elderly patient

A 72-year-old woman with a history of well-controlled hypertension presents with sudden-onset headache and vomiting. Neurological exam reveals mild neck stiffness but is otherwise normal. A CT angiogram reveals a posterior communicating artery aneurysm, which was subsequently coiled. The image shows a post-coiling angiogram. 24 hours post-procedure, she develops worsening headache and new-onset right-sided weakness. What is the MOST appropriate next step?

A 72-year-old man presents to the emergency department with a 6-hour history of worsening pain in his right groin. He has a known right inguinal hernia that has been present for several years and was previously reducible, but he has been unable to push it back in today. The pain is now constant and severe, rated 8/10. He denies fever, chills, nausea, or vomiting. His vital signs are: temperature 37.2°C, heart rate 96 bpm, blood pressure 140/90 mmHg, respiratory rate 18 breaths/min, oxygen saturation 97% on room air. On examination, there is a firm, exquisitely tender, non-reducible mass in the right inguinal region. The overlying skin appears slightly erythematous. Bowel sounds are present and normal. An urgent CT scan of the abdomen and pelvis is performed, and a representative axial image is shown. Considering the clinical presentation and the findings demonstrated in the image, what is the MOST appropriate immediate next step in management?

A 68-year-old male presents with fatigue and weight loss. The provided image was obtained. Which of the following is the MOST appropriate next step in management?

A 64-year-old woman presents for follow-up after experiencing intermittent episodes of right upper quadrant colicky pain over the past year, which have since resolved. She denies any current pain, fever, jaundice, or changes in bowel habits. Physical examination is unremarkable, and recent liver function tests are within normal limits. An elective abdominal ultrasound was performed, yielding the image shown. Considering the clinical context and the findings demonstrated, what is the most appropriate next step in her management?

A 68-year-old male presents with a serum calcium of 2.8 mmol/L (2.1-2.6 mmol/L) and PTH of 95 pg/mL (10-65 pg/mL). He denies kidney stones but reports new-onset constipation. Relevant imaging is shown. What is the MOST likely diagnosis?

A 70-year-old male presents to his general practitioner complaining of mild, chronic lower back pain that has been present for several months. He describes the pain as a dull ache, worse with prolonged standing. He has a significant past medical history including hypertension, hyperlipidemia, and a 50-pack-year smoking history, all of which are currently managed with medications. He denies any acute abdominal pain, pulsatile sensation, or leg symptoms. On physical examination, his vital signs are stable: blood pressure 135/85 mmHg, heart rate 72 bpm, respiratory rate 14 breaths/min, and oxygen saturation 99% on room air. Abdominal examination is soft, non-tender, with no palpable masses. Peripheral pulses are symmetric and strong. As part of the investigation into his chronic back pain, a contrast-enhanced CT scan of the abdomen and pelvis is performed. An axial view from the scan is shown. Based on the clinical presentation and the findings demonstrated in the provided image, which of the following is the MOST appropriate next step in management?

A 62-year-old patient presented with a subarachnoid haemorrhage secondary to a ruptured cerebral aneurysm and underwent endovascular coiling. They have recovered well and are on routine follow-up. The image shows a recent angiogram performed as part of their surveillance. Considering the findings, what is the MOST appropriate next step in this patient's management?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). The provided image was obtained as part of his staging workup. Which of the following is the MOST appropriate next step in management?

A 70-year-old woman with a history of diabetes presents with fever, cough, and weight loss. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A 70-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with sudden onset, severe chest pain radiating to his back. He is diaphoretic and anxious. His blood pressure is 90/60 mmHg. Which of the following is the most likely diagnosis?

A 68-year-old male with known Hepatitis B related cirrhosis and a history of alcohol excess presents for routine surveillance. His alpha-fetoprotein (AFP) level, which has been stable at 15 ng/mL for the past two years, is now noted to be 185 ng/mL. A screening ultrasound performed three months prior was reported as showing diffuse parenchymal changes consistent with cirrhosis but no focal lesions. Due to the elevated AFP, a repeat ultrasound was performed, which identified a 2.5 cm nodule in segment VIII. To further characterise this lesion, a contrast-enhanced ultrasound (CEUS) was performed, and the images provided are representative findings from this study. The patient has well-compensated cirrhosis (Child-Pugh A) and no significant comorbidities. His liver function tests are within normal limits except for a slightly elevated GGT. Given the clinical context and the findings demonstrated in the provided images, what is the most appropriate next step in the management of this patient?

A 68-year-old woman presents to her GP with a 3-month history of a persistent, mildly pruritic skin lesion on her left chest wall. She had a left simple mastectomy for invasive ductal carcinoma 10 years ago, followed by adjuvant therapy. She denies fever, weight loss, or other systemic symptoms. Physical examination reveals the appearance shown. What is the most appropriate initial diagnostic investigation?

