Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 54-year-old man presents to a metropolitan hospital with a catheter laboratory after seventy minutes of central chest pain, which is continuing. His blood pre…
Acute Care · Pre-internship · middle twist
A 68-year-old woman is brought in from a residential aged care facility with fever and new confusion. Her temperature is 38.9 degrees Celsius, blood pressure 82…
Acute Care · Pre-internship · middle twist
A 28-year-old man is stung by a bee in a hospital car park. In the emergency department he has generalised urticaria, audible wheeze and a blood pressure of 84/…
Acute Care · Pre-internship · middle twist
A 71-year-old man collapses in the radiology department and is apnoeic with a palpable carotid pulse. You are first to arrive with a self-inflating bag, mask an…
Acute Care · Pre-internship · middle twist
You are the intern on night cover. At 02:00 the nurse asks you to see a 68-year-old man on the second night after a right hemicolectomy. His respiratory rate is…
Acute Care · Pre-internship · middle twist
A 7-year-old boy is brought to the emergency department because he has been breathing hard since the morning. He has vomited repeatedly for two days and says hi…
Acute Care · Clinical rotations · middle twist
In late July a 34-year-old man attends with both his housemates. All three have had headache, nausea and poor concentration that build up through each evening a…
Acute Care · Clinical rotations · middle twist
A 58-year-old man is admitted with three days of fever and a productive cough. He weighs 138 kg, uses continuous positive airway pressure at home for witnessed…
Acute Care · Pre-internship · middle twist
A 24-year-old man is brought to the emergency department after falling four metres from scaffolding onto concrete. He opens his eyes to voice, is confused and l…
Acute Care · Pre-internship · middle twist
A 47-year-old man chokes on a piece of bread roll while talking at a workplace lunch. He coughs hard for a few seconds, then the coughing becomes silent and his…
Acute Care · Clinical rotations · middle twist
You are the intern on a paediatric ward in Perth at 9 pm. A 3-year-old admitted that morning with bronchiolitis has observations that all sit inside the normal…
Acute Care · Pre-internship · middle twist
A 58-year-old man is seen in a pre-admission clinic before a hernia repair. He weighs 138 kg and his upper arm circumference is 42 cm. The nurse records 176/98…
Acute Care · Clinical rotations · middle twist
You are the first doctor to reach a 68-year-old man found slumped in a chair in the day therapy unit. He does not respond to voice or to a firm shake, he makes…
Acute Care · Pre-internship · middle twist
An 84-year-old woman is on the ward on the evening of the first day after hemiarthroplasty for a fractured neck of femur. She has a morphine patient-controlled…
Acute Care · Clinical rotations · middle twist
A 63-year-old man collapses in an emergency department waiting room. He is shocked once for ventricular fibrillation and a palpable pulse returns after four min…
Acute Care · Pre-internship · middle twist
A 13-year-old boy weighing 52 kg develops widespread urticaria, a hoarse voice and wheeze about ten minutes after eating a satay skewer at a school camp. He is…
Acute Care · Pre-internship · middle twist
A 46-year-old woman is admitted with two days of vomiting and lightheadedness. Her regular tablets are alendronate, esomeprazole and prednisolone, all of which…
Acute Care · Pre-internship · middle twist
A 24-year-old man is brought to a regional emergency department after his motorcycle struck a guard rail. The ambulance officers report that he lost his output…
Acute Care · Pre-internship · middle twist
A 68-year-old woman is admitted with fever and dysuria. Blood cultures were taken and she received gentamicin and amoxicillin within 40 minutes of arrival. She…
Acute Care · Pre-internship · middle twist
A 63-year-old man wakes at 5 am with swelling of his lower lip and the left side of his tongue. There is no rash and nothing itches. His voice is normal, his ch…
Acute Care · Clinical rotations · middle twist