bestBETs

A 45 year old female with a diagnosis of Rheumatoid Arthritis (RA) presents to the physiotherapy department requesting the current best physiotherapy treatment and advice for her chronic, multiple joint pains and stiffness.

A 75 years old man presents with acute onset of central abdominal pain. He has never had this pain before. Abdominal examination revealed central abdominal tenderness but no guarding or masses. The general examination was unremarkable. Routine blood tests came back as normal. You request a CT scan of the patient’s abdomen as he continues to be in pain with no obvious pathology but wonder if the CT scan is a sensitive predictor of significant underlying pathology and if it will help you in clinical decision making.

A 65 year old gentleman presents with his wife after collapsing at home. He is FAST positive with a clear onset time of 1 hour. On examination in the emergency department he has a dense right hemiplegia and expressive dysphagia. CT shows no bleed. Stroke thrombolysis is considered however the patient is unable to tell you how much he weights and his wife is unsure. The doctor and nurses looking after him think he is around 70kg. Is this an accurate enough estimation for drug dosing?

A 40- year-old woman presents at the ED with complaint of severe lower back pain of 2 days duration after carrying a heavy load. She is able to ambulate with no sciatica but reports having urinary incontinence. Physical examination is unremarkable with no neurological deficits in limbs and intact perianal sensation with good anal tone. You wonder whether her urinary symptoms are indicative of cauda equina syndrome.

A 78 years old man presents to the Emergency Department with central abdominal and back pain for 2 hours. He is smoker, overweight, hypertensive and is on bisoprolol and amlodepine 5 mg each daily. Clinical examination reveals tenderness and pulsation in the epigastrium and around the umbilicus his pulse is 78 beat per minute and systolic blood pressure is 85mm Hg. You wonder if you can rely on your examination to rule out a leaking AAA.

A 79 years old man presents to the Emergency Department with acute onset of central abdominal pain and one attack of bloody diarrhoea. The pain is severe and not relieved by simple analgesia. Abdominal examination shows central abdominal tenderness but no guarding. On general examination the pulse was 110/minute irregular but other examination was unremarkable, serum amylase was also normal. The patient gave a history of hyperlipaedemia, hypertension, smoking and peripheral vascular disease. You started titrated doses of morphine to relive the pain. You suspect acute mesenteric ischaemia and wonder if any blood test can help in supporting or excluding the diagnosis.

35 year old builder presented to A&E after having bleach spashed into eyes. Does the new solution Diphoterine offer better visual outcome compared to normal saline when used to irrigate acutely contaminated eyes?

A 25 year old female presents to the emergency department after falling from her bicycle on to her left shoulder. After x-ray and physical exam, she is determined to have sustained an uncomplicated anterior shoulder dislocation and undergoes closed reduction. She has no prior history of shoulder dislocation. You wonder how long her shoulder should be immobilized, and whether you should place her shoulder in external or internal rotation.

A 65 year old female presents to the Emergency Department acutely short of breath. You diagnose an acute exacerbation of COPD. You take an arterial blood gas, but wonder whether a venous one would have sufficed.

A non-obese 68-year-old man is brought to the emergency department by his family with a history of progressive dyspnea over the last week; he has both a productive cough and a fever. He’s very confused and non-combative. His initial saturation is 84% with a reservoir oxygen mask; he is tachypneic with a respiratory rate of 35. You decide to intubate this patient and you need to optimize his saturation before induction. One of your colleagues suggests that you should try Continuous Positive Airway Pressure (CPAP) prior to intubating him. You have not yet used this technique in similar situation. You wonder if CPAP should be used as a means of optimizing oxygenation in non-obese patients with hypoxia before intubation.

A 78 years old lady presents to the Emergency Department with right lower quadrant abdominal pain for 2 days. She is known hypertensive and take bisoprolol 5 mg every morning. Clinical examination showed very slight tenderness in the right lower quadrant and suprapubic area, there is no guarding, masses or organomegaly. Urine dip and bowel sounds were normal. General examination is otherwise normal with temp of 37 degree Celsius, pulse of 58 beat per minute. You wonder if you can rely on normal blood tests to be able to exclude appendicitis.

A 56 year old palliative care patient with transitional cell urothelial carcinoma presents with excruciating cancer related pain in the Emergency Department (ED). He is no longer responsive to opioids for moderate pain and now requires management of his severe cancer related pain. He has experienced constipation, nausea, vomiting and decreased cognition since being placed on morphine (70 mg/day) previously and would like to avoid significant side effects of his medication and focus on maintaining a good quality of life.

A young person with autism comes to hospital for an intervention and the procedure is cancelled as a result of the patient’s challenging behaviour and distress. You wonder if an individualised care plan would have reduced patient anxiety and improved cooperation with the intervention.

A 6 month old child is referred to Occupational Therapy (OT) from the consultant led clinic with camptodactyly. You want to try to correct the flexion deformity at the PIP joints and wonder if splinting may be a useful technique effective in improving PIP joint range of movement (ROM) and hand function.

You heard from a colleague that "if there is a radial pulse, then the SBP is at least 80mmHg", you wonder if this is actually true in the trauma patient.