A 68-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with subjective fever, chills, and nausea. He reports some recent constipation. On examination, his temperature is 38.5°C, pulse 95 bpm, BP 130/80 mmHg. Abdominal examination reveals tenderness and guarding in the left iliac fossa. Bowel sounds are reduced. Blood tests show a white cell count of 15 x 10^9/L (neutrophils 85%) and C-reactive protein of 120 mg/L. Urea, electrolytes, and creatinine are within normal limits. A CT scan of the abdomen and pelvis is performed (image provided). Considering the clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate initial management strategy?

A 65-year-old male presents to the emergency department with 2 days of constant right upper quadrant pain radiating to the back, associated with nausea and subjective fever. On examination, he is febrile (38.5°C) with significant tenderness and a positive Murphy's sign in the right upper quadrant. His white cell count is elevated at 15 x 10^9/L, and CRP is 120 mg/L. Liver function tests are within normal limits. Considering the clinical findings and the provided imaging, what is the most appropriate next step in the management of this patient?

A 78M presents with cough, fever, confusion. BP 90/60, RR 30, Temp 38.5, SpO2 90% on air. CXR shows LUL consolidation. What is the most appropriate initial management?

A 63-year-old man presents with increasing shortness of breath and epigastric discomfort, particularly after meals. He has a history of GERD. Physical examination reveals decreased breath sounds at the left lung base. An axial CT image is shown. Considering the clinical presentation and imaging findings, what is the MOST appropriate next step in management?

A 65-year-old male presents with a 3-month history of unintentional weight loss and early satiety. Gastroscopy and biopsy confirmed a gastric mixed adenoneuroendocrine carcinoma. Staging CT imaging is shown. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate initial management strategy?

A 72-year-old man with a history of cholelithiasis presents with a 2-day history of fever, jaundice, and severe right upper quadrant pain. His vital signs are stable, but laboratory tests show elevated bilirubin and alkaline phosphatase. He is undergoing urgent ERCP for management of suspected choledocholithiasis and cholangitis. Following successful cannulation and injection of contrast, the image is obtained. Considering the findings demonstrated in the image in the context of this patient's presentation, what is the most appropriate immediate next step during this procedure?

An 82-year-old female presents with a 3-month history of intermittent retrosternal burning pain, worse after meals, and occasional shortness of breath on exertion. Vital signs are stable. Physical exam unremarkable. A chest X-ray is performed. Considering the findings on the image, what is the most appropriate initial management step?

A 68-year-old male presents for a routine check-up. He has a history of smoking and hypertension, managed with lisinopril. He denies any abdominal pain, back pain, or lower extremity claudication. Physical exam is unremarkable. A contrast-enhanced CT scan of the abdomen is performed, the axial view is shown. What is the MOST appropriate next step in management?

A 72-year-old male with a history of hypertension presents with a sudden onset of right-sided weakness and expressive aphasia. He underwent endovascular coiling for a PCA aneurysm 1 year ago. The attached image was obtained. What is the MOST likely cause of his current presentation?

A 72-year-old male presents to the clinic complaining of a painless swelling in his right groin that has been present for several years. He reports that the swelling occasionally increases in size with prolonged standing or heavy lifting, but it usually reduces when he lies down. He denies any acute pain, nausea, vomiting, or changes in bowel habits. His past medical history includes well-controlled type 2 diabetes mellitus and a remote appendectomy. On physical examination, his vital signs are within normal limits. Abdominal examination is unremarkable. Examination of the groin reveals the finding shown in the image. The swelling is easily reducible when the patient is supine. Which of the following is the MOST appropriate initial management strategy for this patient?

A 70-year-old male presents with jaundice and abdominal distension. The provided image was obtained. What is the MOST likely underlying cause of the jaundice?

A 72-year-old male presents with new onset back pain. His CT is shown. What is the most appropriate initial management?

A 72-year-old male with acute cholangitis is undergoing ERCP for stone extraction. The image is obtained after cannulation. Based on the findings, what is the most appropriate immediate next step in the procedure?

A 72-year-old male presents with vomiting and abdominal pain. An abdominal X-ray is performed. What is the MOST likely underlying cause?

A 72-year-old woman presents to her oncologist for follow-up. She underwent a left simple mastectomy for invasive ductal carcinoma 10 years ago. She reports a new, persistent skin change on her left chest wall over the past few months. Physical examination reveals the findings depicted. A recent biopsy of the affected area confirmed the presence of malignant cells consistent with Paget's disease. Considering the patient's history and the biopsy findings, which of the following investigations is the most appropriate next step in her management?

