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A 24-year-old man presents following a fall on an outstretched hand. He has clinical signs of a scaphoid fracture but his initial x-rays are normal. You wonder if ultrasound could be used to identify an occult scaphoid fracture.

A 2.5 year old boy has presented in clinic with mild to moderate general delay in all areas. There is no other relevant history, no family history and clinical examination is normal. The paediatric registrar decided to order some investigations for identifying the possible aetiology of the global developmental delay including the biotinidase activity level. His consultant asked him to justify the test for biotinidase deficiency based on the prevalence of biotinidase deficiency in the population of pre-school children with developmental delay and the possible efficacy of treatment.

A two year old boy - 'Lance' - presents to the emergency department after falling off his bike. He sustained a head injury and is currently drowsy. After recently completing the ATLS course, you try to apply the ABCDE mnemonic to Lance. You remember GCS forms parts of 'D for Disability' but struggle to assess speech in a this child. You wonder if best motor response is sufficient in children?

A 10-year-old boy with well controlled epilepsy on sodium valproate attends your clinic. On a previous clinic visit his mother complained that he was hyperactive, impulsive and could not concentrate. This was affecting his school work. You sent Conners' Questionnaires to his parents and the school, and asked the attention deficit hyperactivity disorder (ADHD) nurse to observe him in school. The results of these investigations are strongly suggestive of a diagnosis of ADHD. You would like to treat him with methylphenidate (MPH) because you know this works well in other children. However, you remember reading some National Institute for Health and Clinical Excellence (NICE) guidance that suggests caution when treating children with epilepsy with psychostimulants. What should you do?

An 8 year old presents to A&E with a sore throat and anterior cervical lymphadenopathy and a 3 day history of a cough. She is examined and told it is probably just a virus'. Is there any evidence for this statement or should she be investigated further?

A 29-week gestation neonate is having frequent apnoeas while on continuous positive airway pressure, so you prescribe caffeine to help prevent apnoeas of prematurity. You notice another baby of the same gestation is not on caffeine but recall reading caffeine treatment may reduce future neurodevelopmental disability. You wonder how strong the evidence is and whether all neonates under 32 weeks gestation should be on caffeine treatment.

A young man is brought into your emergency department by ambulance with a suspected opiate overdose. His respiratory rate was initially adequate but has now dropped to 7/min, and his GCS is 6. His peripheral veins all seem obliterated and, recognising him from previous attendances, you remember him to be HCV positive. You have heard that naloxone is now given intranasally by a number of ambulance services in the US and wonder whether this might be worth trying.

A 25 year old man presents to the emergency department after inversion injury to his ankle. He has sustained an unstable closed ankle fracture, which requires open reduction and internal fixation. An orthopaedic consultant has told you previously that the patient should have a pneumatic foot pump incorporated into the cast, as this will speed the patient''s time to surgery by facilitating the resolution of traumatic oedema. You wonder what the evidence there is to support this.

A patient presents to the Emergency department with significant dyspnoea. A chest x-ray reveals a pleural effusion. Should the chest drain be aimed apically or basally to drain efficiently?

You are the senior house officer on duty in the emergency department and a 79 year old male is brought in by his son who states that the patient collapsed at home after having sudden onset central abdominal pain radiating through to the back. He is cold and clammy with a pulse rate of 126/ min and his blood pressure reading is 74/46 mm Hg. You commence active resuscitation and the nurse provides you with a blood glucose reading of 1.2 mmol/l. The test was done with a glucometer on a capillary finger prick sample. You commence IV glucose after sending a venous lab sample. The lab result comes back as 23 mmol/l. You dont understand the reason for the difference between the lab result and the glucometer reading. Meanwhile your consultant has also arrived and she says that she has read somewhere in one of the journals that in cases of impaired peripheral perfusion, the glucometer result on a venous sample is more accurate than the capillary sample for assessment of blood glucose. You decide to do a literature search to find the evidence.

While working a busy nightshift in A&E, you see a patient with an acute exacerbation of COPD. They require bronchodilators & the nurse asks you if you want 2.5mg or 5mg of nebulised salbutamol. You usually administer 5mg however wondered if 2.5mg salbutamol would have the same effect?

A 40 year old man attends the emergency department having sustained facial injuries following an alledged assault. Examination of the oropharynx reveals a missing tooth. The patient has no clear memory of what happened to his tooth. You wonder whether a chest x-ray would aid diagnosis.

A 47 year old man arrives to the emergency department with severe chest pain. His chest pain significantly improves with sublingual nitroglycerin. You wonder if the relief of patient’s chest pain with nitroglycerin has any prognostic value in the diagnosis of cardiac chest pain.