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The questions in this chapter on paediatrics will test not only the common areas that present to paediatricians, but also relevant issues such as knowledge of disease factors, ethics, and risk management in relation to children and their families. This chapter contains 45 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 30 questions that encompass all of the important areas of anaesthesia and intensive care, with detailed explanations. Anaesthetists need to be able to assimilate knowledge of the basic sciences with skills in history and examination, in order to plan for, and respond to, patient needs. In answering these questions, you will be asked to use similar skills. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

Mental health problems are estimated to affect one in four people each year in the UK, making mental illness one of the commonest presentations to General Practice surgeries, outpatient clinics, and Emergency Departments. Yet many doctors and medical students feel uncertain about how to approach patients with a psychiatric disorder. This chapter contains 45 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 34 questions that encompass all of the important areas of primary care, with detailed explanations. They will assess your knowledge in the common areas that present, testing diagnostic skills and reasoning. They also test negotiating skills to ensure patient compliance, teamworking within the primary care setting, and risk management. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

Among surgical patients presenting to the ED, abdominal pain is the most common complaint, comprising 10% of ED visits. Evaluation of such patients in the ED is often challenging for a variety of reasons, such as the variability in the description of the perception of pain in individual patients, variable and changing physical findings with time, and life-threatening conditions presenting as seemingly benign symptoms. I always advise inexperienced doctors working in the ED to bear in mind seven time bombs that may be ‘sitting inside’ every adult patient’s abdomen who presents with abdominal pain. Patients who are discharged, but in whom one of these diagnoses was missed, will be blue-lighted back to the department dead. Therefore, before discharging a patient presenting with acute abdomen pain, all such conditions as listed below must be excluded beyond reasonable doubt. These conditions are: • Ruptured AAA • Hollow viscus perforation • Mesenteric ischaemia • Ruptured ectopic pregnancy • Acute pancreatitis • Intestinal obstruction • Acute myocardial infarction. Acute (inferior) myocardial infarction may present as upper abdominal pain and cannot afford to be missed. Patients >50 years presenting with abdominal pain must have an ECG in the ED, not only for detecting acute myocardial infarction, but for other associated cardiac problems precipitating an abdominal catastrophe. Elderly patients are more likely to have life-threatening conditions such as a ruptured AAA, mesenteric ischaemia, peptic perforation, and diverticulitis. Atypical presentations and rapid progression of these diseases, coupled with decreased diagnostic accuracy, may increase the risk of mortality in elderly patients. The only way to avoid the above is, as importantly as in other parts of medicine, by taking an accurate history, performing a thorough full clinical examination, arranging appropriate investigations rapidly, and making the correct decisions as to whether or not urgent surgery is required. Even with advanced imaging techniques, a good understanding of background clinical information is of utmost importance for accurate interpretation of imaging findings. This chapter includes questions on acute abdominal emergencies to give the reader an insight into the latest management strategies for these situations.

This chapter contains 37 questions that encompass all of the important areas of dermatology, with detailed explanations. The questions in this chapter will test your knowledge of the skin problems that are frequently encountered in non-specialist clinical practice. Other more rare skin disorders are also covered, either because they are potentially life-threatening or because they are a sign of systemic disease. The questions are designed to improve your ability to recognize the morphology and distribution of cutaneous physical signs. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 15 questions that encompass all of the important areas of pre-hospital care, with detailed explanations. Although it is unlikely that many students will have encountered pre-hospital medicine directly, it is likely that they will encounter patients who have received timely pre-hospital care. An understanding of the therapies, clinical decision-making, and emergent scenarios faced by doctors working in pre-hospital emergency medicine (PHEM) is therefore vital. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

Obstetrics, like all fields of medicine, continues to evolve at a rapid pace, and keeping up-to-date with the latest literature, guidelines, and protocols can be a daunting task. This chapter contains 26 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 33 questions that encompass all of the important areas of ear, nose, and throat (ENT), with detailed explanations. The questions are based on the important knowledge that needs to be accrued as an undergraduate or a recently qualified doctor, as many readers may not have the opportunity to work as a junior doctor in an ENT team before treating ENT patients in the Emergency Department or in a general practice setting. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 24 questions that encompass all of the important areas of orthopaedics, with detailed explanations. There is a great deal of knowledge required to be proficient in this field, and it is important that the principles of orthopaedic surgery be studied to ensure thorough understanding. The questions in this section range from neonatal orthopaedic complaints, through to serious pathologies which can be life-changing for patients and career-changing for the clinicians that miss them. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 19 questions that encompass all of the important areas of trauma, with detailed explanations. The questions highlight the important principles of trauma care and aim to help the reader comprehend the management of a seriously injured trauma patient. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 13 questions that encompass all of the important areas of eponyms, with detailed explanations. The questions are designed to challenge the reader’s ability to recognize clinically relevant combinations of symptoms and signs that may be encountered in practice as a doctor. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

Gynaecological practices are changing constantly, with more emphasis on management in primary care, conservative, rather than surgical, management of conditions, and an increase in sub-specialization such as gynaecological oncology and urogynaecology. This chapter contains 29 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

This chapter contains 35 questions that encompass all of the important areas of emergency medicine, with detailed explanations. These questions have been designed to develop the reader’s analytical and decision-making skills by showing how to approach solving clinical problems that are commonly encountered in the Emergency Department, how to use tests efficiently and effectively, and some of the options for treatment that are available other than admission under inpatient teams. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

