bestBETs

A 45 year old man presents to the emergency department with a painful shoulder following a direct fall with hyper extension of the shoulder. After examination and appropriate investigations a tear of the rotator cuff is diagnosed. You wonder whether conservative management is suitable for this patient.

An 80 year-old man is admitted on the medical take with a three day history of melaena. He is on aspirin 75mg following an MI 18 months ago. He is not on a PPI and from his risk factors he does not seem to have any other risk factors for an upper GI bleed? DO you continue the aspirin?

You are dispatched to a house in which a 45yr old man has collapsed. He is in cardiac arrest when you arrive. During the resuscitation process, you and your team wonder if the use of the mechanical autopulse device to provide chest compressions during the resuscitation will result in a better outcome for the patient.

A patient presents to the Emergency Department with acute onset of a left sided hemiplegia. The blood glucose is measured and found to be 12mmol/l. Would using insulin to control the blood glucose closely improve the patients outcome?

A 4 year old child presents to the Emergency Department with a history of fever and symptoms of a viral upper respiratory tract infection. On examination the child is well and apyrexial. However you notice a non-blanching rash over the child's hip. You wonder whether the child will need further investigations or a period of observation to exclude meningococcal disease.

A 56 year old lady has a convulsion whilst waiting in her cubicle in the emergency department. She collapses to the floor and maintains her own airway. You wonder whether an oropharyngeal is better than a nasopharyngeal airway in providing initial airway protection.

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 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 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.

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 63 year old lady presents to the Accident and Emergency department with pain in her right wrist after a fall onto an outstretched hand. She is extremely tender over her distal radius and has poor range of movement. An x-ray of her wrist confirms a diagnosis of Colles fracture. Whilst in the plaster room, the question is raised of which position is best in order to immobilise her wrist in a plaster cast.

A 25 year old woman presents to the emergency department with acute headache. You wonder whether a C Reactive Protein (CRP) measurement will help in excluding the diagnosis of intracranial infection.

You are at a weekly hospital lecture meeting and a guest lecturer has come to discuss the current treatment of pulmonary embolus. The discussion turns to prophylaxis protocols for DVTs in your hospital. It becomes evident that the general physicians, and all non-cardiac surgeons are routinely using low-molecular-weight-heparin for all their patients. The lecturer asks one of your colleagues why you do not use it in cardiac surgery, and he replies that the incidence is very low in cardiac surgery due to the clotting derangements post-operatively and anyway we would give all our patients pericardial effusions if we did. You are not sure that he is correct and therefore resolve to look up the answer.

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 45 year old male smoker attends the Emergency department with exacerbation of COPD. Repeated doses of nebulised Salbutamol and Ipratropium Bromide has been administered and Aminophyllin infusion has been commenced. You feel that the patient will require intubation and ventilation. You have got access to Heliox and you feel that it might improve the condition of the patient and might avoid intubation. Is there any evidence to support use of Heliox in such situation?

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.

A child is diagnosed with UTI and you want to prescibe some medication. You wonder whether a short 2-3 day course is better than longer 7-14 day course of antibiotics.

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 34-year-old man has been diagnosed with gonococcal urethritis. Your consultant suggests you prescribe oral cefixime, but you had heard that i.m ceftriaxone is the first line treatment for this condition. You wonder which antibiotic would be better at eradicating his infection.