bestBETs

A 24 year old man presents with a sore throat, anterior cervical lymphadenopathy, fever and tonsillar exudates. He is prescribed penicillin V but the SHO wonders if cephalosporin would be more effective?

An 18 year old presents to A&E with a sore throat, fever, tonsillar exudates and anterior cervical lymphadenopathy and no history of a cough. She is prescribed antibiotics but should she be investigated further?

A seven year old child presents with primary oropharyngeal infection. The SHO wonders if if oral aciclovir will be of use or if conservative treatment should be prescribed.

A 35 year old prison guard was brought into the emergency department after being bitten by a HIV- positive inmate 4 hours ago. There was a superficial laceration wound on his right leg that bled profusely when bitten. You wonder whether he will benefit from HIV prophylaxis.

The major determinant of survival from cardiac arrest due to ventricular fibrillation (VF) is the time interval between collapse and defibrillation. For every minute that defibrillation is delayed, survival rates drop by as much as 7 – 10%. In an effort to hasten access to defibrillation, the automatic external defibrillator (AED) was developed. AED's can now be found in a wide variety of public places from airports to supermarkets. Designed for use by people with little or no training, they are of proven benefit in improving the prognosis of adults who suffer out-of-hospital cardiac arrests. Ventricular fibrillation was assumed to have an extremely low incidence in children, therefore AED were designed solely for the treatment of adults. In 1995, a study by Mogayzel et al. demonstrated that VF was the initial rhythm in as many as 19% of children suffering out-of-hospital cardiac arrest. Therefore the use of AED's may be beneficial to a significant number of children. The efficacy of AED's in children is uncertain due to two major concerns. Firstly, there are concerns as to whether an AED can accurately assess ventricular arrythmia in children and respond appropriately. Secondly, AED's provide fixed-energy shocks that could potentially inflict myocardial damage in young children. In the event of an out-of-hospital paediatric cardiac arrest, would it be safe to use an adult AED?

A 6 year old child presents to the Emergency department with symptoms of UTI. You obtain an MSU and want to send it for urgent microscopy. However, the lab technician calls to tell you that there is no need for microscopy if urine dipstick has been done, as it can confirm or rule out UTI. You wonder if the lab technician is right or whether you should send the sample for microscopy after dipstick analysis.

A 27 year old male arrives at the Emergency Department due to pain in his flank. A urinalysis and KUB are performed. the SHO wonders whether the KUB is an accurate method of detecting calculi.

You have just diagnosed a child with a UTI and are about to start them on a course of antibiotics. You wonder which antibiotic is most appropriate, Nitrofurantoin or Trimethoprim, in eradicating symptoms and preventing recurrance.

A 30 year old male attended the Emergency Department with complaints of loin pain on the right side. Urinalysis was performed which came back as negative for haematuria. The SHO questioned whether that was enough to discard the diagnosis of a calculus as he knew that a percentage of patients are indeed diagnosed with urinary calculi despite having no haematuria.

A 29 year old woman presents to the emergency department with tricyclic antidepressant overdose. She remains alert and shows no sign of major toxicity. You wonder how long this patient must be monitored before she can be safely discharged

a 27 male is admitted to the Emergency Department with pain in the right flank. A KUB is taken for an initial diagnosis. The SHO wondered whether a CT scan would be better than an US scan in confirming the presence of a calculus.

A 12 month old baby presents to the Emergency department and you suspect UTI. The hospital policy is to refer to the infant to paediatrics. You wonder why this is the case and the paediatrician explains that it is because of the need to investigate this young age group due to the high incidence of GU abnormalities in children <2years. You wonder what the incidence oF GU abnormality is in children <2years

A 40 year old man is brought into the emergency department unconscious and smelling of alcohol. On examination he has pinpoint pupils, bradypnoea and needle track marks consistent with heroin injection. His friend claims they drank a bottle of whiskey together prior to him injecting. You wonder if the alcohol will potentiate his repiratory depression and result in a poorer prognosis.

A seventy year-old man presents to the Emergency Department with a thirty-minute history of chest pain. ECG shows left bundle branch block (LBBB) and you are not sure whether it is pre-existent. You have heard of the scoring system derived by Sgarbossa for use in this situation but you wonder if it will enable you to accurately decide whether this man is having an acute myocardial infarction (MI), in order that thrombolytic therapy may be considered.

in our tertiary neonatal unit, we had a preterm baby, who was born at 26 weeks. we had difficulty in weaning from ventilation as she had symptomatic PDA. we tried with indomethacin twice but we could not help her. once we have done the ligation, she came off the ventilator very soon after the surgery. then we wondered about the best initial treatment for PDA.

A 55 year old women presents to A & E with palpitations and shortness of breath. The physician on-call performs an ECG revealing a regular rhythm, with a p-wave distorting the start of the QRS complexes. The patient is diagnosed with atriventricular nodal re-entry tachycardia. Induction of AV block is attempted using both the carotid sinus massage and the valsava manoeuvre unsucessfully. The clinical team considers using either verapamil or adenosine as the next step in the managing this patient's arrhythmia.

A healthy 28 yr old psychiatric female patient was brought into the emergency department after being bitten by another psychiatric male patient on her wrist. There was profuse bleeding of the wound. The female patient was not vaccinated against hep B. You wonder whether she needs hep B vaccination.

A 55 year old woman represents to her general practitioner with back pain of 3 years duration. Previous assessments and investigations have not suggested a serious cause of her back pain but it so severe that she has had to give up work and has become depressed. She attends as she has rad on the internet that the joints of the back can be injected and that this can relieve her pain. She asks you if this is true and if so could you refer her for the treatment.

A 55 year old woman represents to her general practitioner with back pain of 3 years duration. Previous assessments and investigations have not suggested a serious cause of her back pain but it so severe that she has had to give up work and has become depressed. She attends as she has read on the internet that the nerves to the joints in the back can be electrified and that this will cure her pain. She asks you if this is true and if so could you refer her for the treatment.

A 35 year old woman presents to the emergency department with acute lower back pain radiating to her right buttock. Neurological examination is normal and there are no "red flag" symptoms or signs to suggest that this is anything other than simple low back pain. You treat her with oral paracetamol and voltarol and return to review her later. She is still in pain and appears to get a lot of spasm when she tries to get up. You suggest a course of diazepam to act as a muscle relaxant but your registrar says that it is a waste of time and to get her going quick as it is 3 hours since she arrived in the department.