bestBETs

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 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.

A 4 year old boy was brought into the ED by her parents who were worried about a lump in her neck. During clinical examination, it was measured to be 3 cm at its widest diameter. Nonetheless it was not tender, no signs of erythema was seen and the child was well and happy without any recent history of infection. The only thing that is worrying the examining doctor is the size of the lump which is suspected to be a lymphadenopathy. Should the child undergo further investigations?

A 7 year old boy was brought into the ED by his mum who was worried about a lump in his neck which has not disappeared. It was first noticed almost 2 months ago. This is the first time they are seeking medical attention. What investigations should be done?

A 3 year old boy was brought to the ED because of a fever, sore throat and an inflamed and tender tonsils. Tonsillitis is suspected. Should the treating doctor perform a throat swab first before prescribing antibiotics?

A 5 year old boy was brought in to the ED by his parents who were worried about a lump in their child's neck which has been present for a week. The child was noted to be restless and has a temperature. The family just came back from Pakistan 2 weeks ago. On clinical examination, the doctor noticed that the lump is warm and fluctuant. What further investigations should be done?

A 50- year old woman presents to the Emergency Department with a letter from her GP stating that her serum potassium level is 5.6 mmol/L. A repeat blood test confirms hyperkalaemia, with a serum potassium of 5.8 mmol/L. You immediately order a 12-lead ECG, then wonder if the findings are going to alter your management plan.

A 3 year old boy was brought to the ED because of a fever, sore throat and an inflamed and tender tonsils. A diagnosis of tonsillitis was made. What course of antibiotics should be prescribed to the child? Which is more effective, a short-course or long-course antibiotic?

A 65 year-old man is referred to the ED by his GP with a serum potassium concentration of 6.5mmol/L. Repeat tests confirm hyperkalaemia. You order an ECG which shows characteristic hyperkalaemic changes. ............

A 12 year old boy came into the ED brought by his parents who were concern that an enlarged lymph node in the boy's neck has not subsided since it was present about 3 months ago. Initial history and clinical investigations were done. Should the boy undergo ultrasound to further assess the lymphadenopathy?

A 2 year old girl is brought in to the ED by her mother who is worried about the fever she has been having for the past 5 days. The little girl was also noted to have an enlarged lymph node on her neck which was not tender. She didn't have any history of sore throat or a previous URTI. The doctor treating her suspects Kawasaki Disease. Will a CRP level help confirm this diagnosis?

A 78 year old man on warfarin for AF presents to the ED with a head injury following a mechanical fall. There was no LOC, nausea or vomiting, amnesia or visual disturbances and neurological examination was normal. He did however sustain a laceration to his occiput, which required suturing. Despite not fulfilling NICE criteria he underwent a CT head, which was unremarkable besides an old infarct. The gentleman was admitted for observation and 10hrs later dropped his GCS to 4/15. Repeat CT demonstrated a large subdural haematoma. He subsequently died 14hrs later. In hindsight, should his INR have been reversed regardless of its value to help prevent delayed bleeding?

A 24 year old man attends the Emergency Department having suffered an injury to his right shoulder whilst playing rugby. He has severely restricted movement. Plain x-ray shows no fracture. MR scan shows rotator cuff disruption. He is referred and subsequently undergoes operative repair. He is sent for rehabilitation post operatively. You wonder whether hydrotherapy will benefit him.

A 64 year old male presents with epistaxis. Your usual approach is to attain haemostasis, check for hypertension and coagulopathy. As you prepare to gain IV access and take blood you wonder whether there is any evidence to show that checking the clotting is warranted.

An otherwise healthy 25 year old woman presents to the ER with 3 days of runny nose, sneezing, and nonproductive cough. She reports it feels like a common cold and usually she recovers without intervention. She has never received relief from over the counter cold medications. She is seeking care because she has a job interview in two days and wants to know if there is anything she can take to recover faster. You have heard that some providers use second generation antihistamines for upper respiratory infections, and wonder if there is any evidence behind the practice.

You're having a bad day! You've just seen your third neonate in 2 hours with a sticky eye and the senior nurse informs you that you dispensed the final bottle of chloramphenicol eye drops in the Emergency Department to the last child. In a rapidly deteriorating mood, you ring pharmacy, who suggest fucidic acid (Fucithalmic) eye drops. You wonder if it is comparable to the standard treatment with chloramphenicol.