Management

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 38-year-old woman presents with three weeks of aching pain in the front of her neck that worsens when she turns her head or swallows and radiates up to both e…

Endocrine and Metabolic · Clinical rotations · 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 33-year-old woman at 33+5 weeks has a blood pressure of 168/112 mmHg on two occasions despite oral treatment. She has persistent right upper quadrant pain; pl…

Obstetrics and Gynaecology · Clinical rotations · middle twist

A 24-year-old woman with type 1 diabetes on a basal-bolus insulin regimen is an inpatient awaiting elective surgery scheduled for the afternoon. Mid-morning she…

Nursing · Clinical rotations · common

A 62-year-old woman is receiving her first unit of packed red blood cells for symptomatic anaemia. Fifteen minutes after commencement her temperature rises from…

Nursing · Pre-internship · common

A 58-year-old man is receiving his first dose of intravenous vancomycin for a surgical site infection, charted to run over 60 minutes. Twenty minutes into the i…

Nursing · Clinical rotations · common

A registered nurse on night shift realises she has written a progress note about one patient in a different patient's paper medical record. The entry is factual…

Nursing · Clinical rotations · common

A 71-year-old woman attends a community nursing service with a shallow ulcer above the left medial malleolus present for 8 weeks. The surrounding skin is brown-…

Nursing · Clinical rotations · middle twist

A 74-year-old woman develops profuse watery diarrhoea on day 5 of intravenous antibiotic therapy for pneumonia. Stool testing confirms Clostridioides difficile…

Nursing · Clinical rotations · common