Archives: BETs

A 12 year old boy came into the ED brought by his parents who were concern that an enlarged lymph node in the boy's neck has not subsided since it was present about 3 months ago. Initial history and clinical investigations were done. Should the boy undergo ultrasound to further assess the lymphadenopathy?

A 3 year old boy was brought to the ED because of a fever, sore throat and an inflamed and tender tonsils. Tonsillitis is suspected. Should the treating doctor perform a throat swab first before prescribing antibiotics?

A 5 year old boy was brought in to the ED by his parents who were worried about a lump in their child's neck which has been present for a week. The child was noted to be restless and has a temperature. The family just came back from Pakistan 2 weeks ago. On clinical examination, the doctor noticed that the lump is warm and fluctuant. What further investigations should be done?

A 7 year old boy was brought into the ED by his mum who was worried about a lump in his neck which has not disappeared. It was first noticed almost 2 months ago. This is the first time they are seeking medical attention. What investigations should be done?

A 4 year old boy was brought into the ED by her parents who were worried about a lump in her neck. During clinical examination, it was measured to be 3 cm at its widest diameter. Nonetheless it was not tender, no signs of erythema was seen and the child was well and happy without any recent history of infection. The only thing that is worrying the examining doctor is the size of the lump which is suspected to be a lymphadenopathy. Should the child undergo further investigations?

A 50- year old woman presents to the Emergency Department with a letter from her GP stating that her serum potassium level is 5.6 mmol/L. A repeat blood test confirms hyperkalaemia, with a serum potassium of 5.8 mmol/L. You immediately order a 12-lead ECG, then wonder if the findings are going to alter your management plan.

A 50- year old woman is referred to the Emergency Department by her GP with a serum potassium level of 6.4 mmol/L. A repeat blood test confirms hyperkalaemia, with a serum potassium of 6.8 mmol/L. After giving a cardiac membrane stabiliser and IV insulin and glucose her serum potassium is still high. You are about to prescribe IV salbutamol, then remember someone telling you they always prescribe nebulised salbutamol in hyperkalaemic. You wonder which of the two is more effective.

A 50- year old woman is referred to the Emergency Department by her GP with a serum potassium level of 6.4 mmol/L. A repeat blood test confirms hyperkalaemia, with a serum potassium of 6.8 mmol/L. After giving a cardiac membrane stabiliser and an IV infusion of insulin and glucose her serum potassium is still high. You consider prescribing nebulised salbutamol but wonder how effective this would be at this stage.

A 50- year old woman is referred to the Emergency Department by her GP with a serum potassium level of 6.4 mmol/L. A repeat blood test confirms hyperkalaemia, with a serum potassium of 6.8 mmol/L. After giving a cardiac membrane stabiliser you order an IV infusion of insulin and glucose, but wonder how effective this will be in lowering her serum potassium.

A 55-year-old man presented to the emergency department due to nausea, jaundice, and mild abdominal pain over the right-upper quadrant that had persisted for three days. Lab data showed hyperbilirubinemia and abdominal CT revealed multiple stones in the common bile duct (CBD). ERCP was performed for removal of CBD stones. Both amylase and lipase were elevated the day following ERCP and post-ERCP pancreatitis was diagnosed. As it is a feasible route for a patient treated without oral intake, you wonder if the use of rectal indomethacin would have lowered the occurrence of post-ERCP pancreatitis?

A 23 year old male presents to the emergency department with a knee injury sustained whilst playing football. You diagnose a probable anterior cruciate tear and decide to immobilise the patient in a cricket pad splint. He has a family history of deep vein thrombosis. He is partially weight bearing. You wonder whether the splint will increase his risk of a venous thromboembolic (VTE) event and in particular whether there is any potential benefit from the use of thromboprophylaxis.

A 12 year old male involved in a motor vehicle crash is brought in by EMS. His vitals are within normal limits, however on exam you do note moderate left upper quadrant tenderness. Before sending the patient to the CT scanner you wonder if a negative read will be sensitive enough to rule out significant intra-abdominal injury (IAI).

A 36 year old motorcyclist sustained an isolated cervical spinal cord injury at C5/6 level discovered on MRI after falling off his motorcycle in a road traffic collision. You wondered whether hyperbaric oxygen therapy may be a useful treatment to improve his neurological outcome.

A four year old attends the emergency department with a head laceration that requires suturing. You have heard of ketamine/propofol mixtures being used for sedation and wonder if you should consider using it for procedural sedation

A 25 year old female presents to your department having fallen off her bike and is diagnosed with an undisplaced midshaft humeral fracture by a junior collegue. Plaster immobilisation and fracture clinic follow up in one week is arranged. It is likely that the arm will be immobilised for at least four weeks. There is no relevant medical history of note, however there is a family history of thromboembolic events, and the patient is on the oral contraceptive pill. You wonder if upper limb immobilisation carries similar risks to lower regarding venous thromboembolic disease.