Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 398 questions.
A 56-year-old man is referred by his employer after lodging a third complaint alleging that colleagues are conspiring to have him dismissed. He keeps a dated fo…
Psychiatry · Clinical rotations · middle twist
A 29-year-old woman has been treated for "depression" for six years and has now been referred for electroconvulsive therapy after adequate trials of three antid…
Psychiatry · Clinical rotations · middle twist
A 44-year-old accountant has had trouble getting to sleep for eight months. She goes to bed at 9.30 pm hoping to catch up, then lies awake for two or three hour…
Psychiatry · Clinical rotations · middle twist
A 45-year-old man with major depressive disorder has been treated for seven weeks and his mood has clearly improved. He now reports intensely vivid, unpleasant…
Psychiatry · Clinical rotations · middle twist
A 24-year-old primary school teacher is referred because of painless swelling at the angles of both jaws over four months. She is 165 cm tall and weighs 61 kg,…
Psychiatry · Clinical rotations · middle twist
A 34-year-old operating theatre nurse has had eight admissions in a year with episodes of sweating and confusion. Today her blood glucose is 1.6 mmol/L (3.0 to…
Psychiatry · Clinical rotations · middle twist
A 46-year-old man has consulted five doctors in two years convinced he has bowel cancer. He has had three colonoscopies, all normal, and inspects his stool ever…
Psychiatry · Clinical rotations · middle twist
A 20-year-old warehouse worker has spent five hours a day washing since he handled a leaking drum of solvent three months ago. He is certain he will poison his…
Psychiatry · Clinical rotations · middle twist
A 24-year-old woman is referred because of mood swings since her late teens. Twice in two years she has had six-day spells of sleeping three hours a night, talk…
Psychiatry · Clinical rotations · middle twist
A 71-year-old man is three months into rehabilitation after a left middle cerebral artery infarct. He eats little and has lost 4 kg. He wakes at 4 am and cannot…
Psychiatry · Clinical rotations · middle twist
A 24-year-old man has recovered from his first episode of schizophrenia and has been well on aripiprazole for four months. He has moved back in with his parents…
Psychiatry · Clinical rotations · middle twist
A 19-year-old man is brought to the emergency department by police after being found shouting at parked cars. He is guarded, gives his name and little else, and…
Psychiatry · Clinical rotations · middle twist
A 25-year-old man has taken risperidone 4 mg at night for six months for schizophrenia, and his voices and persecutory beliefs have gone. His mother says he now…
Psychiatry · Clinical rotations · middle twist
A 47-year-old woman, whose mother died six weeks ago, tells her general practitioner that she has three times seen and spoken with her mother in the family home…
Psychiatry · Clinical rotations · middle twist
A 29-year-old man is seen by the consultation-liaison team. Over the past twelve months he has needed steadily more alcohol for the same effect, has twice tried…
Psychiatry · Clinical rotations · middle twist
A 68-year-old woman is admitted after a fall at home. She says she takes 'a sleeping tablet now and then' and drinks 'a small sherry before bed'. Her speech is…
Psychiatry · Clinical rotations · middle twist
A 34-year-old woman attends for a routine health check. She drinks four to five standard drinks on each of five evenings a week and has done so for three years.…
Psychiatry · Clinical rotations · middle twist
A 47-year-old man completed inpatient alcohol withdrawal and has been abstinent for eight days. He wants medication to help him stay off alcohol and is attendin…
Psychiatry · Clinical rotations · middle twist
A 72-year-old woman who came to Australia from Vietnam forty years ago is brought to a memory clinic by her son, who describes two years of gradually worsening…
Psychiatry · Clinical rotations · middle twist
A 78-year-old woman is brought by her daughter because over eighteen months she has become slower at finding words and repeatedly mislays her keys. She still dr…
Psychiatry · Clinical rotations · middle twist