Medical Trainees

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"

Dyspepsia in adults: what are two acceptable next steps?

Dyspepsia

You see a 50 year old woman in a gastrointestinal clinic who has been referred with epigastric pain which started six months ago. She had been treating herself with antacids which were initially effective, but the pain returned four weeks ago. At that time the pharmacist suggested she try omeprazole 10 mg once a day (available to buy without a prescription in the UK). She did so, but it is also failing to control her symptoms.

What would you do next?

Our case based module Hospital presentations: dyspepsia will help you to answer this and many more clinical conundrums. It covers diagnostic criteria, investigations and indications for endoscopy, red flag symptoms, proton pump inhibitor therapy, and H pylori eradication. You’ll learn as you work through a clinical scenario, and then test your knowledge with an end-of-module assessment to gain a certificate of completion.

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

“Very informative, practical, user friendly”

“Thank you so much. It was a perfect guide through the guidelines with mentioning the differences in a very clear and informative way. I was badly in need for such a review for this topic!”

Genital discharge and ulceration: best practice for examination, investigation, and management

Genital discharge and ulcerationYou are finishing up work in a busy hospital cardiology outpatient clinic for the morning. As your last patient gets up to leave she mentions she’s worried because an ex-boyfriend has told her he has gonorrhoea. She asks what tests she needs to make sure she is not infected too. You recommend she goes to the sexual health clinic, but she is nervous and wants more information from you.

What should you tell her about the likely tests needed?

Brush up your knowledge of genitourinary medicine with our fully updated module Hospital presentations: Genital discharge and ulceration. You will learn by working through two patient scenarios, answering questions along the way. The module includes information from all the latest guidelines, put into a practical perspective. “I want to know more” links give you the option to go into greater depth on specific aspects of the topic.

Diabetes and kidney disease, a common conundrum

Acute kidney injuryA 57 year old man with type 2 diabetes and hypertension presents with increasing ankle oedema. He has no other significant past medical history and no known pre-existing renal disease. He takes metformin and amlodipine. On examination the oedema has progressed up to his knees and is pitting bilaterally. Test results are:

  • - Serum creatinine: 105 micromol/L (normal range: 60 micromol/L to 110 micromol/L)
  • Serum albumin: 27 g (normal range: 37 g to 49 g)
  • Urinary protein:creatinine ratio: 480 mg/mmol (normal: 30 mg/mmol)
  • Urine dipstick: proteinuria ++++

What is your initial diagnosis and next management steps?

Check your answer in our case-based module Hospital presentations: acute kidney injury and chronic kidney disease. It covers everything from the recognition, assessment, treatment, and prognosis of AKI and CKD. Feedback from other users includes:

"Exactly what I was looking for (and more)!"

"It is an excellent summary of facts that a clinician should know."

Polydipsia: what tests should you order and how should you interpret the results?

PolydipsiaA 45 year old woman presents with excessive thirst. She drinks about half a litre of water every two hours. She reports urinary urgency and frequency, and gets up to urinate five times each night. She has bipolar disorder and vitamin D deficiency, and is taking lithium and calcium carbonate/colecalciferol. She is obese with a family history of type 2 diabetes. Clinical examination is unremarkable. A random venous glucose, recorded by her GP, was normal.

What would be the most useful initial test to perform?

Check your answer in our case-based module Hospital presentations: polydipsia. It covers the recognition of polydipsia and its underlying causes, appropriate work-up, and initial management of a patient presenting with excessive thirst. It’s getting great reviews from other doctors:

"Very easy to grasp what I previously found difficult."

"Really good module, clear and precise. Feel a lot more confident managing polydipsia."

Non-invasive ventilation: when and how to start it and avoiding complications

Non-invasive ventilation: a guide to its useA 65 year old man presents to you with shortness of breath and a productive cough. He has known chronic obstructive pulmonary disease. An arterial blood gas shows that he is in type 2 respiratory failure with a respiratory acidosis (pH 7.12, PO2 7.83 kPa, PCO2 7.3 kPa). Despite initial medical therapy with nebulisers and steroids he does not improve. You think the patient requires non-invasive ventilation (NIV).

How should you start NIV?

Check your answer in our module Non-invasive ventilation: a guide to its use. It covers everything you need to know to support your practical experience, including when to use NIV, how to set it up, how to monitor its effect, and what to do if NIV is failing.

You might also like to try the modules in our Airway management course, which will help your understanding of common airways procedures, including the relevant anatomy and physiology, when they should be used, and how to use them in an emergency situation.

Test your knowledge of jaundice

Ask the consultant: DiabetesA 16 year old male is admitted with jaundice, sore throat, unilateral knee joint pain, and general weakness. His liver function tests are normal, except for a bilirubin of 60 µmol/l (normal: 0 to 21 µmol/l). His body mass index is 22 and his blood pressure is 125/75 mmHg. He had jaundice once before along with glandular fever when he was age 13.

What is the most likely reason for his jaundice?

Check your answer in our updated module Hospital presentations: jaundice. It covers the pre-hepatic, hepatic, and post-hepatic causes of jaundice, plus safe prescribing practices.

It’s getting great feedback from other users:

"Good cases with good explanations that definitely improved weak areas of knowledge"

"This is par excellence. The man hours to design such a good presentation is well appreciated."

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.

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