Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 6-year-old girl falls from the monkey bars onto an outstretched right hand. She holds the elbow semi-flexed with diffuse swelling over the distal humerus, and…
Acute Care · Pre-internship · middle twist
A 68-year-old woman is admitted with three days of increasing breathlessness. She has smoked 30 cigarettes a day for 40 years and has lost 6 kg over three month…
Acute Care · Clinical rotations · middle twist
A 7-year-old girl falls from the monkey bars onto an outstretched right hand. She is tender about 2 cm proximal to the wrist with mild swelling, no deformity, f…
Acute Care · Clinical rotations · middle twist
A 41-year-old woman is bitten by her cat three hours ago. She has two puncture wounds over the dorsum of the right hand, one of them directly over the second me…
Acute Care · Pre-internship · middle twist
A 26-year-old man who moved to Australia two years ago stands on a nail while clearing out a chicken run. He presents 30 hours later with a deep puncture throug…
Acute Care · Pre-internship · middle twist
An 81-year-old woman catches her shin on a tow bar. There is a 6 cm triangular flap of skin over the front of the lower leg, based distally, pink to its tip, wi…
Acute Care · Clinical rotations · middle twist
A 27-year-old man is brought in after his motorcycle struck a guardrail. A binder has been applied for an open-book pelvic fracture and he is haemodynamically s…
Acute Care · Pre-internship · middle twist
An 88-year-old woman in residential aged care has had an indwelling urethral catheter for eight months for a neurogenic bladder, and it will be needed indefinit…
Acute Care · Pre-internship · middle twist
An 84-year-old man with prostate cancer and bone metastases is catheterised in the emergency department for painless retention that has built up over several we…
Acute Care · Clinical rotations · middle twist
A 68-year-old man on the stroke unit has a fine-bore nasogastric tube inserted for feeding after a large middle cerebral artery infarct. Insertion was straightf…
Acute Care · Clinical rotations · middle twist
A 19-year-old woman with type 1 diabetes is on the surgical ward the evening after an appendicectomy. Two hours after her usual insulin she becomes sweaty and t…
Acute Care · Clinical rotations · middle twist
A 31-year-old man is intubated in the emergency department after falling from a roof and is transferred to the intensive care unit. Sedation has been withheld f…
Acute Care · Pre-internship · middle twist
A 58-year-old man is found collapsed at home and brought to the emergency department. He does not respond when his name is called loudly and does not open his e…
Acute Care · Clinical rotations · middle twist
A 63-year-old woman with type 2 diabetes presents with two days of vomiting and upper abdominal pain, during which she has eaten almost nothing. She takes metfo…
Acute Care · Clinical rotations · middle twist
A 68-year-old woman weighing 65 kg is in the emergency department with urinary sepsis. Intravenous antibiotics were given within 30 minutes of arrival and she h…
Acute Care · Pre-internship · middle twist
A 58-year-old man was admitted 36 hours ago with severe acute pancreatitis and has been given 7 litres of sodium chloride 0.9%. He is alert and normotensive, is…
Acute Care · Clinical rotations · middle twist
A 4-year-old girl has had three days of watery diarrhoea and vomiting. She is irritable with dry mucous membranes and reduced urine output; her hands are warm,…
Acute Care · Clinical rotations · middle twist
A well 24-year-old woman has routine blood tests before starting a combined oral contraceptive. She takes no medication and her blood pressure is 112/70 mmHg. B…
Acute Care · Clinical rotations · middle twist
A 58-year-old man is receiving intravenous vancomycin for a prosthetic joint infection through a 20 gauge cannula in the dorsum of the left hand. Six hours into…
Acute Care · Clinical rotations · middle twist
A 3-year-old boy is pulled unresponsive from a community swimming pool. He is not breathing normally and a lifeguard has started chest compressions while an amb…
Acute Care · Clinical rotations · middle twist