23 Scenarios contain the text: 'fracture' |
| Title | Description |
|---|---|
| Delirium / dementia | You are on call with the orthopaedic house officer and are called to see an 84 year old NZ European woman who has recently returned from the operating theatre after having her femoral neck fracture repaired. She has become 'very confused' and the nursing staff are having difficulties keeping her in bed. You find her trying to climb out of bed despite having surgical drains and a catheter in place. She demands to be left alone and asks to stop being 'tortured'. Her son arrives in the ward after being called by staff and he is able to calm her to some extent but both the son and the ward staff want to know what should be done if this happens again and the son can't attend. You check the most recent investigation results and note that her serum sodium is slightly reduced at 133 mmol/L and the urine is cloudy, has WBC present, and has grown E. Coli. D/O: Geriatric Medicine (•••), Psychiatry/Health Psychology (•••) PTT: General duties |
| Forearm / wrist injury | A 24 year old male Māori forestry worker presents with severe and worsening left forearm and wrist pain after his arm was crushed between two heavy logs of wood at work. An X-ray shows comminuted mid-shaft fractures of the radius and ulna. He develops compartment syndrome. This is not diagnosed immediately and despite surgical decompression he goes on to suffer serious disability. D/O: Musculoskeletal System (•••), Orthopaedics (•••) PTT: Musculoskeletal |
| Fracture | A mother presents to the Emergency Department with her 2 year old NZ European child who is not using their right arm. D/O: Emergency Medicine (•••), Musculoskeletal System (•••), Orthopaedics (•••), Paediatrics (•••), Radiology (•••) PTT: Musculoskeletal |
| Hip fracture | An 82 year old NZ European woman with a fractured neck of femur is brought to the Emergency Department by her neighbour. The woman is confused and unable to give a history but was found lying in her driveway. Earlier in the day, the neighbour heard the woman arguing with her son over him withdrawing money from her bank account. The medical records show a past history of chronic obstructive pulmonary disease, long-term oral corticosteroid use and surgical removal of a melanoma two years ago. An hour later her son arrives and says that he does not want her to have an operation. D/O: Geriatric Medicine (•••), Musculoskeletal System (•••), Orthopaedics (•••), Endocrinology (••), Radiology (••) PTT: Musculoskeletal |
| Hand injury | A 19 year old NZ European male presents with a swollen, painful right hand after falling whilst intoxicated. There is swelling over the back of his hand and he has two small wounds over his 4th and 5th knuckles. He appears angry and gives little extra history. D/O: Musculoskeletal System (•••), Orthopaedics (•••), Plastic Surgery (•••), Ethics (••) PTT: Musculoskeletal |
| Head trauma | A 26 year old NZ European male presents to the Emergency Department having received a head-high tackle in a rugby game one hour previously. He was knocked out at the scene and now has ongoing headache. He is repetitively questioning and has a reduced level of consciousness. He has no other injuries. D/O: Emergency Medicine (•••), Nervous System (•••), Neurosurgery (•••) PTT: Seriously ill patient |
| Neck injury | A 24 year old NZ European female is brought into the Emergency Department after a high-speed motor vehicle crash. She was an unrestrained front-seat passenger. She is thought to have sustained significant head and neck injuries. D/O: Emergency Medicine (•••), Ethics (•••), Musculoskeletal System (•••), Neurosurgery (•••), Orthopaedics (•••) PTT: Musculoskeletal, Neurological |
| Unexplained loss of consciousness | An 87 year old NZ European woman is brought to the Emergency Department by ambulance. She is unconscious and was found on the floor by a cleaner. You have no other history. D/O: Cardiology (•••), Cardiovascular System (•••), Emergency Medicine (•••), Nervous System (•••), Neurology (•••), Respiratory Medicine (•), Respiratory System (•) PTT: Cardiovascular, Neurological |
| Chronic illness in paediatrics | A 12 year old Samoan girl presents to Emergency Department with her mother after a fall from her wheelchair during a seizure. They have a recent outpatient clinic letter which outlines her past medical history to include spastic quadriplegic cerebral palsy from birth; she is wheelchair-bound and fully dependent for all self-cares. She has epilepsy and global developmental delay and is nonverbal. She has had a gastrostomy for night feeding since 4 years of age and has orthopaedic problems including scoliosis and tendoachilles contractures. She has bronchiectasis with two previous episodes of severe pneumonia, the last of which 6 months ago required a prolonged admission and she now remains on nocturnal VPAP (variable positive airway pressure). She attends the local intermediate school via satellite class and has multiple community services involved in her schooling, transport and therapy. D/O: Paediatrics (•••), Nervous System (••), Neurology (••), Orthopaedics (••), Respiratory Medicine (••), Musculoskeletal System (•), Respiratory System (•) PTT: Child health |
| Deep vein thrombosis | While on your GP placement you see a 45 year old NZ European woman who has just returned from holiday in London. She has noticed that her left leg has become swollen and painful. This has never happened to her before but her sister has had a 'clot in the leg' in the past. During the consultation, the GP remembers that she started the patient's 15 year old daughter on the combined oral contraceptive pill a few weeks ago, without her mother's knowledge. D/O: General Practice (•••), Haematology (•••), Clinical Pharmacology (••), Ethics (••), Radiology (••) PTT: Blood and lymph |
