Australia

A 16-year-old boy collapses at the finish of a school cross-country race in Perth on a 39-degree day. He is confused, cannot say where he is, and is unsteady wh…

Acute Care · Clinical rotations · middle twist

A 19-year-old man walks into a small country hospital 40 minutes after being bitten on the right calf by a snake he disturbed while moving hay bales. A bystande…

Acute Care · Pre-internship · middle twist

A 24-year-old man is brought to the surf club first aid room at a Perth beach in February. Ten minutes ago, while swimming, he felt sudden severe burning pain i…

Acute Care · Clinical rotations · middle twist

A 22-year-old man is brought in 20 minutes after eating a satay skewer at a food van. On arrival he had widespread welts, audible wheeze and a blood pressure of…

Acute Care · Pre-internship · middle twist

A 62-year-old man wakes at 5 am with swelling of his lips and tongue that has worsened over three hours. He ate prawns and drank a glass of wine at a restaurant…

Acute Care · Clinical rotations · middle twist

An 81-year-old woman was brought from a residential aged care facility two hours ago with fever and dysuria; her observations were normal at triage and she was…

Acute Care · Pre-internship · middle twist

You are the intern on an evening shift at a public hospital in Perth. A 3-year-old boy was admitted this morning with a febrile illness. His mother has told the…

Acute Care · Pre-internship · middle twist

A 79-year-old woman is brought in drowsy and clammy after two episodes of collapse at home. The monitor shows complete heart block with a ventricular rate of 34…

Acute Care · Pre-internship · middle twist

A 58-year-old man had a witnessed collapse at a shopping centre. Bystanders started compressions, ambulance officers delivered one shock, and spontaneous circul…

Acute Care · Pre-internship · middle twist

A 4-year-old boy weighing 16 kg has had profuse watery diarrhoea and vomiting for three days and has not passed urine since yesterday. In the emergency departme…

Acute Care · Pre-internship · middle twist

A 63-year-old man with two hours of chest pain has 3 mm of ST elevation in leads II, III and aVF. He is alert but cold and clammy. Pulse is 52 beats per minute…

Acute Care · Pre-internship · middle twist

A 5-year-old girl weighing 20 kg is admitted with right lower lobe pneumonia. She is febrile at 38.9 degrees Celsius, saturating 93% on 2 litres per minute of o…

Acute Care · Pre-internship · middle twist

A 24-year-old man is brought in after his motorcycle struck a fence post. He opens his eyes to pain, makes incomprehensible sounds and localises with his right…

Acute Care · Clinical rotations · middle twist

An 82-year-old woman in a residential aged care facility has had watery diarrhoea and intermittent vomiting for two days. She is alert and oriented, her mucous…

Acute Care · Clinical rotations · middle twist

A 58-year-old man has had constant central chest heaviness for 70 minutes, radiating to his left arm, with sweating and nausea. The pain is unchanged by posture…

Acute Care · Clinical rotations · middle twist

A 79-year-old woman is admitted with ongoing lower gastrointestinal bleeding and a haemoglobin concentration of 72 g/L (reference range 115–155). She is receivi…

Cardiovascular · Pre-internship · middle twist

A 61-year-old man is brought to the emergency department after fainting and passing a large amount of bright red blood. His blood pressure is now 102/70 mmHg af…

Gastroenterology and Hepatology · Clinical rotations · middle twist

A 74-year-old woman presents with sudden passage of a large volume of dark red blood per rectum. After two litres of intravenous crystalloid her blood pressure…

Emergency and Toxicology · Pre-internship · middle twist

A 58-year-old man with established alcohol-related cirrhosis presents with two episodes of black, offensive stool and light-headedness. His blood pressure is 10…

Infectious Diseases · Clinical rotations · middle twist

A 32-year-old woman shares a bedroom with her partner, who has been admitted with laboratory-confirmed meningococcal meningitis. She has no fever or rash and fe…

Obstetrics and Gynaecology · Clinical rotations · middle twist