Our team has released a 4-day clinical case series, covering common topics encountered during internship.
Access all questions and suggested answers below!
Case 1: HYPERKALAEMIA
You are the after-hours intern covering a surgical ward, and you’re asked to review Mrs JS, a 68 year old female with a potassium result of 6.2.
Mrs JS is currently being investigated for a suspected small bowel obstruction and left lower limb cellulitis. She is on the appropriate IV antibiotics. She does not have pre-existing cardiac disease. She is haemodynamically stable and has no other electrolyte abnormalities. You review her ECG, which does not show any concerning signs (no peaked T Waves, no flattened P wave and no broad QRS complex).
What is your most immediate management step?
A – Repeat serum potassium level to rule out a false reading, repeat ECG and re-assess based on repeat results
B – Calcium gluconate 1g in 10ml intravenously, over 2-3 mins
C – Start resonium (sodium polystyrene sulfonate) 15g orally TDS (stat dose tonight), and repeat bloods in the morning
D – Short-acting insulin 10 units IV bolus plus glucose 10% 250 mL IV over 15 minutes
E – Start resonium (sodium polystyrene sulfonate) 45g rectally daily (stat dose tonight), and repeat bloods in the morning
Case written by Dr Neel Gobin. Contact Neel via email.
Case 2: PRIORITISING TASKS
You are the intern covering aged care and neurology this evening. You open up your job list to find plenty of jobs and your pager goes off with a clinical review.
The tasks you need to complete are:
1) resite cannula for IV antibiotics
2) take blood for APTT for heparin infusion, due in 20mins
3) clinical review for hypertension in a patient admitted for cellulitis, on IV Abx, other obs fine, asymptomatic
4) rechart meds, you have now been paged twice about this
5) call radiology to chase up a CT brain the neurology reg has asked for for a possible stroke
Rank your tasks in order of priority:
A) 5, 3, 2, 1, 4
B) 3, 5, 1, 2, 4
C) 2, 1, 3, 4, 5
D) 3, 1, 2, 4, 5
E) 1, 5, 4, 3, 2
Case written by Dr Ashleigh Phillips. Contact Ashleigh via email.
Case 3: INSULIN CHARTING
You are the evening JMO covering the medical wards when you receive a page at 6pm asking you to review a pre-meal BSL of 15.4 on patient Mr DM. He is a 65kg 72M who is day 3 into admission for an infective exacerbation of COPD currently being treated with prednisolone 50mg (amongst other therapy). He also has a background history of type 2 diabetes mellitis on metformin XR 1g daily and basal-bolus insulin (a long-acting insulin 15 units at bedtime and an ultra-short-acting insulin 8/8/10 units at mealtimes). You note that his day team has made adjustments to his usual basal dose of insulin so that his fasting BSL is within normal range. After you have reviewed the patient to make sure he is not acutely unwell, what action would you take?
A – Chart a supplemental insulin order and advise the nurse to give a dose of Novorapid 6 units
B – Chart a supplemental insulin order and advise the nurse to give a dose of Novorapid 4 units
C – Chart a supplemental insulin order and advise the nurse to give a dose of Actrapid 4 units
D – Increase basal insulin dose by 4 units
E – Reassure the nurse and write a comment for the day team to consider increasing the regular pre-meal (dinner) insulin dose the next day by 10%
Case written by Dr Kim Van. Contact Kim via email.
Case 4: MEDICO-LEGAL
You are the after-hours JMO covering the orthopaedics ward. While you were in the middle of a clinical review, a rapid response call goes off and you quickly attend the call. Unfortunately, the patient had passed away before you arrived at the scene and the medical registrar hands you the task of filling out the death certificate. As you do not know the patient, you trawl through her notes and discover that she was a 93 year old female who fell down a flight of stairs and suffered a right neck of femur fracture and was operated on by the orthopaedics team yesterday. You are unsure if this case is reportable to the coroner as the patient passed away within 24hrs of an anaesthetic. You call the medical registrar who suggests calling the orthopaedics reg. The orthopaedics registrar is similarly unhelpful in suggesting for you to sort it out with the medical registrar as she had not met this patient before. What is your next best approach?
A – Call the medical registrar and request for help in filling in the death certificate as you have never done one before
B – Fill out the death certificate and refer to coroners as it is a coroners case
C – Call the Coroner and for further clarification into whether to report to coroner or not
D – Fill out the death certificate and do not refer to coroner as it is not a coroners case
E – Call the orthopaedics consultant in charge and clarify with him whether to refer to coroners or not
Case written by Dr Raymond Shi. Contact Raymond via email.
If you have any questions about our case series, or have an interesting case to suggest – please email us: firstname.lastname@example.org
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