Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
A 27-year-old man was struck on the head at football a week ago. He now sees two images, one above the other, worst when reading or going down stairs. The verti…
Anatomy · Foundations · middle twist
A 19-year-old man sustains a closed fracture of the right tibial shaft in a football tackle. The leg was grossly angulated at the scene and was straightened bef…
Anatomy · Foundations · middle twist
A 68-year-old woman is reviewed six weeks after a right hip replacement performed through a lateral approach. She walks with her trunk lurching to the right. Wh…
Anatomy · Foundations · middle twist
A 52-year-old woman has six months of tingling in the right thumb, index and middle fingers, worst at night and relieved by shaking the hand. The muscle bulk at…
Anatomy · Foundations · middle twist
A 45-year-old storeman has three weeks of neck pain radiating into the right arm. Pushing a heavy door open with that arm is weak, and so is bending the wrist f…
Anatomy · Foundations · middle twist
A 44-year-old cabinetmaker develops an ache in the upper right forearm over several weeks and then finds he cannot straighten his fingers. On examination he can…
Anatomy · Foundations · middle twist
A 79-year-old woman is admitted with ongoing lower gastrointestinal bleeding and a haemoglobin concentration of 72 g/L (reference range 115–155). She is receivi…
Cardiovascular · Pre-internship · middle twist
A 61-year-old man is brought to the emergency department after fainting and passing a large amount of bright red blood. His blood pressure is now 102/70 mmHg af…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 74-year-old woman presents with sudden passage of a large volume of dark red blood per rectum. After two litres of intravenous crystalloid her blood pressure…
Emergency and Toxicology · Pre-internship · middle twist
A 58-year-old man with established alcohol-related cirrhosis presents with two episodes of black, offensive stool and light-headedness. His blood pressure is 10…
Infectious Diseases · Clinical rotations · middle twist
A 32-year-old woman shares a bedroom with her partner, who has been admitted with laboratory-confirmed meningococcal meningitis. She has no fever or rash and fe…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 24-year-old man presents with two days of sore throat, fever and increasing difficulty swallowing. He has muffled speech, tender cervical nodes and a grey-whi…
Infectious Diseases · Pre-internship · middle twist
A 41-year-old man undergoes urgent debridement for a necrotising infection of the calf. Initial broad-spectrum treatment has been given, and deep tissue culture…
Emergency and Toxicology · Clinical rotations · middle twist
A 35-year-old woman at 35 weeks of pregnancy presents with vomiting, malaise and jaundice. She is normotensive, has no proteinuria and has mild right upper quad…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 42-year-old woman has 18 months of fatigue, pruritus and intermittent discomfort beneath the right costal margin. Alkaline phosphatase is 410 U/L (30–110), al…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 52-year-old man attends for a health assessment. He does not smoke, has no diabetes, chronic kidney disease or established cardiovascular disease, and his fat…
Cardiovascular · Clinical rotations · middle twist
A 46-year-old woman has a body mass index of 32 kg/m² and treated hypertension. Her mother developed type 2 diabetes at 58 years of age. She has no polyuria, po…
Endocrine and Metabolic · Clinical rotations · middle twist
A 68-year-old man taking gliclazide modified release for type 2 diabetes is found drowsy with a blood glucose concentration of 2.1 mmol/L. He improves after int…
Emergency and Toxicology · Clinical rotations · middle twist
A 24-year-old woman with type 1 diabetes presents with abdominal pain, vomiting and deep breathing. Her blood glucose concentration is 24 mmol/L, venous pH is 7…
Endocrine and Metabolic · Clinical rotations · middle twist
A 26-year-old woman with asthma is reviewed after three hours of emergency department treatment with inhaled salbutamol and ipratropium, systemic corticosteroid…
Respiratory · Pre-internship · middle twist