| Diplopia | A 66 year old Māori woman presents with intermittent double vision which has been gradual in onset, but steadily worsening and has now become constant. She had cataract surgery 2 years ago with good vision in each eye postoperatively and she has had reasonably controlled type 2 diabetes for 10 years. D/O: Neurology (•••), Ophthalmology (•••), Endocrinology (••) PTT: Eyes |
| Knee injury | A 26 year old Cook Island male presents with pain and swelling of his right knee after a twisting injury sustained over the weekend whilst playing rugby league. He has noticed that the knee seems to 'give way' since the injury. D/O: Musculoskeletal System (•••), Orthopaedics (•••) PTT: Musculoskeletal |
| Knee pain | A 70 year old Māori woman with a 1 year history of worsening knee pain underwent a left total knee joint replacement 6 weeks ago. She is a local kaumātua, helping to run a training programme for Māori youth, and usually plays bowls twice a week. She now presents with 5 days of increasing pain and swelling in this knee. She had a rigor and when she measured her temperature last night it was 38.8°C. Her left knee is markedly swollen, hot to touch and she cannot walk because of the pain. D/O: Infectious Diseases (•••), Musculoskeletal System (•••), Orthopaedics (•••), Rheumatology (•) PTT: Musculoskeletal |
| Non-specific back pain | A 50 year old NZ European male presents with low back pain of two weeks duration. His symptoms interfere with his work, personal life and nighttime rest. D/O: General Practice (•••), Musculoskeletal System (•••), Nervous System (•••), Neurology (•), Orthopaedics (•) PTT: Musculoskeletal |
| Penetrating chest trauma | A 23 year Indian medical student is brought by ambulance to the resuscitation room of the Emergency Department after a high-speed road traffic crash. He has major injuries including a fence post lodged in his chest. There is evidence of splenic trauma. D/O: Emergency Medicine (•••), General Surgery (•••), Respiratory System (•••), Ethics (••) PTT: Seriously ill patient |
| Regional limb pain | A 53 year old NZ European female presents with pain in her right shoulder that is worse with movement and restricts her range of motion. She states the pain has been present for the past 6 months and has developed gradually. It has become worse this week after she had a minor fall. The pain is now affecting her occupation as a bartender and causing her to have multiple days off work. D/O: Musculoskeletal System (•••), Orthopaedics (•••), Rheumatology (•••) PTT: Musculoskeletal |
| Acute or chronic red eye | A 56 year old hypermetropic (long sighted) Chinese woman presents to an emergency GP with a painful red right eye, which began earlier in the evening. She also complains of nausea. On examination the right pupil is fixed and mid-dilated, and the cornea is slightly hazy. To palpation the right eye feels hard in comparison with the left eye. D/O: Ophthalmology (•••) PTT: Eyes |
| Alcohol | The government has established an inquiry into the damage to health caused by alcohol, and steps that can be taken to prevent harm. Your specialist college wishes to make a submission and you have been asked to prepare the first draft. D/O: Population Health (•••), Gastroenterology & Hepatology (••), Psychiatry/Health Psychology (••) PTT: General duties |
| Altered level of consciousness in an adult | A 28-year-old Māori man presents following a motor vehicle crash in which he was an unrestrained driver. Following a lucid interval, he is unresponsive on arrival to the Emergency Department. He has a dilated right pupil and his best motor response is abnormal flexion to painful stimulus. His blood pressure starts to rise and heart rate begins to fall. D/O: Emergency Medicine (•••), Nervous System (•••), Neurology (•••), Intensive Care Medicine (••), Neurosurgery (••), Anaesthesiology (•) PTT: Seriously ill patient |
| Child with abnormal gait | A Somali woman brings her 2 year old son to the GP, because her husband is concerned about the way he is walking. His mother wears a veil for religious reasons. D/O: Musculoskeletal System (•••), Orthopaedics (•••), Paediatrics (•••), General Practice (••) PTT: Musculoskeletal |
| Child with red swelling around one eye | A 6 year old NZ European boy presents with a warm red swelling around the right eye of 24 hours duration, to the extent he is unable to open the eye himself. He is feeling unwell, off his food, and his mother is worried that he has been 'quiet' for the last few hours. She has come to you seeking antibiotics. D/O: Ophthalmology (•••), General Practice (••), Infectious Diseases (••), Paediatrics (••) PTT: Eyes |
| Child with sore joints | A 5 year old Niuean girl is brought to the local Emergency Department as she has difficulty walking. On examination she has tenderness in her left ankle and her right knee is tender and swollen. D/O: Hauora Māori (•••), Orthopaedics (•••), Paediatrics (•••), Rheumatology (•••) PTT: Child health, Musculoskeletal |
| Irritable infant | A 2 month old NZ European boy is brought to the Emergency Department in the middle of the night by his mother. She is concerned because since about two weeks of age he has been much more irritable than her first child and has been crying for 2 hours tonight. He is gaining weight and feeding well otherwise. D/O: Paediatrics (•••), Emergency Medicine (••) PTT: Child health |
| Title | Description |
