Medical Trainees

Hospital presentations: dyspepsia

Hospital presentations: dyspepsia

You review a 55 year old patient in the gastroenterology clinic. He has a four month history of epigastric pain, episodic bloating, and excessive postprandial fullness. He has not vomited, lost weight, or had dysphagia during this time.

He uses no regular prescribed medication and has no known drug allergies. He smokes 10 to 15 cigarettes a day and describes himself as a “social” drinker of alcohol.

Physical examination is normal.

How would you manage this patient?

Find out in our module Hospital presentations: dyspepsia. You’ll work through an interactive case history and learn when to request an endoscopy for patients who have dyspepsia, the importance of Helicobacter pylori eradication, and how to distinguish between functional dyspepsia and non-erosive reflux disease.

Our users said: "well-structured, interactive and informative module" and "good update on current practice."

Ask the consultant: Stroke

Ask the consultant: Stroke

You are looking after a 76 year old patient who was admitted to hospital with an ischaemic stroke three days ago. She received thrombolysis with alteplase. She has been diagnosed with atrial fibrillation.

When should you start anticoagulation?

Check your answer in our brand new module Ask the consultant: Stroke. Dr Don Sims, consultant stroke physician, answers trainees’ questions, including:

  • - When to start anticoagulation after thrombolysis for patients who have atrial fibrillation
  • Imaging of the posterior fossa in suspected posterior circulation stroke
  • The role of mechanical thrombectomy
  • How to distinguish a stroke from a transient ischaemic attack in the first few hours.

The module also discusses the NICE 2019 stroke guidelines and the use of the ABCD2 score. We hope you find it useful.

Hospital presentations: Delirium

Hospital presentations: Delirium

Our module Hospital presentations: Delirium has been fully updated with the revised NICE guidelines on delirium: prevention, diagnosis and management. Learn how to assess and investigate a patient with symptoms suggestive of delirium, and how to establish whether a patient’s confusion is due to delirium, dementia, or both. Which, if any, drugs could you prescribe to alleviate a patient’s distress? And would you feel confident spotting a patient with hypoactive delirium? You’ll learn through an interactive case-scenario and gain one hour of accredited CPD. We hope you find the module helpful.

The red eye: diagnostic picture tests

The red eye: diagnostic picture tests

A 52 year old woman who has rheumatoid arthritis presents with a one week history of a painful right eye. The pain has been getting progressively worse. She has no photophobia, nausea, or vomiting, and does not see haloes around lights. She says the pain is worse when she moves her eye. On examination you observe a global but mild restriction of eye movements because of pain. The globe is red and tender.

What is the most likely diagnosis?

Check your answer in our module The red eye: diagnostic picture tests. You’ll learn about common and serious causes of a red eye, and how to narrow down your differential diagnosis by asking about associated symptoms.

Our users wrote: "excellent module, clear learning points and helpful images" and "very clear and concise."

We hope you find it useful too.

Hospital presentations: falls

Hospital presentations: falls

A 67 year old woman attends the emergency department following a fall at home. She reports that she tripped on a rug and hit her head on a wooden floor. She did not lose consciousness. She has a past medical history of hypertension and atrial fibrillation, for which she takes enalapril, warfarin, and bisoprolol. Her observations are stable and examination is unremarkable, except for a small bruise on the left side of her forehead.

What would you do next?

Find the answer in our module Hospital presentations: falls. Working through an interactive case history, you will learn the pertinent questions to ask in a falls assessment, how to distinguish falls from syncope, which investigations to request, and what medications to stop or reduce when a patient has had a fall.

Users recently said:

‘Excellent, Comprehensive and to the point’

‘Very detailed and useful module!’

We hope you find it useful too.

Hospital presentations: haematuria

Hospital presentations: haematuria

You are assessing a 25 year old man with a short history of loin pain and frank haematuria. He has no past medical history, but there is a family history of renal stones in both of his parents. You arrange imaging, which is normal. You notice that his blood pressure is 158/84 mmHg.

What is the most likely diagnosis?

Find the answer in our module Hospital presentations: haematuria. You’ll learn about the six presentations of glomerular disease, and when to refer to a nephrologist or urologist. Plus, what you should do when your patient has non-visible haematuria on a urine dip, and how to investigate haematuria in a patient with a raised INR.

Recent reviews include:

‘This is an excellent module for hospital doctors, with this being a common presentation on call.’

We hope that you find the module useful.

Hospital presentations: Headache

Hospital presentations: palliative and end of life care

A 40 year old man presents to the emergency department with an abrupt onset of headache, nausea, and bilateral blurred vision, which started about 10 hours ago. He says he was fit and well before his symptoms started, but remembers feeling feverish with some neck pain when the head pain began.

This headache is not similar to the migraines he had in his teens. When asked again, he tells you he feels awful and that this could be his worst headache ever.

What should you do next?

Check your answer in our updated Hospital presentations: Headache module. You’ll work through four interactive case studies, and learn how to investigate patients with thunderclap headaches, how and when to prescribe steroid treatment for giant cell arteritis, options for migraine prophylaxis, and how to assess a patient with acute Horner’s syndrome.

Symptom control in palliative care

Hospital presentations: palliative and end of life care

Mr S is a 65 year old man who has been admitted to the medical admissions unit. He was diagnosed with prostate cancer two years ago. He describes a two week history of gradually worsening aching pain in his right hip, which is present at rest and worsens on weight bearing. His mobility is limited secondary to pain and he walks with a stick. Two weeks ago he was independently mobile and able to walk for half a mile without stopping.

You order a hip radiograph, which shows a lucent area in the right neck of femur. There is no fracture. You suspect a bony metastasis.

How would you manage his pain?

Check your answer in our updated Hospital presentations: palliative and end of life care module. Working through clinical cases, you’ll learn how to manage common symptoms including pain, nausea and vomiting, breathlessness, constipation and agitation, and how to explore relatives’ concerns about dehydration in the last days of life. You’ll also review the medicolegal aspects of ‘do not resuscitate’ decisions and completing a death certificate.

Accidental hypothermia: everything you need to know

Hospital presentations: Accidental hypothermia

A 23 year old surfer is brought to hospital after collapsing on the beach. He has been immersed in cold water. His heart rate is 30 beats per minute and his blood pressure is 110/62 mmHg. His core body temperature is 29°C.

How should you manage his hypothermia?

Find out in our newly updated module: Hospital presentations: accidental hypothermia. Working through an interactive case study, you’ll learn how to stage hypothermia clinically, how to rewarm patients safely and effectively, and what to do if a hypothermic patient has a cardiac arrest.

Drug interactions in clinical practice: case studies

Drug interactions 1: underlying principles

A 62 year old man with a history of chronic lymphocytic leukaemia presented with a three day history of fatigue, dyspnoea, fever, and a cough. His only medication was valproic acid for epilepsy. Clinical and radiological findings showed bilateral pneumonia, and his doctors started therapy with ceftriaxone, clarithromycin, voriconazole, and codeine.

On the fourth day of his hospital stay the patient's level of consciousness rapidly deteriorated. His pupils became miotic and he required ventilation. Investigations showed mild renal impairment and serum valproate levels within the normal range.

What caused this deterioration in his condition?

Our module Drug interactions 1: underlying principles will help you to answer this question and many more. You’ll learn about drug metabolism through a series of case studies, including how to determine whether a drug interaction is responsible for a new symptom.

Other users have found it helpful and we hope you will too:

"A periodic reminder of the principles of pharmacodynamics and pharmacokinetics is never redundant, since prescribing is our most frequent intervention on patients. Safety should always be at the forefront. Very useful module"

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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