Boring Question: How useful are physical examination manoeuvres for an adult patient with suspected meningitis?

In Clinical Questions by Jatin Kaicker4 Comments

Background For a patient who presents with a headache, it is imperative to consider a broad initial differential diagnosis to rule out life threatening causes such as meningitis. Bacterial meningitis is a medical emergency with an annual incidence of 4 to 6 cases per 100,000 adults, with early treatment considerations being essential (1). We are commonly taught to consider a triad of symptoms including fever, neck stiffness and altered mental status. However, the …

Boring Question: Does this medication cause long QT? (with Bonus: Tiny Tips!)

In Clinical Questions, Tiny Tips by Jatin Kaicker7 Comments

The Clinical Case A 70-year-old female presents to the emergency department with new palpitations and 2 syncopal episodes, witnessed by her son. These episodes have started within the past 10 days. Her past medical history includes diabetes, hypertension, depression, dyslipidemia and atrial fibrillation. She is a long-standing diabetic and is followed by a nephrologist for her diabetic nephropathy. Her medications included: metformin, atorvastatin, aspirin, warfarin and sertraline. She was recently seen in hospital …

View Post

Boring Question: How useful are plain abdominal films for bowel obstruction?

In Clinical Questions by Jatin Kaicker3 Comments

Clinical Scenario An otherwise healthy 65 year old comes into the emergency department with an 8 hour history of abdominal pain. Her last bowel movement was 3 days ago and she’s not sure if she has passed gas.  She endorses nausea but has not vomited. She has not taken her temperature but does not believe she has been febrile. She’s tried Tylenol for analgesia with little relief. She last ate 12 hours ago …

View Post

Boring Question: How useful are bowel sounds?

In Clinical Questions by Jatin Kaicker5 Comments

This month we launch the first post in a new series entitled “Boring Questions”.  This column will focus on reviewing key literature around common questions that might be asked during a shift.  – Teresa Chan (Managing Editor) Clinical Scenario: A 60-year-old female presented to the emergency department with a 24 hour history of lower abdominal pain. The pain had increased in intensity over the past day and was 7/10 on presentation. She has …