A variety of ENT disorders present to the ED on a regular basis and are seen by the ED junior doctors. The majority of these are benign, but a few may be life-threatening conditions that require immediate recognition, rapid assessment, management, and involvement of the ENT specialist, for example, severe epistaxis (especially posterior type), acute epiglottitis, angio-oedema, and Ludwig’s angina. Therefore a basic knowledge and an understanding of the diagnostic features of the common ENT conditions are vital. It would be impossible to cover the large extent of ENT conditions presenting to the ED within a small space, hence this chapter will focus on a few common ENT emergencies that a newly starting ED doctor would have to deal with on a regular basis. There is a wide variety of ENT symptoms depending on the region affected. However, it is important to keep in mind the red flag symptoms that signal urgent help of an ENT specialist is required. Some examples are: sudden unexplained sensorineural deafness, facial nerve palsy, CSF leak, difficulty swallowing with toxic appearance, and drooling saliva. The ENT physical examination is different from other systems as its components are largely inaccessible, particularly in the ED. A good headlight, an auroscope, and correct patient positioning are all important accessories. Although rod lens and flexible fibreoptic scopes for nasoendoscopy and laryngoscopy are routine investigative aids, they are outside the realm of emergency medicine. Most of the diagnosis and management, however, of ENT emergencies can be achieved by following simple rules and using basic equipment. If any patient requires more than an auroscope or standard nasal speculum for a thorough examination, they should be referred to the ENT specialist. All sorts of foreign bodies may become lodged in the ears, nose, or throat. Most of them cause discomfort but are not life-threatening. A foreign body in the throat may have the potential to compromise the airway—a fact to be borne in mind. A lot of them can be removed in the ED, particularly in adults, but children sometimes may require attention of the ENT specialist depending on their age and the capacity to cooperate.

Ophthalmology principally aims to prevent visual loss, restore visual function, and relieve ocular discomfort. The majority of the pathology can be directly visualized and thus requires proficient ocular examination techniques and visual recognition skills. This chapter contains 17 questions that encompass all of the important areas of this subject, with detailed explanations. Unique to this series, questions are rated by difficulty and are cross-referenced to the eleventh edition of Oxford Handbook of Clinical Specialties to track revision progress and revise effectively.

An infectious disease, as the name implies, is caused by pathogenic microorganisms such as bacteria, viruses, parasites, and fungi, and it spreads from one person to another through various ways, directly or indirectly. Most, but not all, of such diseases present to the ED with fever. Septic shock, respiratory failure, or central nervous system involvement may occur following an infection and threaten life. Such a situation presenting with tachycardia, reduced BP, tachypnoea, or depressed GCS requires immediate assessment and resuscitation. Following the principles of ABCDE, promptly carry out airway protection, oxygenation, and IV access with collection of blood samples for investigations, and fluid resuscitation. The aetiology of fever may be wide ranging, but a careful history and a detailed physical examination should help in determining the cause in majority of cases presenting to the ED. In addition to this, the initial investigations may help further in establishing the diagnosis. In elderly patients, the source of such infections may be the respiratory system, the genitourinary system or the involvement of the soft tissues, and they are often serious. In the otherwise healthy younger patient, one must keep in mind the other systems such as the central nervous system, as well as abdominal and soft tissue infections. Patients may often present in septic shock. Even if the cause of a fever may not be evident at the outset, the best ‘guestimate’ often helps in determining which antibiotics to start with, which should be given as soon as the culture samples have been collected. One must make every effort to collect appropriate samples of body fluids (blood, urine, stool, sputum, etc.) to find the source of infection so that targeted antimicrobial therapy may be started if the empirical treatment has not worked. A discussion with the on-call microbiologist to properly direct the empirical antibiotic therapy is often most rewarding. A patient with an infectious disease may put others at risk as well, resulting in devastating effects, particularly in hospitals.

O&G is one of the broadest hospital-based specialties, encompassing medicine, surgery, and childbirth; so it is no wonder that O&G patients with a diverse range of symptoms present to the ED on a daily basis. The most common symptoms are PV bleeding, in both pregnant and non-pregnant females, PV discharge, and lower abdominal pain. The majority of these cases are benign and the patient can be discharged after reassurance and arrangement of primary care follow-up, but a few of them may have an underlying life-threatening condition. One classic example is a ruptured ectopic pregnancy. About 10% of females who present to the ED with PV bleeding or abdominal pain in the first trimester of the pregnancy have an ectopic pregnancy. Such patients may present in shock following a catastrophic haemorrhage in the abdomen or arrive at the ED well but collapse in the waiting room. Management of these emergencies requires establishment of IV fluid resuscitation, analgesia, and involvement of an O&G specialist. Such patients are often rushed to the theatre for emergency operation to control the haemorrhage. In other situations, the normal practice of taking a history and physical examination should be followed. Bear in mind that close attention to privacy and confidentiality is most crucial during the procedure. Interview the patient without the other family members if possible, as the patient may be reluctant to tell the whole story in their presence. Pelvic examination is sometimes painful, undignified, and embarrassing to many patients especially if the examining doctor is a male. This can be avoided to a large extent by explaining the process of examination, and performing it gently in the presence of a chaperone. It must not be forgotten that vaginal bleeding during pregnancy produces maternal distress, for which also the patient will need support. Patients presenting with lower abdominal pain often have a disease related to the female genital tract or the urinary system. But the lower GI tract may also contribute to the pain and should therefore be included in the differentials. With regard to the reproductive system, there are a few causes of pain during pregnancy.