Archives: BETs

A 44 year old man presents to the Emergency Department with a week long history of blood in his urine. You wonder if this patient would be more appropriately referred to a nephrologist or a urologist since you are aware that there are many causes of haematuria and that in a younger person a lot of them are not surgically defined urological problems.

A 33 year old lady who has had cystitis before presents to the Emergency Department with pain on passing urine. Urine dipstick reveals haematuria. You wonder if it is necessary to send a sample for microscopy or whether you can assume the cause is infective and treat blind with empirical antibiotics.

A 27 year old male arrives at the Emergency Department due to pain in his flank. A urinalysis and KUB are performed. the SHO wonders whether the KUB is an accurate method of detecting calculi.

A 6 year old child presents to the Emergency department with symptoms of UTI. You obtain an MSU and want to send it for urgent microscopy. However, the lab technician calls to tell you that there is no need for microscopy if urine dipstick has been done, as it can confirm or rule out UTI. You wonder if the lab technician is right or whether you should send the sample for microscopy after dipstick analysis.

A 69 year old male with a history of heart failure presents to the A & E department with acute onset of shortness of breath. The clinician wonders whether it would be better to treat him with nitroglycerin or a combination of furosemide and morphine.

A 70 year old man presents to the Emergency Department with a tummy ache. As part of your examination you dipstick his urine and find that he has microscopic haematuria. At the end of your history, examination and investigation you find that he is constipated. You conclude that the haematuria was an incidental finding. You wonder if further investigation of the haematuria would uncover significant underlying pathology. The man's 20 year old grandson who is accompanying him tells you that after his GP dipsticked his urine and found the same thing as part of a check-up he was referred for further investigation at the hospital.

A healthy 28 yr old psychiatric female patient was brought into the emergency department after being bitten by another psychiatric male patient on her wrist. There was profuse bleeding of the wound. The female patient was not vaccinated against hep B. You wonder whether she needs hep B vaccination.

A 25 year old science teacher comes into the emergency department with a partial thickness burn to her hand after being careless with a bunsen burner. You wonder if silver sulphadiazine cream is better than normal dressings at reducing the risk of infection and healing time.

A 29 year old man presents to the Emergency Department with a cat bite wound on left his arm. He says he was bitten some 6 hours prior to attendance. The wound is cleaned and it is noted that there are no signs of infection. You wonder whether prophylactic antibiotics are required to reduce the risk of wound infection.

A 35 year old prison guard was brought into the emergency department after being bitten by a HIV- positive inmate 4 hours ago. There was a superficial laceration wound on his right leg that bled profusely when bitten. You wonder whether he will benefit from HIV prophylaxis.

You have just diagnosed a child with a UTI and are about to start them on a course of antibiotics. You wonder which antibiotic is most appropriate, Nitrofurantoin or Trimethoprim, in eradicating symptoms and preventing recurrance.

A 42 year old female patient presents with moderate to severe right upper quadrant colicky pain radiating to the back with one episode of vomiting. She is apyrexial and examination reveals mild right subcostal tenderness with no guarding. You diagnose biliary colic and wonder is buscopan is effective in relieving pain.

You are scheduled to perform corrective surgery on a 3-year-old boy with a diagnosis of secundum atrial septal defect (ASD). The child presented with progressive cyanosis of one year's duration accompanied by easy fatigability on exercise. There were no indications of hepatic disease. On physical examination, clubbing was noted. Oxygen saturation was 74% in room air, and hemoglobin was 21 g/dl. Echocardiography demonstrated an interrupted inferior vena cava with azygos continuation to a right superior vena cava and a small secundum ASD. Heart catheterization was performed revealing anomalous drainage of all hepatic veins into the left atrium and a small secundum ASD with no measurable cross shunting. Contrast echocardiography confirmed the presence of a pulmonary arteriovenous malformation. You explain to the boy's father that during surgery you will be diverting the hepatic flow and coronary sinus from the left to the right atrium using an autologous pericardial patch. The father asks if this procedure will improve his child's oxygen saturation and if the child will regain a normal level of activity. You are unable to answer him to your satisfaction and therefore you resolve to check the literature for evidence of regression of intrapulmonary shunts after surgical correction of anomalous hepatic venous drainage.

A 55 year old woman presents to her GP with lower back pain radiating to her right buttock. The pain has been present for 4 months and you have seen her on many occasions with persistance of symptoms. She has been investigated with an MR scan which revealed no specific pathology except moderate OA changes. Neurological examination is normal and there are no "red flag" symptoms or signs to suggest that this is anything other than simple low back pain. You have treated her with oral paracetamol and NSAIDs but she now requests that you supply some muscle relaxants as her friends have told her that it is probably spasm causing her pain. You wonder if this is a good idea.

A 35 year old man presents to the emergency department with acute lower back pain. He has a normal neurological examination and no symptoms to suggest a serious cause. You discharge him from the emergency department with some NSAIDs and advice to stay active. He returns to the department 5 days later still complaining of ongoing back pain. You ask one of your emergency department physios to have a look and he offers to take him on for out-patient physio and Laser therapy. You wonder if there is any evidence to support the use of Laser in back pain patients.

A 28 year old male dentist presents to the emergency department following a suspected Amitriptyline overdose. You remember that tricyclic antidepressants delay gastric emptying and wonder whether gastric lavage or activated charcoal would be of benefit

A 7 year old child presents to A&E with severe tonsillitis for the fourth time in 10 months. As they are discharged with antibiotics the SHO wonders if she should write to the GP suggesting ENT referral.

A 28 year old female accountant is brouught in the the Emergency department. She has a glasgow coma scale of 8/15, her BP is 80/50 and her ECG shows signs of QRS prolongation. You wonder whether sodium bicarbonate will improve her condition

A 30 year-old woman presents to A&E after having burnt her forearm on a gas stove whilst cooking dinner. She is complaining of a moderate amount of pain. You wonder whether cooling the burn will relieve some of her pain.

A 29 year old man is brought into accident and emergency suffering massive burns after having been soaked in petrol and set alight. You need to assess the depth of his burns and wonder which clinical assessment will give the best accuracy of burn depth in the emergency setting.