Investigation

A 5-month-old girl has had a fever of 39.2 °C for 24 hours with vomiting and irritability, and no cough, runny nose or rash. Examination is otherwise unremarkab…

Paediatrics · Clinical rotations · middle twist

An 8-month-old previously well boy has had a 12-hour history of episodes in which he suddenly screams, draws his knees up to his chest and goes pale, lasting a…

Paediatrics · Clinical rotations · common

An 18-month-old boy is brought by his parents because he has no words. He walked at 13 months and runs and climbs well. He does not point to show things, does n…

Paediatrics · Clinical rotations · middle twist

A 58-year-old man who smokes and drinks heavily presents with a painless lump below the angle of his left jaw that he first noticed six weeks ago and which has…

Eyes, Ears, Nose and Throat · Clinical rotations · middle twist

A 63-year-old man who has smoked for 40 years and worked for 20 years in a tyre factory reports that on two occasions in the last month his urine has been brigh…

Renal, Urology and Electrolytes · Clinical rotations · common

A 41-year-old woman presents with a headache that began abruptly while she was lifting weights at the gym yesterday evening, reaching maximum intensity within s…

Neurology · Clinical rotations · common

A 27-year-old woman of Greek background attends for pre-pregnancy advice. She feels well. A full blood count taken by her previous doctor shows: haemoglobin 108…

Haematology and Oncology · Clinical rotations · middle twist

A 31-year-old woman presents with six months of fatigue, nausea and 7 kg of weight loss. She has been adding extra salt to everything and craves potato chips. F…

Endocrine and Metabolic · Clinical rotations · common

A 29-year-old woman asks whether she has coeliac disease. For three years she had bloating, loose stools and tiredness; four months ago she removed gluten from…

Gastroenterology and Hepatology · Clinical rotations · middle twist

A 44-year-old woman develops a severe headache while lifting her young child; she says it was already unbearable before she could put the child down. She has vo…

Neurology · Clinical rotations · middle twist

A 27-year-old man with no previous psychiatric history is brought to hospital by his family after two weeks of little sleep, expansive business plans and increa…

Psychiatry and Mental Health · Clinical rotations · common

A 72-year-old man is found to have a serum creatinine of 286 micromol/L, compared with 98 micromol/L 3 months earlier. He reports six months of poor urinary str…

Gastroenterology and Hepatology · Clinical rotations · common

A 68-year-old man reports persistent thoracic back pain and fatigue for 3 months. His haemoglobin is 92 g/L (reference range 130–170), creatinine is 180 micromo…

Haematology and Oncology · Clinical rotations · common

A 72-year-old man presents to the emergency department with a sudden onset of severe right leg pain over the past 3 hours. He also reports numbness and weakness…

Year 4 · Clinical rotations · middle twist

A 45-year-old woman presents to the emergency department due to the sudden onset of nausea, vomiting, and epigastric pain radiating to the back for the past 6 h…

Year 4 · Clinical rotations · middle twist

A 55-year-old with progressive difficulty swallowing solid foods over 4 months has no accompanying chest discomfort or unpleasant oral taste. Weight loss of abo…

Year 4 · Clinical rotations · common