Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 76 questions.
A 16-year-old boy with anorexia nervosa weighing 39 kg was admitted three days ago and nasogastric feeding was commenced and increased daily. He has received th…
Psychiatry · Pre-internship · niche
A 26-year-old woman with a two-year eating disorder is admitted with cramps and profound weakness. She weighs 58 kg and has not lost weight. She denies vomiting…
Psychiatry · Pre-internship · niche
A 26-year-old woman with a history of childhood sexual abuse collapses in the emergency department waiting room and develops generalised shaking. Twelve minutes…
Psychiatry · Pre-internship · niche
A 36-year-old woman was abused by a relative between the ages of six and sixteen. She has nightmares about it, avoids the suburb where it happened and startles…
Psychiatry · Pre-internship · niche
A 74-year-old woman has been an inpatient for five weeks with a severe depressive episode. She has completed adequate trials of sertraline and then venlafaxine…
Psychiatry · Pre-internship · niche
A 62-year-old man is reviewed in the cardiology clinic eight weeks after an anterior myocardial infarction. He meets criteria for a moderate depressive episode…
Psychiatry · Pre-internship · niche
A 63-year-old woman has taken slow-release morphine for eighteen months for pain from vertebral metastases, prescribed and reviewed monthly by her oncologist. S…
Psychiatry · Pre-internship · niche
A 76-year-old man with dementia with Lewy bodies has become convinced that his son is stealing from him and has started accusing and shoving care staff. Over th…
Psychiatry · Pre-internship · niche
A 27-year-old man with schizophrenia is assessed at home in Perth after his sister contacted the community mental health team. He stopped his olanzapine six wee…
Psychiatry · Pre-internship · niche
A 78-year-old woman is on day six after an elective right hemicolectomy. Since the second postoperative day she has had episodes lasting about twenty minutes in…
Psychiatry · Pre-internship · niche
A 24-year-old man admitted with a first episode of psychosis started olanzapine six days ago and had the dose increased four days ago; he has also taken sertral…
Psychiatry · Pre-internship · niche
A resident is completing the discharge summary for a woman treated for a first manic episode. The diagnosis was made at the bedside against the criteria in the…
Psychiatry · Pre-internship · niche
A 22-year-old woman is admitted with three weeks of rapidly worsening persecutory beliefs and speech that is increasingly hard to follow. In the last week her f…
Psychiatry · Pre-internship · niche
A 24-year-old man with treatment-resistant schizophrenia is on day 18 of clozapine, now 250 mg at night. He is febrile at 38.4 degrees Celsius with a pulse of 1…
Psychiatry · Pre-internship · niche
A 68-year-old woman arrives at 10 pm vomiting, with a painful red right eye and rings around the streetlights. The right cornea is cloudy, the pupil is mid-dila…
Ophthalmology · Pre-internship · niche
An 82-year-old woman is admitted overnight with a fractured neck of femur after a fall at home. She has had no chest pain, breathlessness or palpitations. Preop…
Acute Care · Pre-internship · niche
A 24-year-old man comes off a trail bike at speed and arrives in a semi-rigid cervical collar and head blocks applied at the scene. He opens his eyes to voice,…
Acute Care · Pre-internship · niche
You are the intern covering a medical ward at 2 am. A 61-year-old woman with cirrhosis due to hepatitis C is admitted with hepatic encephalopathy; she is drowsy…
Acute Care · Pre-internship · niche
A 74-year-old man with type 2 diabetes is brought to the emergency department by his wife because he has become sweaty, tremulous and muddled at home. His capil…
Acute Care · Pre-internship · niche
A 24-year-old woman is admitted with an exacerbation of asthma. After an hour of nebulised salbutamol and ipratropium and oral prednisolone she is speaking in f…
Acute Care · Pre-internship · niche