenta is complete and there is no vaginal or cervical tear. Despite ute…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 72-year-old woman with severe chronic obstructive pulmonary disease is admitted with worsening breathlessness. Her pulse is irregular at 118 beats per minute.…
Cardiovascular · Clinical rotations · middle twist
A 32-year-old woman presents seven days after an uncomplicated delivery with five sudden, severe headaches over 48 hours. Each begins abruptly during bathing or…
AMC · Clinical rotations · middle twist
A 49-year-old man develops abrupt retro-orbital pain and vomiting while exercising. In the next hour he becomes drowsy and develops left ptosis with limitation…
AMC · Clinical rotations · middle twist