Australia

A 34-year-old woman arrives 20 minutes after eating a satay skewer at a food van. She has widespread weals, a hoarse voice and expiratory wheeze. Blood pressure…

Acute Care · Pre-internship · middle twist

A 29-year-old woman, gravida 2 para 1, is 13 weeks and 2 days pregnant by a dating scan at 8 weeks. She has had six hours of moderate vaginal bleeding and cramp…

Acute Care · Pre-internship · middle twist

A 44-year-old man presents three hours after a sudden severe occipital headache that reached its worst within a minute while he was straining at stool. He vomit…

Acute Care · Pre-internship · middle twist

A 71-year-old man presents with two hours of severe left loin pain radiating into the groin, with vomiting. He has never had pain like this before. He smokes 20…

Acute Care · Clinical rotations · middle twist

A 26-year-old man is brought to a Perth emergency department by his brother. For six weeks he has slept about two hours a night, has given away his car and most…

Acute Care · Pre-internship · middle twist

An 81-year-old man is three days from a hemiarthroplasty for a fractured neck of femur. Overnight he believes he is on a fishing boat and asks his wife about tw…

Acute Care · Pre-internship · middle twist

A 23-year-old university student is reviewed after being given a salbutamol inhaler by a locum six months ago. He uses it about three times most weeks for chest…

Acute Care · Clinical rotations · middle twist

A 62-year-old man with treated hypertension develops severe pain between his shoulder blades while carrying a bag of potting mix. It was as bad in the first few…

Acute Care · Clinical rotations · middle twist

A 24-year-old motorcyclist is brought in thirty minutes after a high-speed collision. Blood is pulsing from a deep laceration on the medial aspect of his left t…

Acute Care · Pre-internship · middle twist

A 68-year-old man presents with two days of rigors and right flank pain and is confused on arrival. Temperature 38.8 °C, respiratory rate 26/min, heart rate 118…

Acute Care · Pre-internship · middle twist

A 19-year-old woman walks into a metropolitan emergency department with her sister ninety minutes after swallowing thirty modified-release paracetamol tablets.…

Acute Care · Clinical rotations · middle twist

You are the intern in a Western Australian emergency department. A 3-year-old girl was triaged two hours ago with fever and vomiting. The paediatric registrar r…

Acute Care · Pre-internship · middle twist

A 52-year-old man who lives alone is found drowsy on his kitchen floor and brought in by ambulance. He drinks heavily, is visibly thin, and his neighbour says h…

Acute Care · Pre-internship · middle twist

A 34-year-old man is brought to the emergency department six hours after his general practitioner increased his sertraline and added tramadol for back pain. He…

Acute Care · Clinical rotations · middle twist

An 18-year-old woman took 30 paracetamol tablets after her relationship ended. She has completed acetylcysteine; at 20 hours her alanine aminotransferase is nor…

Acute Care · Pre-internship · middle twist

A 74-year-old man on the orthopaedic ward is found drowsy six hours after his first dose of slow-release oxycodone for a fractured neck of femur. He rouses brie…

Acute Care · Pre-internship · middle twist

A 17-year-old girl weighing 55 kg says she swallowed 45 tablets of immediate-release paracetamol 500 mg about ten hours ago after an argument with her partner.…

Acute Care · Pre-internship · middle twist

A 70 kg man has a 12 cm laceration across the extensor surface of his right forearm from a falling pane of glass. Tendon function through the full range of move…

Acute Care · Pre-internship · middle twist

A 7-year-old girl fell from a scooter onto her outstretched hand yesterday. Her wrist is swollen and tender about 2 cm proximal to the wrist crease, she is usin…

Acute Care · Pre-internship · middle twist

A 34-year-old man is brought in after a petrol fire in a shed. The skin over the whole front of his chest and abdomen is blistered, moist and painful. His right…

Acute Care · Clinical rotations · middle twist