A 43 year old female present to the emergency department with an acute porphyric attack. You wonder if a beta blocker would be safe to use to reduce her heart rate and blood pressure.
A 43 year old male presents to the ED with severe abdominal pain. He tells you suffers from acute intermittent porphyria, he is having an acute attack and requires IV pethidine. Your colleague takes you aside and advises you to not to give him any opiate analgesia as he suspects the patient is an opiate abuser. You wonder if there is a higher incidence of opiate abuse in patients with an acute porphyria.
A 33 year old female presents to the ED with an acute porphyric attack. The medical student shadowing you tells you that he has done a special study module on porphyria and suggests IV heme therapy. You wonder if this would be better than conservative therapy.
A 24 year old female with acute intermittent porphyria presents to the emergency department with abdominal pain, paresis and difficulty breathing after a night of heavy drinking. You fear progression to respiratory paralysis so decide to perform rapid sequence induction. You wonder if the use of suxamethonium as a muscle relaxant may exacerbate the attack.
A 36 year old female presents to the ED with abdominal pain and vomiting after a week of crash dieting. She tells you she has been previously diagnosed with an acute porphyria but has never experienced these symptoms before. You remember reading that urinary porphobilinogen is raised in the acute attack. You wonder if this is of use in diagnosing the acute attack?
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.
Does antibiotic ointment make a corneal abrasion more comfortable than antibacterial eye drops
A carpenter presents to the emergency department complaining that they can feel something in their eye. On examination a foreign body is found and removed leaving a small corneal abrasion. Prophylactic antibiotics are prescribed to prevent infection. The patient tells you it is painful and you wonder whether it is best to give him an ointment or drop preparation of chloramphenicol and if one of them may make the eye more comfortable.
How long should you wait before testing in presumed sexually transmitted disease?
A 26-year-old man presents to the emergency department with a 2-day history of urethral discharge. He had unprotected sex a week previously. You want to take a urine sample from him straight away, but a colleague tells you that the sample must be taken four hours from his last urination. You wonder if there is any evidence for this.
A 39 year old man with sickle cell disease presents to the emergency department with a 24hr history of pain in his arms and legs. His pain is consistent with his usual painful crisis. You wonder to yourself how long on average does a painful crisis last .
A 30 year old man with sickle cell disease presents with a 3 day history of pain in his arms and legs. His pain is consistent with his usual painful crisis. He is febrile but has normal vital signs and no acute findings on physical examination. You promptly treat his pain. As you order blood cultures and other tests to find if there is any cause for infection you wonder would starting empirical antibiotics be of any benefit to the patient.