Archives: BETs

You are a paediatric specialist registrar giving discharge advice to the parents of a 7 year old girl who is recovering from an episode of acute asthma. She has a frequent episodic pattern of asthma and normally receives 100mcg of fluticasone morning and night. Her parents ask you if they should wait to see a doctor before commencing her on prednisolone if she has another 'asthma attack'?

A 35 year old fit female presents with several years history of lower back ache/pain. She is otherwise well. Her work requires her to be mobile, flexible and strong enough to assist in the movement of heavy objects while also having a minor desk role. She also enjoys an active sporting/social life. She wishes to know if pilates can help her back pain and prevent any further recurrence.

A 40 year old man presents with an acute on chronic exacerbation of lower back pain after lifting. He has no other symptoms. He has suffered minor injuries to his back while playing rugby in his twenties and thirties. He spends most of his working time at a desk. The pain is usually improved with pain relief. He wishes to know if yoga can help to improve the chronic pain.

A 32-year-old healthy man attends the emergency department with a right shoulder injury he sustained during a hockey game. Clinical examination reveals a defect in his glenohumeral joint, an anterior shoulder dislocation and no neurovascular deficits. x Rays reveal an anterior shoulder dislocation and no fracture. You are aware of endless discussion about the "best" technique for reduction and see no reason why you should not join in. In this light you wonder whether the scapular manipulation technique or Milch’s technique is the best at achieving the most successful reduction?

A 65 year old man presents to the A&E department with shortness of breath and cough productive of green sputum. There is radiological evidence of pneumonia on chest x-ray and oral amoxicillin is started. You wonder whether adding in a macrolide would benefit the patient.

An elderly lady sustains a displaced Colles fracture that needs manipulating. She is given a Bier's block. Two minutes after the injection of prilocaine, she has an asystolic cardiac arrest. Resuscitation commences following ALS protocols, but after ten minutes, she remains asystolic. Should lipid rescue be used in this situation?

A 30 year old male presents in surgical outpatient with typical history of chronic anal fissure. Clinical examinations confirms this. You decided to try medical treatment as first line in managing his condition however you wonder whether DTZ (2%) or GTN (0.2%) cream would provide better symptomatic relief and promote healing of anal fissure.

A 14 year old boy presents to the paediatric assessment unit with a 24 hour history of right iliac fossa pain. After a full history and examination the clinical diagnosis is of acute appendicitis. He is booked for theatre as an emergency appendicectomy. Which is the best approach: laparoscopic or an open procedure?

A 29 yr old male is admitted to the ICU following a significant head injury sustained in a road traffic accident. He is being managed in accordance with head injury guidleines but in addition he is prescribed Omeprazole 20 mg i.v od, for gastric ulcer prophylaxis. This is changed to Ranitidine 50 mg i.v tds, two days later on the advice of the pharmacist, the indication remaining the same. You wonder if there is any difference in benefit between the two drugs for the prevention of gastric stress ulcers.

You are looking after a 55-year old man with mitral regurgitation who underwent a mitral valve repair with a quadrangular P2 resection and an annuloplasty ring. He is in sinus rhythm and well. You had talked to him about warfarin in the context of a mitral replacement in case you couldn't repair the valve. However he is now keen to eliminate any additional risk of stroke as his mother had a severe stroke 5 years ago. He says that he would like to take warfarin if there was any additional chance of preventing a stroke. You decide to review the literature to answer his question.

You are reviewing a 55-year-old patient in the clinic who underwent coronary bypass grafts 6-weeks ago after he suffered a non-ST segment myocardial infarction (NSTEMI) the week before. You notice that the cardiologist saw him last week and restarted his clopidogrel in addition to the aspirin you gave him. The cardiologist wrote in his letter that he recommenced this on the basis of the 2004 ACCP guidelines. You resolve to investigate this further.

You are about to perform CABG and aortic valve replacement surgery on a 75-year-old man with a history of diabetes, hypertension, carotid disease and transient ischaemic attacks. Your colleague suggests that you should give your patient aprotinin to minimise the risk of cerebrovascular complications but given recent controversies you decide to review the literature to investigate what evidence there is to suggest aprotinin has neuroprotective properties.

A 2-year-old girl presents with chickenpox. The girl has typical vesicular lesions but has no evidence of complications on examination. Her mother reports that she is scratching continuously and has had very little sleep over the past few days as a result of the pruritus. Considering the therapeutic options, we wonder whether there is any evidence to support the use of either calamine lotion or antihistamines to alleviate pruritus in varicella zoster infection.

A newborn baby born at 37 weeks is noted to be unwell at 18 h postnatally. The mother gives a history of prolonged rupture of membranes for 36 h. The baby is feeding poorly and is jittery, with a temperature of 38°C. A clinical diagnosis of early sepsis is made and lumbar puncture is suggested on the ward round as a part of sepsis evaluation. Several publications on the use of lumbar puncture in late-onset sepsis, including a recent review article by Malbon et al,1 suggest that lumbar puncture is an important method of investigation and should be considered in babies for >48 h old, with suspected sepsis. We wonder whether there is sufficient evidence to justify lumbar puncture in early sepsis.

A 34 year old lady was admitted with leg pain and diagnosed to have lower limb DVT.She was started on LMWH initially and warfarinised prior to discharge.Should she be monitored in the hospital clinics or at her GP surgery?

A 6 year-old boy presents to the emergency department with a two day history of earache and fever. After examination, Acute Otitis Media was diagnosed and a prescription for analgesia and oral antibiotic course were given. You wonder if the administration of topical analgesia (ie eardrops) would be helpful in providing additional and fast relief of this child's pain symptoms.

A patient presents to the Emergency Department with complaints of abdominal pain and vaginal discharge. You find out she is pregnant and has chlamydia; will antibiotic treatment help decrease the incidence of miscarriage and/or preterm labor?

A 50 years old man attends the Emergency department with a 12 hours history of palpitations. He denies any history of previous ischaemic heart disease. He complains of no other symptoms other than mild dizziness. On clinical examination he has a normal BP, no signs of heart failure and an ECG shows him to be in AF with a rate of 140/min. You wonder if flecainide is better than placebo at cardioversion.

An adult patient presents to the emergency department unwell with a temperature but no specific signs of a focus of infection. You wonder how useful a measurement of C Reactive Protein (CRP) will be in making a diagnosis of severe bacterial sepsis.

A man attends the Emergency department with a 12 hours history of palpitations. He denies any history of previous ischaemic heart disease. He complains of no other symptoms other than mild dizziness. On clinical examination he has a normal BP, no signs of heart failure and an ECG shows him to be in AF with a rate of 140/min. You have read some studies that have shown both intravenous and oral flecainide is effective at converting AF to sinus rhythm, but wonder which route is more effective and safe.