Middle twist
One twist — a threshold, a comorbidity, an atypical presentation. 776 questions.
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 woman develops ongoing haemorrhage during an emergency caesarean section for uterine atony. After 3 units of red blood cells and 2 units of fresh frozen plasm…
Obstetrics and Gynaecology · Pre-internship · 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
A 72-year-old woman has developed a new unilateral temporal headache over three weeks. She reports pain when chewing and two recent episodes in which vision in…
AMC · Clinical rotations · middle twist
A 29-year-old woman presents with 10 days of progressive daily headache and brief episodes of greying vision. She is six weeks postpartum and takes a combined o…
AMC · Clinical rotations · middle twist
A 38-year-old woman with bipolar disorder started haloperidol 10 days ago for a manic episode. She now reports that she cannot sit still, repeatedly walks aroun…
Psychiatry and Mental Health · Clinical rotations · middle twist
A 32-year-old woman at 10 weeks’ gestation presents with four days of almost no sleep, excessive spending and increasingly intrusive plans to start several busi…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 23-year-old man has recurrent episodes of muscle cramps during intense exercise. During an episode, plasma lactate rises from 1.2 to 1.5 mmol/L (reference 0.5…
Biomedical Science · Foundations · middle twist
A 54-year-old woman has progressive exertional dyspnoea. Spirometry shows a forced expiratory volume in one second of 2.4 L (reference greater than 2.0 L) and a…
Biomedical Science · Mechanisms of disease · middle twist
A 41-year-old woman has progressive weight gain, proximal muscle weakness and easy bruising. Her 24-hour urinary free cortisol is 780 nmol/day (reference less t…
Biomedical Science · Mechanisms of disease · middle twist
A 29-year-old woman has a plasma bicarbonate concentration of 15 mmol/L (reference 22–29 mmol/L) and a normal anion gap. Her urine pH is 6.2 during bicarbonate…
Biomedical Science · Mechanisms of disease · middle twist
An 84-year-old man admitted three days ago with a fractured neck of femur is found to have an area of skin change over the sacrum during hygiene cares. The skin…
Nursing · Clinical rotations · middle twist
A 71-year-old woman attends a community nursing service with a shallow ulcer above the left medial malleolus present for 8 weeks. The surrounding skin is brown-…
Nursing · Clinical rotations · middle twist
A 9-year-old boy is brought to a regional Victorian hospital 45 minutes after a suspected snakebite to the calf while walking through long grass. A pressure imm…
Emergency and Toxicology · Clinical rotations · middle twist
A 19-year-old man presents six hours after an acute ingestion of an unknown number of immediate-release paracetamol tablets in a suicide attempt. He is alert, w…
Emergency and Toxicology · Pre-internship · middle twist
A 24-year-old woman presents to the emergency department two hours after impulsively swallowing 32 tablets of 500 mg immediate-release paracetamol (16 g) follow…
Emergency and Toxicology · Pre-internship · middle twist