bestBETs

A 32 year old woman presents to the emergecny department with vaginal bleeding. You want to know if she is pregnant, and wonder if a urinary pregnancy test is sensitive enough to detect an ectopic pregnancy?

A 25 year old female presents to your department having fallen off her bike and is diagnosed with an undisplaced midshaft humeral fracture by a junior collegue. Plaster immobilisation and fracture clinic follow up in one week is arranged. It is likely that the arm will be immobilised for at least four weeks. There is no relevant medical history of note, however there is a family history of thromboembolic events, and the patient is on the oral contraceptive pill. You wonder if upper limb immobilisation carries similar risks to lower regarding venous thromboembolic disease.

Your patient in the Emergency Department is diagnosed with Community Acquired Pneumonia and requires antibiotic treatment. You are advised by the Medical team to give a stat dose of oral Clarithromycin as research shows oral Clarithromycin is as effective as an intravenous Clarithromycin for treatment of Community Acquired Pneumonia, and provides a cost effective treatment

A 30 year old man presents to the ED with a painful knee due to a traumatic sporting injury. You suspect a soft tissue injury and wonder if he needs an x-ray?

A 30 year old woman has been bitten by a venomous snake. In anticipation of emergency medical care, a bystander tied a compression bandage and a splint. You wonder if a compression bandage combined with immobilisation is a safe and effective first aid measure to reduce the effect of envenomation.

It is rare for Alzheimer’s disease patient to present with brain tumor. You are working in a Radiation Oncology Clinic when the nurse informs you that a patient with CNS Lymphoma and Alzheimer’s disease has arrived. You wonder the safety of cranial irradiation in an Alzheimer’s disease patient and the management of this clinical challenge.

It is not uncommon for non-insulin dependent diabetes mellitus patients having the co-morbidity of cardiovascular disease. You are working in a busy Intensive Care Unit when the nurse informs you that a congestive cardiac failure patient with Hyperosmolar non-ketotic diabetes mellitus has just arrived. You wonder the management, as treatment of one condition is contraindication for the other. Cardiovascular disease complicating Hyperosmolar Nonketotic diabetes mellitus is not a rare phenomenon and lethal if not treated properly. Both diseases are treatable individually. Treatment of one condition being the contraindication to the other, clinical judgment on management is difficult, when one complicates the other.

A 3 year old girl presents to the Emergency department with 48 hr history of low grade fever, anorexia, malaise and lesions to her hands, feet and oral mucosa (buccal mucosa, gingiva and tongue). Her mother states she is now refusing to eat and drink due to her painful mouth ulcers. Upon physical examination you diagnose her with Hand-foot and mouth disease and deem her to be mildly dehydrated. You wonder if administering a topical anesthetic (i.e. viscous lidocaine) to her mouth lesions would result in an improved oral fluid intake.

A 30 year old man presents to the Emergency Department with a painful, swollen knee after sustaining a sports-related injury. You suspect a soft-tissue injury and wonder if he still requires an x-ray?

Patient thought to be using alcohol hazardously or showing early signs of alcohol withdrawal. You want to know the best way to assess their risk of alcohol withdrawal syndrome.

Patient is experiencing symptoms of alcohol withdrawal. You want to know which is the best benzodiazepine to give.

Patient is in alcohol withdrawal. You want to know which is the best benzodiazepine to prescribe.

Patient attends the emergency department following an episode of collapse with no obvious cause. How should you assess the suitability for in/ out patient management? How successful is the San Francisco syncope rule at highlighting the patients that are at risk of significant future events. The San Francisco Syncope rule attempts to highlight those patients who are at risk of a serious outcome following an episode of syncope, by scoring the patients according to the outcomes of initial investigations. The mneumonic often used to remember these is "CHESS" history of Congestive heart failure, Hematocrit <30%, abnormal ECG, a patient complaint of Shortness of breath, and a systolic blood pressure <90 mm Hg.