bestBETs

A 27 year old man attends the Emergency Department having been involved in a fight. He had been hit on the nose and has an obvious displaced nasal fracture without septal haematoma. As yet there is no gross swelling. You wonder whether immediate reduction would be better than delayed reduction.

A 23 year old woman attends the emergency department with a strange growth on the end of her finger. She cut herself on glass some 6 weeks previously. Examination reveals a lesion with the appearance of a pyogenic granuloma. You wonder whether you should remove the lump surgically or chemically.

A 24 year-old woman is brought into the Emergency Department having fallen into a frozen lake. Passers-by heard her cries for help and alerted the Emergency Services who rescued her 15 minutes later. On the way to hospital she suffered a cardiac arrest. Her core temperature on arrival is 25 degrees centigrade. You know that she needs rewarming but wonder whether her eventual outcome will be improved by cardiopulmonary bypass rather than external rewarming.

A 20 year old woman presents to the emergency department having suffered her first lateral patellar dislocation 1 hour before. She has managed to reduce it herself. You know that surgery offers no advantage over conservative management, but wonder what is the best approach to initial immobilisation.

A 28 year old man presents to the emergency department with a swollen, bruised and painful ankle following an inversion injury. After examination and appropriate investigations a grade 2 inversion ankle sprain is diagnosed. You wonder whether early mobilisation or immobilisation in a short leg cast is more suitable for this patient.

A 40 year old man attends the emergency department having recently eaten fish. He feels that a bone has got stuck in his throat. Examination of the oropharynx does not reveal a bone. You wonder whether an x-ray would aid diagnosis.

A young woman attends the Emergency Department with pain in her right eye. Her infant son has inadvertently put his hand in her eye. Examination reveals a corneal abrasion. You wonder whether an eye patch should be applied to protect the cornea.

A 24 year old male with asthma presents to the Emergency Department with severe wheeze and dyspnoea. While nebulised bronchodilators are being administered you wonder whether it is better to prescribe oral or intravenous steroids.

A 24 year old man is brought into the Emergency departmment having sustained a laceration over the dorsal aspect of the metacarpophalangeal joint of the left index fingger. You explore the wound and find that there is a 50% laceration of the extensor tendon. You wonder whether this requires repair.

A 38 year old woman presents to the emergency department following an inversion injury of the right ankle. Clinical examination and x-ray confirm that there is an avulsion fracture at the base of the fifth metatarsal. You wonder whether immobilisation in a plaster cast is better than simple support bandaging.

A young man comes into the emergency department after sustaining a knee injury while playing football. Examination reveals a tense haemarthrosis; there is no evidence of fracture on x-ray. You wonder whether a MRI scan would be better than an arthroscopy to establish a diagnosis.

A 25 year old patient with no history of respiratory disease attends the Emergency Department with acute onset of shortness of breath. A chest x-ray reveals a left-sided pneumothorax of approximately 50% the volume of the left lung; there is no tension. You wonder whether needle aspiration or chest drain insertion is the treatment of choice.

A 76 year old male is brought in to A&E in a collapsed state. He has a history of ischaemic heart disease. He is agitated, tachypnoeic and sweating profusely. His neck veins are distended and there are widespread coarse crepitations in his chest. He has a diminished oxygen saturation. You make a clinical diagnosis of acute cardiogenic pulmonary oedema. In addition to vasodilator treatment and opiates, you wonder whether you should administer non-invasive continuous positive airways pressure (CPAP).

A 25 year old male presents at casualty with partial thickness burns to his arm and elbow. The visual analogue scale shows 80mm on the 100mm scale. Do you give opiate analgesia or another method of pain control.

A 17 year old female presents to the Emergency Department following a fall onto the right forearm. She complains of elbow pain and has a limited range of movement of that joint. X-ray reveals a moderate elbow effusion and an undisplaced fracture of the radial head (Manson type 1). You wonder whether aspirating the joint is worthwhile.

A 25-year-old man attends the emergency department with a one-day-old wrist injury caused by falling onto his outstretched hand. He is tender in his anatomical snuff box and also on longitudinal thumb compression, but he is in very little pain on normal everyday movements. You send him for a scaphoid series of x-rays which reveal no fracture. You arrange for him to return to the department in two weeks time for a repeat radiological and clinical examination. You wonder whether his wrist should be immobilised in a plaster cast or whether a simple elastic support bandage will suffice.