Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 22-year-old woman is brought to the emergency department after 30 minutes of rapid, deep breathing that began during an argument. She reports tingling around…
Physiology · Foundations · middle twist
A 24-year-old man has passed up to twelve watery stools a day for five days after returning from a trek in Nepal. He is thirsty and weak. His pulse is 118/min a…
Physiology · Foundations · middle twist
A 58-year-old man has vomited large volumes each day for nine days, bringing up food eaten the day before. The vomitus contains no bile. He has lost 5 kg, his m…
Physiology · Foundations · middle twist
A 19-day-old boy has vomited after most feeds for the past week. He is 9 per cent below his birth weight, lethargic, with dry mucous membranes and cool peripher…
Physiology · Foundations · middle twist
A 32-year-old woman has passed large volumes of pale urine for four months and drinks about eight litres of water each day, having decided this would improve he…
Physiology · Foundations · middle twist
A 7-year-old boy has passed large volumes of urine and craved salty food since infancy, and he is small for his age. His blood pressure is 92/56 mmHg and he has…
Physiology · Foundations · middle twist
A 24-year-old man is brought to the emergency department after a motorcycle crash. He has an unstable pelvic fracture and has lost an estimated 1500 mL of blood…
Physiology · Foundations · middle twist
A 68-year-old man has had 4 days of fever, cough and left-sided pleuritic pain. There is dullness to percussion, bronchial breathing and increased vocal resonan…
Physiology · Foundations · middle twist
A 76-year-old man is admitted after falling down four steps at home. He weighs 75 kg. He has fractures of the left fifth to eighth ribs and it hurts him to brea…
Physiology · Foundations · middle twist
A 34-year-old woman has had 8 months of heavy menstrual bleeding. She is breathless climbing one flight of stairs and tired all day. Her conjunctivae are pale.…
Physiology · Foundations · middle twist
A 68-year-old man with a 20-year history of hypertension is examined before elective hernia repair. His pulse is regular at 72 beats per minute. With the bell o…
Physiology · Foundations · middle twist
A 62-year-old man has had 4 months of worsening constipation with cramping pain that comes in waves and eases after a few minutes; he cannot point to one spot w…
Anatomy · Foundations · middle twist
A 71-year-old woman has coughed violently for 3 weeks. Yesterday, during a bout of coughing, she felt sudden tearing pain in the right lower abdomen and now has…
Anatomy · Foundations · middle twist
A 19-year-old man has had 20 hours of pain that began around the umbilicus and has settled in the right lower abdomen, with anorexia and a temperature of 37.9 C…
Anatomy · Foundations · middle twist
A 58-year-old builder has noticed a bulge in the right groin over 6 months. It appears when he coughs or lifts and disappears when he lies down. On standing, th…
Anatomy · Foundations · middle twist
A 27-year-old man had an intercostal catheter inserted through the fifth intercostal space in the midaxillary line after a crush injury to the chest. Two weeks…
Anatomy · Foundations · middle twist
A 68-year-old man has become breathless over three weeks. He is examined sitting upright, and the right side of his chest expands less than the left. Bedside ul…
Anatomy · Foundations · middle twist
A 52-year-old woman has had two months of numbness over the right forehead, the right upper eyelid and the tip of her nose, with a gritty feeling in the right e…
Anatomy · Foundations · middle twist
A 44-year-old man has had 18 months of worsening hearing on the left with constant ringing in that ear. He still follows conversation in a quiet room but cannot…
Anatomy · Foundations · middle twist
A 58-year-old man has sudden vertigo and a hoarse voice, and chokes when he drinks. The palate elevates to the right and there is no gag response when the left…
Anatomy · Foundations · middle twist