Medical Trainees

Your practical questions on diabetes answered

Ask the consultant: DiabetesA 48 year old man with known chronic kidney disease presents with evidence of a community acquired pneumonia. He is noted to have raised capillary blood glucose levels throughout his admission, and his HbA1c is reported as 64 mmol/mol.

How should you manage this patient?

Check your answer in our Q&A module Ask the consultant: diabetes. It covers diabetic ketoacidosis, hyperosmolar hyperglycaemic state, oral antidiabetic drug combinations, managing hyperglycaemia, and other practical questions on managing diabetes in hospital.

Here are some comments from other users:

"Very clear explanations and a good cluster of useful questions"

"This illustrates some of the complex situations encountered in acute medicine and provides clear answers and advice."

Investigating a patient presenting with acute confusion

Hospital presentations: deliriumYou are called to review a 78 year old man in the emergency department with suspected left basal pneumonia who has become confused. It has not been possible for the emergency department staff to take a clear history as he’s so easily distracted. He scores 5/10 on the abbreviated mental test and cannot complete a clock drawing test. His neurological examination is normal.

What would be your next step in assessing his cognitive impairment?

Check your answer in our updated module Hospital presentations: delirium. It covers assessment, investigation, and diagnosis of patients presenting with acute confusion, along with initial management and prevention of  delirium. It’s getting great feedback from other users:

“Very good overview of delirium and beautifully explained”

“Great module made me think”

Why not also try our companion module Hospital presentations: aggressive or disturbed behaviour, which follows the same patient through some further scenarios during their hospital admission.

Joint swelling: can you spot the diagnostic clues?

A 61 year old woman presents with pain in her hips and shoulder myalgia. She has stiffness in the morning that lasts for at least an hour before starting to ease slightly. The symptoms started two weeks ago after she had recovered from what she thought was a bad cold.

What is the most likely diagnosis?

Check your answer in Hospital presentations: joint swelling. It’s been fully updated to include the latest UK guidance and will help you recall the main causes, interpret and act on initial investigations, and be aware of treatment options and their complications.

Other modules on related topics include:

Septic arthritis: a guide to diagnosis and management

Practical skills: aspiration and injection of the shoulder

Practical skills: aspiration and injection of the knee

How would you manage this patient's fluid status?

Fluid management in acutely ill patients

A patient comes to the emergency department with chest pain and dyspnoea due to multiple pulmonary emboli. His jugular venous pressure is elevated at 4 cm, and he has minimal ankle oedema, but his blood pressure is 85/50 mmHg and his urine output is reduced.
How should you initially manage his fluid status?
Check your answer in Fluid management in acutely ill patients. It covers the fundamentals of fluid balance, assessing fluid status in acutely ill patients, and tailoring fluid balance to individual patients.
It’s getting positive feedback from other users: 
"A great refresher and very clear explanations of the physiology. The scenarios at the end pulled it all together"

A patient comes to the emergency department with chest pain and dyspnoea due to multiple pulmonary emboli. His jugular venous pressure is elevated at 4 cm, and he has minimal ankle oedema, but his blood pressure is 85/50 mmHg and his urine output is reduced.

What is your initial management?

Check your answer in Fluid management in acutely ill patients. It covers the fundamentals of fluid balance, assessing fluid status in acutely ill patients, and tailoring fluid balance to individual patients.

It’s getting positive feedback from other users:

"A great refresher and very clear explanations of the physiology. The scenarios at the end pulled it all together"

How would you manage a patient admitted with accidental hypothermia?

A 70 year old homeless man is brought in by ambulance in cardiac arrest with resuscitation in progress. A tympanic temperature is taken and found to be 29°C.

What would you do next?

Check your answer to this and other management scenarios in our case-based module Hospital presentations: hypothermia. It will give you the knowledge and confidence to manage the rewarming of patients and understand how hypothermia can alter the management of advanced life support.

It’s getting great reviews from other users:

“Excellent scenarios with real life situations. Good questions, great and concise tips and learning points. Genuinely enjoyed doing this module. Thank you authors!”

Dysuria: what treatment would you start?

A 35 year old man attends the emergency department with a one day history of worsening dysuria, frequency, low back pain, and myalgia. On examination, he is febrile and tachycardic. A per rectal examination reveals a swollen and very tender prostate. Urine dipstick: leucocytes 3+, nitrites 3+

What is your diagnosis and initial management?

Check your answer in our latest hospital presentations module on dysuria. It follows the investigation and management of two patients presenting with painful urination, and covers topics such as risk factors for urinary tract infection (UTI), when to treat asymptomatic bacteriuria, preventing recurrent UTI, and the pathophysiology and management of infective urethritis.

Other modules in the same series on related topics include:

Genital discharge and ulceration

Delirium

Acute headache: can you identify a potentially life-threatening cause?

Can you recognise and relate different presentations of acute new headache to the underlying pathology? Do you know when to arrange urgent imaging? Can you spot the features of raised intracranial pressure and other red flags? Do you know how and when to start prompt drug treatment for a patient presenting acutely with headache?

Get up to speed on these and other clinical issues with our case-based module Hospital presentations: Headache. It follows the assessment and initial management of four patients with different presentations of severe headache, testing your knowledge and clinical skills along the way.  Throughout the module you’ll see “I want to know more” links, giving you the option to go into more depth on specific aspects of the topic. Just click on the link to see additional information.

It’s already proving popular with other users:

"Fantastic review of primary and secondary headaches"

"This was such a good review of the material we have covered so far in class. Although we haven't done management side of headaches it was easy to follow and really helpful summaries. Thanks!"

Your tricky questions answered on dermatological infections

A 65 year old woman presents to you with excruciating pain in her right foot. She says it started with a small blister a couple of days ago, but is now much worse. She describes the pain as the worst pain imaginable. On examination the entire foot is dusky grey with bullae and areas of necrosis. There are crepitations on palpation.

What should you do next?

Find out the answer to this and other practical questions posed by BMJ Learning users in Ask the consultant: Dermatological infections. It’s been getting great reviews:

"Helpful review of some common and thankfully not so common (necrotising fasciitis) dermatological conditions."

“Very useful module on topics of dermatology that I did not know too much about. Nice detailed explanations of answers to a range of interesting topics”

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

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