bestBETs

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 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.

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?

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.

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

A patient is showing signs of alcohol withdrawal. You want to know whether using the CIWA-Ar tool is better than using your own clinical judgement at assessing whether this patient is indeed in alcohol withdrawal and preventing symptoms.

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

A patient is referred for physiotherapy with greater trochanteric pain syndrome and you wonder if electrotherapy modalities will be beneficial in improving pain.

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?