A 23 year old female with variegate porphyria presents to the emergency department with generalised seizures. You ask your colleague about the protocol for fitting but she points out that some anticonvulsants may exacerbate porphyric attack.
A 39 year old woman presents to the emergency department with a thunderclap headache. She has not suffered from anything like this before. You suspect a subarachnoid haemorrrhage. You send her for urgent CT scan which comes back negative. You then wait until 12 hours after the onset of the symtoms and do a lumbar puncture which also comes back negative. You are worried about discharging her because you have heard horror stories about the consequences of misdiagnosis of SAH. You feel you have done everything you can you know want to know if you can dicharge this patient
A 6 year old child arrives in A and E with a temperature of 39°c. In order to reduce the child's fever and distress you would like to prescribe an antipyretic but are unsure which is better Ibuprofen or Paracetamol.
A 44 year old South African female with variegate porphyria presents to the ED with severe abdominal pain. You wonder whether IV pethidine or morphine would be safe and effective at relieving the pain.
Timing of Initiation and Duration of Postexposure Prophylaxis after Sexual Exposure To HIV
It is 5pm on a Sunday afternoon. Your patient is a gentleman in his mid 20s who tells you that he had unprotected receptive anal sex on Thursday night with a man he now knows to be HIV positive, The patient is aware of PEP through literature he has seen in the GUM clinic, and requests a prescription. You calculate that 69 hours have passed between the exposure and now, and wonder if giving PEP at this time will reduce the risk of seroconversion. When giving the patient details of the PEP prescription, he is surprised to learn that it is a 28-day course. You wonder if a 28-day course has proven to be more efficacious in reducing the rate of seroconversion compared to a shorter course.
Behavioural Interventions to Reduce Risk-Taking Sexual Behaviour
It is 7am on a Saturday morning and you are seeing a 19 year-old female university student who is dishevelled and still wearing the clothes she wore to a club the night before. She smells faintly of alcohol. She tells you she had unprotected sex while drunk, and requests the morning-after pill and postexposure prophylaxis for HIV. When you question her as to her need for PEP, she tells you that her partner of the night before was a student from South Africa, and she was aware of the high prevalence of HIV infection there. While giving you her medical history, she tells you that she has had the morning-after pill four times in the past eight months, all purchased over-the-counter in the large city-centre pharmacy, to avoid, she says, 'sanctimonious proselytising' from her GP. As you give her her prescription, you wonder if there are any behavioural interventions that might help reduce her risk-taking behaviour.
Efficacy of postexposure prophylaxis after sexual exposure to HIV
A 24 year old female attends the emergency department at 10pm on a Sunday night with her boyfriend. She tells you that a condom broke during penile-vaginal intercourse, and her boyfriend is HIV positive, though she is not. She had recently read a newspaper article about postexposure prophylaxis and wished for it to be precribed. You wonder if it would reduce the risk of seroconversion in this patient.
An 11 month old child presented to the emergency department after just having a febrile convulsion. The child does not like to look at the lights in the department but otherwise appears well. You wonder whether this child should be investigated for meningitis, and whether a lumbar puncture is necessary.
A 6 month old child arrives in the emergency department distressed (crying) with a fever of 38.5°c, she received oral Paracetamol treatment to reduce the temperature but the mother asks if there is anything else that could possibly be done to cool her child down as she is worried the high temperature may cause a febrile convulsion.
The best scale for predicting poor prognosis in pancreatitis
A 48 year old woman presented to the accident and emergency department with severe epigastric pain radiating to the back. Acute pancreatitis was diagnosed. You wonder if Ranson's criteria or Glasgow criteria is better in predicting the need for referring her to the intensive care unit.
Are topical antihistamines better than systemic at relieving allergic conjunctivitis symptoms
A 14 yr old patient comes into the accident and emergency eye centre with red, sore, itchy eyes. He had been out in the countryside on an activities day with school and has a clear case of allergic conjunctivitis. His eyes have become incredible swollen and itchy and you want to give him some relief as quickly as possible and you wonder if topical antihistamines might be more effective than systemic tablets.
A 51 year old male attends the accident and emergency department with acute severe epigastric pain. You suspect that he may have acute pancreatitis and have sent off bloods for his serum amylase level to confirm the diagnosis. You wonder if an ultrasound scan or a CT scan at this stage is better in identifying the cause of his condition.
A 34-year old male pedestrian presents to the accident and emergency department after being involved in a vehicle vs. pedestrian event. He is haemodynamically stable, and complains of diffuse abdominal pain. Which analgesic should be prescribed in order to provide the best pain relief?
A 19-year old male patient presents to the accident and emergency department following an assault in which he sustained direct blows to the abdomen. Following opiate administration, the SHO dealing with the patient wonders which antiemetic to presecribe, if any.
Following an RTA, the female driver of one of the vehicles is stretchered into the accident and emergency department, complaining of epigastric pain. She displays the "seatbelt sign", her BP is >100mmHg and her pulse rate is 95bpm. The decision is made to CT scan her abdomen, and the use of oral contrast solution is debated between two registrars in the resuscitation area. One advocates its use, arguing that extravastion will be more easily spotted. The other suggests that an unacceptable delay will be cause by its administration. Should oral contrast be used in this situation?
A tearful 10 year old was playing in the park and accidentaly pricked himself with a needle he found. His injury site was still bleeding when he presented to the emergency department. We wondered if HIV postexposure prophylaxis was indicated.
A 20 year old gentleman presents to the Emergency department with a one hour history of an acute onset of severe testicular pain. On examintion the left testicle was found to be rather swollen and tender.
A worried 21 year old student accidentally walked into an intravenous drug user not long ago at a party. On questioning her about the circumstances surrounding the exposure we wondered if the presence of visible blood on the device or a bleeding injury site would increase the risk of transmission of blood bore viruses.
Ibuprofen is probably better than Paracetamol in reducing fever in children
A 6 year old child arrives in the emergency department with a temperature of 39°c in order to reduce the child's fever and distress you would like to prescribe an antipyretic
A 53 year old female with acute intermittent porphyria presents to the emergancy department with abdominal pain. The medical student shadowing you who has done a special study module on acute porphyria tells you that carbohydrate loading had been the standard treatment for decades. You wonder if this could help resolve the attack.