bestBETs

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?

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.

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.

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.

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.

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 24 year old woman presents to the emergency department with sickle cell painful crisis. The pain is in both arms and legs and is consistent with her normal crisis. As you promptly administer intermittent pain relief medication, you wonder to yourself would a PCA be more effective method of pain relief.

A 51 year old male attends the accident and emergency department with acute severe epigastric pain. After carrying out a few diagnostic tests, he is diagnosed with acute pancreatitis. You wonder if epidural analgesia might be better than intravenous morphine in controlling pain in this patient.

A 30 year old male with sickle cell disease presents to the emergency department with pain in the arms and legs for the last few days. The pain was in keeping with her standard painful crisis. As you promptly treat her for the pain you wonder if subcutaneous morphine is a more appropriate way to administer pain relief compared to I.V morphine

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.

A 22 year old woman with sickle cell disease presents with a two day history of pain in her arms, legs and chest. Her pain and symptoms are consistent with an acute chest syndrome. You are about to admit her to the ward when you wonder if her symptoms are severe enough to warrant admission to HDU.