Middle twist

A 52-year-old woman has progressive headaches and difficulty seeing objects to either side. MRI shows a 2.6-cm sellar mass elevating and compressing the optic c…

Endocrine and Metabolic · Clinical rotations · middle twist

A 44-year-old man has an incidental 8-mm pituitary lesion discovered during MRI for headaches. He has normal visual fields, normal pituitary hormone testing, an…

Endocrine and Metabolic · Clinical rotations · middle twist

A 59-year-old man presents with eight hours of continuous vertigo, vomiting and difficulty walking. He has spontaneous right-beating nystagmus and no hearing lo…

Eyes, Ears, Nose and Throat · Clinical rotations · middle twist

A 34-year-old swimmer has had increasing right ear pain for three days. Moving the pinna and pressing the tragus markedly worsen the pain, and the external cana…

Eyes, Ears, Nose and Throat · Clinical rotations · middle twist

A healthy 55-year-old man with no family history of prostate cancer asks for a PSA test after seeing an online advertisement. He has no urinary symptoms, haemat…

General Practice and Population Health · Clinical rotations · middle twist

A 52-year-old man reports a 9-month history of gradually worsening erectile difficulty and reduced sexual desire. He has obesity, hypertension and type 2 diabet…

Cardiovascular · Clinical rotations · middle twist

A 29-year-old woman requests emergency contraception 4 days after unprotected intercourse. Her BMI is 36 kg/m², she is not pregnant and has no contraindication…

Emergency and Toxicology · Pre-internship · middle twist

A 32-year-old woman wants highly effective contraception and would prefer predictable light bleeding. She does not want a method requiring daily action and has…

Obstetrics and Gynaecology · Clinical rotations · middle twist

A 66-year-old man with diffuse large B-cell lymphoma is receiving chemotherapy through a tunnelled central venous catheter. On day 8 he develops fever of 38.6°C…

Haematology and Oncology · Clinical rotations · middle twist

A 63-year-old woman with acute myeloid leukaemia has had febrile neutropenia for 96 hours despite piperacillin-tazobactam. She remains haemodynamically stable,…

Emergency and Toxicology · Pre-internship · middle twist

A 54-year-old woman has a symptomatic isolated posterior calf-vein thrombosis found on ultrasound. She has no cancer, previous venous thromboembolism, marked sw…

Cardiovascular · Clinical rotations · middle twist

A 59-year-old man has a painless left cervical mass that has enlarged over 6 weeks. He reports drenching night sweats and has no dental infection, pharyngitis o…

Haematology and Oncology · Clinical rotations · middle twist

A 77-year-old man with metastatic prostate cancer and an estimated glomerular filtration rate of 18 mL/min/1.73 m² has been receiving regular oral morphine. Ove…

Geriatrics and Palliative Care · Pre-internship · middle twist

A 76-year-old man with probable dementia with Lewy bodies has recurrent visual hallucinations that are frightening but not associated with aggression or immedia…

Geriatrics and Palliative Care · Clinical rotations · middle twist

A 24-year-old man has 9 months of low back pain that began gradually and improves after exercise but not with rest. He wakes in the second half of the night and…

Rheumatology and Musculoskeletal · Clinical rotations · middle twist

A 67-year-old man has recurrent sinusitis, otitis and a persistent cough with occasional blood-streaked sputum. Urinalysis shows dysmorphic red cells and red-ce…

Rheumatology and Musculoskeletal · Clinical rotations · middle twist

A 74-year-old woman has 3 weeks of a new unilateral temporal headache and pain in her jaw when chewing. She has no visual symptoms, limb weakness or constitutio…

Rheumatology and Musculoskeletal · Clinical rotations · middle twist

A 79-year-old man living in Western Australia has recently been diagnosed with a terminal lung disease. He lives alone, receives the age pension, and holds a va…

Year 1 · Foundations · middle twist

A 21-year-old woman presents to the GP with urinary urgency, suprapubic discomfort, and dysuria. This is her third similar episode in the past year. She does no…

Year 1 · Mechanisms of disease · middle twist

A 36-year-old man presents with 2 days of fever, nausea, abdominal cramps, and watery diarrhoea after returning from a trip to Bali. He ate street food and dran…

Year 1 · Foundations · middle twist