Pre-internship
The harder call — the unwell patient, escalation, prioritisation, prescribing detail, ethics and law. 488 questions.
A 54-year-old woman receiving adjuvant docetaxel and cyclophosphamide for breast cancer presents nine days after her second cycle with a temperature of 38.4 °C,…
Haematology and Oncology · Pre-internship · common
A 67-year-old man with prostate cancer on androgen deprivation therapy presents with two weeks of mid-back pain that is worse lying flat and wakes him at night.…
Haematology and Oncology · Pre-internship · common
A 66-year-old woman is on day 8 after an elective total hip replacement and has been receiving subcutaneous enoxaparin 40 mg daily since surgery. Her platelet c…
Haematology and Oncology · Pre-internship · niche
A 31-year-old man who has sex with men presents with a two-week history of a non-itchy pinkish rash on his trunk that now involves his palms and soles, together…
Infectious Diseases · Pre-internship · middle twist
A 61-year-old man presents with 24 hours of severe pain, redness and swelling of his right first metatarsophalangeal joint, left ankle and right knee. He has ha…
Rheumatology and Musculoskeletal · Pre-internship · middle twist
A 72-year-old woman presents with three weeks of a new, persistent right-sided headache. Brushing her hair on that side has become painful, and her jaw begins t…
Rheumatology and Musculoskeletal · Pre-internship · middle twist
A 68-year-old woman with recently diagnosed small cell lung cancer is brought in after a generalised tonic-clonic seizure at home. Over three days she has becom…
Renal, Urology and Electrolytes · Pre-internship · middle twist
A 46-year-old woman was admitted yesterday with epigastric pain and a serum lipase of 3,400 U/L (<60). Ultrasound showed multiple gallbladder stones and a commo…
Gastroenterology and Hepatology · Pre-internship · middle twist
A 26-year-old man born in Vietnam who migrated to Australia at age 10 attends for a pre-employment medical. He is well. Blood tests show: hepatitis B surface an…
Gastroenterology and Hepatology · Pre-internship · middle twist
A 71-year-old man with severe chronic obstructive pulmonary disease presents with three days of increasing breathlessness and green sputum. On arrival he is dro…
Respiratory · Pre-internship · middle twist
A 58-year-old man was started on oral amoxicillin five days ago for right lower lobe pneumonia. He returns because his fevers have continued and he is more brea…
Respiratory · Pre-internship · middle twist
A 52-year-old Aboriginal woman from a community in Cape York presents with a week of palpitations and breathlessness on walking to the store. She had several ep…
Cardiovascular · Pre-internship · middle twist
A 5-month-old girl is brought to the emergency department because her left thigh is swollen and she cries when it is moved. Her father says she rolled off a cou…
Paediatrics · Pre-internship · common
You are the intern attached to a regional public health unit. Its annual child health profile for a town of 4,000 people reports: two-dose measles-mumps-rubella…
Paediatrics · Pre-internship · niche
You are the intern in a regional hospital's paediatric outpatient clinic. A 3-year-old Aboriginal boy has bilateral middle ear effusions and a 35 dB conductive…
Paediatrics · Pre-internship · middle twist
A coastal local government area has recorded four drownings of children under five years of age in five years, every one of them in a backyard swimming pool at…
Paediatrics · Pre-internship · middle twist
You are the intern on a Perth paediatric ward. Over three weeks you admit four toddlers from the same remote community with extensive impetigo, and a fifth chil…
Paediatrics · Pre-internship · middle twist
You are a junior doctor at a regional Western Australian hospital. Hospital data show that Aboriginal children in the district are admitted with skin infections…
Paediatrics · Pre-internship · middle twist
You are a general practice registrar in Perth. A 3-year-old boy attends with his mother for a routine pre-kindergarten review recorded in his personal health re…
Paediatrics · Pre-internship · middle twist
A 6-year-old girl with spastic diplegic cerebral palsy attends a Perth outpatient clinic. She needs continuing physiotherapy and speech pathology to preserve fu…
Paediatrics · Pre-internship · middle twist