Clinical rotations
Working out what is wrong and starting treatment — history, examination, diagnosis, investigations, first-line management. 832 questions.
A 64-year-old man with type 2 diabetes has an HbA1c of 62 mmol/mol (7.8%) despite maximal-dose metformin and attention to diet and activity. He had a myocardial…
Endocrine and Metabolic · Clinical rotations · middle twist
A 52-year-old man has a blood pressure of 162/98 mmHg despite adequate doses of perindopril, amlodipine and hydrochlorothiazide, with good adherence confirmed.…
Endocrine and Metabolic · Clinical rotations · middle twist
A 62-year-old woman who takes sertraline for depression is brought to the emergency department after a witnessed generalised tonic-clonic seizure at home. She i…
Renal, Urology and Electrolytes · Clinical rotations · common
A 23-year-old man presents because his urine has turned dark brown, which he noticed this morning. Two days ago he developed a sore throat and runny nose, which…
Renal, Urology and Electrolytes · Clinical rotations · common
A 76-year-old woman taking perindopril for hypertension and regular ibuprofen for knee osteoarthritis presents after three days of vomiting and watery diarrhoea…
Renal, Urology and Electrolytes · Clinical rotations · common
A 35-year-old man born in Vietnam attends for pre-employment health screening and is found to have the following results: HBsAg negative, anti-HBs positive at 8…
Gastroenterology and Hepatology · Clinical rotations · common
A 58-year-old man is reviewed after routine blood tests show ALT 68 U/L (<40), AST 44 U/L (<40) and GGT 80 U/L (<60). He has type 2 diabetes and hypertension, h…
Gastroenterology and Hepatology · Clinical rotations · common
A 28-year-old woman presents with eight months of crampy lower abdominal pain that eases after opening her bowels, together with bloating and a bowel habit alte…
Gastroenterology and Hepatology · Clinical rotations · common
A 54-year-old man with cirrhosis secondary to chronic hepatitis C presents with two episodes of haematemesis over the past hour. On arrival his blood pressure i…
Gastroenterology and Hepatology · Clinical rotations · middle twist
A 45-year-old woman has a 7-mm calculus in the distal ureter on non-contrast CT. Her pain is controlled with oral analgesia, creatinine is normal, and she is af…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 47-year-old man with chronic kidney disease presents with palpitations and proximal muscle weakness. Serum potassium is 6.8 mmol/L, the sample is non-haemolys…
Cardiovascular · Clinical rotations · middle twist
A 38-year-old woman has recurrent episodes of visible haematuria, but her renal function is normal and urine protein excretion is minimal. The episodes begin wi…
Renal, Urology and Electrolytes · Clinical rotations · common
A 70-year-old man with diabetic kidney disease takes ramipril and spironolactone. Routine testing shows potassium 6.4 mmol/L, confirmed on a non-haemolysed samp…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 46-year-old woman presents with a generalised tonic-clonic seizure. Serum sodium is 112 mmol/L, serum osmolality is 240 mOsm/kg and glucose is 5.2 mmol/L. She…
Neurology · Clinical rotations · common
A 42-year-old man presents with haemoptysis, fatigue and rapidly worsening renal function. Creatinine is 486 micromol/L, urine microscopy shows dysmorphic red c…
Renal, Urology and Electrolytes · Clinical rotations · middle twist
A 59-year-old man has an eGFR of 52 mL/min/1.73 m² on repeated testing over 4 months. His urine albumin:creatinine ratio is 12 mg/mmol, and there is no haematur…
Haematology and Oncology · Clinical rotations · middle twist
A 67-year-old woman develops oliguria and a creatinine rise from 84 to 310 micromol/L after several days of septic shock. Urinalysis shows 2+ blood but no signi…
Renal, Urology and Electrolytes · Clinical rotations · common
A 31-year-old woman at 18 weeks' gestation presents with sudden left flank pain and microscopic haematuria. She is afebrile, her blood pressure is 126/74 mmHg a…
Obstetrics and Gynaecology · Clinical rotations · middle twist
A 35-year-old man reports drinking approximately 6 L of water daily because of anxiety about dehydration. He is alert, euvolaemic and not taking diuretics or an…
Renal, Urology and Electrolytes · Clinical rotations · common
A 29-year-old man presents with facial puffiness, dark urine and ankle swelling. He had an impetigo-like skin infection 18 days ago, and his blood pressure is 1…
Renal, Urology and Electrolytes · Clinical rotations · common