Medical Trainees

What's the diagnosis?

You are asked to assess an 18-year-old man who has presented to the emergency department with a one-week history of rash. He also reports a sore throat and a mild fever. On examination, you note multiple small, pink, scaly macules over his arms, trunk, and thighs. There is redness of his pharynx, but no other oral signs. His nails look normal.

What is the most likely dermatological diagnosis and what treatments would you recommend?

Check your answers in our new Hospital presentations module on Rash. You’ll learn as you work through two patient cases, with tips on the key differentiating features of common rashes and advice on how to manage skin conditions that often present present acutely or on the wards. The module also covers noncutaneous associations of skin conditions and is already getting great reviews from other users:

"Very informative, interesting module with great learning points, good evidence and great images."

What sign can be seen on this x-ray?

A 25-year-old man presents with a one-week history of crampy abdominal pain and frequent passage of bloody stools. His radiograph is shown below. What sign can be seen?

Check your answer in our new module on Interpretation of abdominal radiographs, which will help you to differentiate normal from abnormal features and reach the right diagnosis for a range of common and rarer conditions.

In the module, consultant radiologist Dr Vikas Shah takes you through the ABDO X system for analysing abdominal x-rays and offers invaluable practical tips on how to assess bowel gas patterns, soft tissue structures and bones. Other users are loving the module:

"Magnificent module, very highly recommended."

"An absolute highlight. A dedicated teacher with an extraordinary didactic skill has delivered a perfect introduction into a not-so-easy topic."

Tips for referring a patient to a senior colleague

Do you feel stressed when you know you will need to refer a patient to a senior colleague for advice, to request an investigation or to transfer their care? Making a referral by phone or in person is a common clinical activity, but many junior doctors find it difficult. Our new interactive module, How to make effective referrals, covers what can go wrong, how to prepare by using the core elements of a good in-hospital referral, and strategies for dealing with an aggressive or obstructive response. It includes practical tips, video scenarios, and templates to use in your daily practice. Other users are finding it really useful:

"Very relevant, useful and great realistic examples of referrals made by junior doctors!"

“Very clear and structured approach to referrals. Provides clear advice on how to prevent and manage difficult referrals.”

A patient with dementia is causing disruption on the ward - what should you do?

You are called to a medical ward when working a night shift to see a patient with dementia who is out of bed and wandering round the ward causing disruption and disturbing other patients who are trying to sleep. What factors do you need to bear in mind when deciding on the best approach to managing this patient?

For practical tips on this challenging scenario, see our popular Ask the consultant module on Old-age psychiatry. In this module, consultants Dr Krish Vedavanam and Dr James Warner provide answers to clinical questions submitted by junior doctors. Among the topics covered are management of agitation, recognition of depression in older patients and how to approach care of a patient who feels life is not worth living anymore. The module gets great reviews from other users:

“Really sensible, practical advice. Would highly recommend this module.”

“Really useful module to give you confidence in clinical decision making in these difficult scenarios.”

How confidently can you assess possible causes of blackout?

Do you have a clear strategy for assessing a patient who presents following a transient loss of consciousness? How can you confidently distinguish cardiovascular from neurological and other possible causes? What are the key features to look out for in the history and eyewitness reports? Which investigations are important and which may not be needed?

Check your answers in our highly rated Hospital presentations module on Blackouts and collapse. You’ll learn as you work through typical patient scenarios that you might see in your day-to-day practice. Other junior doctors are giving the module great reviews:

"Well written, excellent presentation of this very common clinical scenario in the emergency department."

“Very good and easy to learn from.” 

Get up to speed on sepsis

A 45 year old woman is admitted with right iliac fossa pain following a laparotomy two weeks ago for endometriosis. She has a respiratory rate of 24 breaths per minute, oxygen saturations of 94% on room air, heart rate 117 bpm, blood pressure 108/68 mmHg, and a temperature of 38.5℃. On examination she has tenderness in the right iliac fossa with pus draining from the incision site. You are asked to do a structured risk assessment for possible sepsis. How will you proceed - and how should your findings guide your management plan?

Check your answers in our new Hospital challenges module on
Sepsis in adults. You will work through patient scenarios that are typical of the situations you face in everyday practice as you learn about all the latest practice-changing developments in the evidence, guidance and classification of sepsis. The module is already proving very popular with other users:

"Excellent module with important details about updated sepsis guidelines."

"Very informative and relevant in clinical practice."

Also try the companion module on Sepsis in children to ensure you know how to identify and manage paediatric patients with infections that put them at high risk of serious illness or death from sepsis.

What do these ABG results indicate?

You see a 20 year old woman with acute severe asthma in the emergency department. She is unable to speak in full sentences. She has been given oxygen (15 l/min) via a reservoir bag mask. Her arterial blood gas results are as follows:

  • pH: 7.47
  • pO2: 11.2 kPa
  • pCO2: 3.7 kPa
  • HCO3-: 25 mmol/l

What is her acid-base disturbance?

Check your answer in our updated module on Arterial blood gases: a guide to interpretation. It offers a practical five-step approach that will help ensure you feel confident on everything from how to distinguish respiratory from metabolic disturbances through to trickier challenges like calculating the alveolar-arterial gradient and understanding what it means for diagnosis and management of the patient.

Join our audience panel

If you’d like to help BMJ Learning ensure we deliver the content that you need as a medical trainee, join our audience panel to provide feedback and ideas. Email clinical editor Jo Haynes.

Animated practical skills modules to support you in your first years on the ward