bestBETs

The mother of a 5-year-old boy with athetoid cerebral palsy complains of difficulties putting his Lycra suit on each day. She is keen to know if it actually helps improve his function and movement.

A 17 year old man presents to the emergency department having been pulled from a local river. He fell whilst intoxicated and was submerged for a short period of time. He has clearly aspirated some water as evidenced by his cough and sputum production. You wonder if prophylactic antibiotics are indicated to prevent lower respiratory tract infection.

A five year boy is presented to the Emergency department by his mother. His mother complains that he has constipation. After examining the boy's abdomen you wonder whether in order to confirm the diagnosis you should perform a digital rectal exam (DRE).

A child presents to the Emergency Department with a history of witnessed coin ingestion in the last 24 h. He is asymptomatic and clinical examination is unremarkable. Chest x-ray reveals a coin lodged in the oesophagus. You wonder whether to observe the child, hoping for spontaneous passage into the stomach or to refer him for removal/assisted advancement of the coin.

A 26 year old otherwise healthy male presents to the emergency department with a dry cough that has been present for 5 days. He has tried over-the-counter medications in an attempt to improve his cough symptoms without success. He would like to know if codeine would be better.

A patient with tricyclic antidepressant overdose is treated in the Emergency Department. He is hypotensive and drowsy and has prolonged QTc on electrocardiogram. Blood gas shows metabolic acidosis. He is given intravenous fluids and sodium bicarbonate boluses until his pH becomes 7.6. However, he remains hypotensive. His rhythm then changes to VT. You remember that intravascular lipid emulsion (intralipid) has been used for overdoses of lipid-soluble drugs and you wonder whether it could be effective in this patient.

A 62 year old, has been admitted to the intensive care unit following an emergency Hartmann’s procedure for a perforated diverticulum. He is clearly septic, with persistent pyrexia, hypotension, tachycardia and is being ventilated. He has been started on the sepsis bundle, including noradrenaline to maintain a decent MAP. He has a past medical history of treated hypertension, hypercholesterolaemia, and diverticullar disease. It is clear that low dose dopamine has no renal protective effects but, you discuss the use of dopexamine on the ward round as an alternative. No one clear about the evidence for and against so you investigate.

A 50 year old female patient presents to the physiotherapy department for assessment of medial ankle and foot pain that came on insidiously 6 months ago. She has been diagnosed with posterior tibialis tendon dysfunction (PTTD) by an orthopaedic consultant, but the patient would like to know what the accuracy/validity of the clinical diagnosis is without also having an MRI scan.

A 50 year old female patient presents to the physiotherapy department for treatment of medial ankle and foot pain that came on insidiously 6 months ago. The clinical diagnosis of Stage 2a posterior tibialis tendon dysfunction (PTTD) has been confirmed with an MRI scan and she has been referred to physiotherapy and podiatry for a trial of conservative management.

56 years old man presented with history of sever back pain which is radiating to the left hip joint and associated with numbness over the left calf . you prescribed oral paracetamol which did not give any relife , so you prescribed diclofenac IM but one of your junior doctors told you that he read article recently in one of the medical journals about the efficacy of rectal diclofenac in the quick relife of the back pain .

A 5 year old child presents to the paediatric emergency department with a linear laceration to his forehead. There are no concerns regarding a head injury. The wound is linear, full skin thickness and occurred within the last 8 hours. You suspect that the child will require sutures to close the wound however his parents are very anxious about him requiring a “needle” whilst he is awake. You wonder if a topical anaesthetic gel could be used to allow closure and therefore prevent the need for him to return at a later date for a general anaesthetic.

An 74 year old lady presents to the emergency department following a fall at home. She complains of pain in her right shoulder. An x-ray confirms an isolated first rib fracture. I wonder if I need to investigate further to exclude associated injuries.

A 14 year old boy presents to the paediatric assessment unit with a 24 hour history of right iliac fossa pain. After a full history and examination the clinical diagnosis is of acute appendicitis. He is booked for theatre as an emergency appendicectomy. Which is the best approach: laparoscopic or an open procedure?

A 45 year old homeless man presents to the emergency department after he was found lying on a park bench. Glasgow Coma Scale is 5, so he is intubated. Prior to administration of intravenous fluids, you consider whether you should administer thiamine to prevent Wernicke Korsakoff syndrome.

A young man presents to the Emergency Department with a left sided foot drop.He was seen three days ago with blunt injury to his left calf whilst playing football. He was treated as a soft tissue injury and discharged. On his return he was diagnosed as a case of compartment syndrome.You wonder what is the diagnostic utility of clinical signs and symptoms in the diagnosis of compartment syndrome of the lower limb.

A 34 year old male with a large right MCA infarct presented with left shoulder subluxation causing pain. Information booklets around the use of surface neuromuscular electrical stimulation has mentioned that it can be used to help reduce shoulder subluxation, however very little was known around current research and literature regarding this. Would treatment with surface neuromuscular electrical stimulation reduce shoulder subluxation in his hemiplegic shoulder?

A four year old boy presents to the emergency department following a fall at school. He sustained a 2cm haematoma to his right forehead. His GCS is 15/15. His mum is concerned as he has idiopathic thrombocytopenia and has been advised to bring him to hospital as he is at risk of intracranial bleeding. You wonder whether this patient should have an urgent CT Brain scan in view of his thrombocytopenia.