A 4-year-old girl has been brought into the Emergency Department having had a febrile convulsion lasting 25 minutes. She has not had a febrile convulsion before. Her parents are extremely worried and are asking if this will cause her any problems in the future. You wonder what advice to give them.
Do antibiotics work for tonsillitis caused by infectious mononucleosis?
An 18 year old male with known infectious mononucleosis presents with sore throat, anterior cervical lymphadenopathy, fever and tonsillar exudates. The SHO wonders if antibiotics would help?
A 69 year old male with a history of heart failure presents to the A & E department with acute onset of shortness of breath. The clinician wonders whether it would be better to treat him with nitroglycerin or a combination of furosemide and morphine.
A 20 year old patient presents to the A & E department with severe pulmonary oedema of cardiac origin. You wonder whether diuretic and ace-inhibitor combination therapy is better than either of them alone.
A 35 year old man came into A&E complaining of a sore throat. He had a fever, anterior cervical lymphadenopathy and tonsillar exudates. He had returned from Russia 1 week ago and was unsure of his vaccination status.
Is prescription of antibiotics or surgical intervention best for recurrent tonsillitis?
A 7 year old child presents to A&E with severe tonsillitis for the fourth time in 10 months. As they are discharged with antibiotics the SHO wonders if she should write to the GP suggesting ENT referral.
A 35 year old presents with an acute sore throat, although no tonsillar exudates, fever or lymphadenopathy. He asks what is the best pain relief?
A 28 year old male dentist presents to the emergency department following a suspected Amitriptyline overdose. You remember that tricyclic antidepressants delay gastric emptying and wonder whether gastric lavage or activated charcoal would be of benefit
Differential diagnosis of narrow complex tachycardias by increasing electrocardiograph speed
A 60 year-old Asian lady, who speaks little English, is brought to the Emergency Department with what seems to be a three-day history of worsening exertional dyspnoea and a three-hour history of resting dyspnoea with light-headedness. On examination she is apyrexial with a pulse of 150 beats/min, a respiratory rate of 20/min, blood pressure 100/60 and oxygen saturation 93% in air. A 12-lead ECG is recorded, which reveals a rapid supraventricular tachycardia. Interpretation of P wave activity is difficult due to the rapid heart rate and you cannot be entirely sure whether this is atrial flutter, junctional tachycardia or sinus tachycardia. You wonder if increasing the ECG speed will help you to make a more accurate diagnosis.
A 40 year old man is brought to the A & E department with acute cardiogenic pulmonary oedema. You wonder whether it would be better to treat him with a combination of nitrates and diuretics, or just nitrates alone.
A 60 year old woman presents to the A & E department with acute heart failure symptoms. The SHO wonders whether the administration of nitrates or ace-inhibitors would be most beneficial.
An eight year old child presents with pain, swelling and local tenderness of the elbow, having fallen onto an outretched hand. a supracondylar fracture of the humerus is suspected. should this patient be treated with immobilisation or referred for surgery
Is a cast as useful as a splint in the treatment of a distal radius fracture in a child
An eight year old child presents to the emergency department with signs and symptoms of a fractured wrist. radiology confirms a fracture of the distal radius.
Treatment for fractures of a lateral condyle of the humeus in a child
an eight year old child presents to the emergency department with signs of a fracture. Radiology shows a fracture of the lateral condyle of the humerus.
Best position of immobilisation in a greenstick fracture of the distal radius
an eight year old child presents to the emergency department with a suspected wrist fracture. radiology confirms a greenstick fracture of the distal radius. treatment is with the application of a plaster of Paris cast, but in which position should the forearm be immobilised (pronated, neutral or supinated)
Influence of clinical information on the diagnosis of a wrist fracture in a child
An eight year old child presents to the emergency department with swelling, local tenderness, pain and crepitus. Can this clinical information accurately diagnose a wrist fracture?
Is penicillin V or cephalosporin more effective for sore throats?
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?
Should sore throats be investigated to reduce inappropriate antibiotic prescription?
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?
Is oral acyclovir effective for treatment of primary herpetic infection?
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.
Is HIV prophylaxis required in all patients with human bites?
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.