A 68-year-old male presents with abdominal distension and obstipation. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

An elderly man presents with a 6-month history of memory decline, recurrent falls, visual hallucinations, agitation, and confusion. His wife reports he talks to people who are not visible. Which of the following clinical features is most helpful in diagnosing his condition?

A 68-year-old presents with a 3-day history of fever, jaundice, and severe RUQ pain radiating to the back. Vitals: T 38.5°C, BP 110/70, HR 95. LFTs show bilirubin 150, ALP 450, ALT 120. An ERCP is performed for stone extraction. The image is captured during the procedure after cannulation. Considering the findings demonstrated in the image, what is the most appropriate immediate next step in management during the current procedure?

A 72-year-old male presents with a 4-month history of increasing fatigue, anorexia, and a 10 kg weight loss. He reports occasional nausea but no vomiting or abdominal pain. His vital signs are stable. Physical examination reveals mild jaundice and palpable hepatomegaly. Blood tests show Hb 105 g/L, elevated AST/ALT, and a mildly raised bilirubin. An upper endoscopy showed a large gastric mass, with histology pending. A CT scan of the abdomen and pelvis was performed. Considering the clinical context and the findings on the provided imaging, what is the most likely implication for this patient's overall management strategy?

An 80-year-old male presents to the emergency department with sudden onset of severe right groin pain and a non-reducible bulge. He has a history of a reducible inguinal hernia. Vitals are stable. A CT scan of the pelvis is performed. Considering the clinical presentation and the provided imaging, what is the most appropriate immediate management step?

A 78-year-old female on warfarin for chronic atrial fibrillation presents to the emergency department with a 24-hour history of increasing pain and discolouration in her right lower leg. She denies trauma or recent falls. Her INR this morning was 2.5 (target 2.0-3.0). Vital signs are stable: BP 130/80, HR 75, RR 16, Temp 36.8°C. Examination reveals the findings shown in the image. Considering the patient's history, current medication, and the clinical appearance depicted, what is the most appropriate immediate management?

A 68-year-old male presents for a routine check-up. He has a history of smoking and hypertension, managed with lisinopril. He denies any abdominal pain, back pain, or lower extremity claudication. Physical exam is unremarkable. A contrast-enhanced CT scan of the abdomen is performed, the axial view is shown. What is the MOST appropriate next step in management?

A 70-year-old man with a history of atrial fibrillation presents with sudden onset of severe pain, pallor, and coldness in his left leg. On examination, the leg is cool below the knee, distal pulses are absent, and sensation is diminished. Which of the following is the most appropriate initial diagnostic investigation?

A 72-year-old man presents to the emergency department with confusion and difficulty walking. His family reports that he has been increasingly forgetful over the past few months and has had several falls. He has a history of hypertension and hyperlipidemia, for which he takes lisinopril and atorvastatin. On examination, he is disoriented to time and place, with a blood pressure of 140/85 mmHg, heart rate of 78 bpm, and a wide-based gait. Neurological examination reveals brisk reflexes and a positive Romberg sign. A CT scan of the head shows mild cortical atrophy but no acute lesions. Which of the following is the most likely diagnosis?

A 65-year-old male presents with left lower quadrant abdominal pain for 3 days, associated with constipation. He denies fever. An abdominal CT scan is performed, the axial view is shown. What dietary advice is MOST appropriate at discharge?

A 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy findings are shown. What is the MOST appropriate next step in management?

A 68-year-old patient presents with chronic intermittent upper abdominal discomfort, postprandial fullness, and occasional regurgitation. Physical examination is unremarkable. A chest radiograph is performed as part of the workup. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate next step in management?

An 82-year-old man with a history of stroke presents with new onset confusion, a mild cough, and a temperature of 37.8°C. A chest X-ray reveals a right lower lobe infiltrate. Which of the following is the most appropriate initial management step?

An 82-year-old woman with a history of paroxysmal atrial fibrillation was recently discharged from hospital following treatment for community-acquired pneumonia. Five days ago, she was commenced on warfarin 5mg daily for stroke prevention. She presents to the emergency department today complaining of severe, rapidly worsening pain and a dark, blistering lesion on her right lower leg that developed over the past 48 hours. She denies any recent trauma to the leg. Her vital signs are stable: blood pressure 132/82 mmHg, heart rate 76 bpm, respiratory rate 18/min, temperature 37.0°C. Physical examination reveals the appearance shown in the image on her right anterior lower leg. Laboratory results show an INR of 4.8, haemoglobin 125 g/L, white cell count 8.5 x 10^9/L, and platelets 250 x 10^9/L. She has no known personal or family history of thrombophilia. Considering the clinical presentation, recent medication changes, and the appearance depicted, which of the following is the most appropriate immediate management strategy?

An 80-year-old male with a history of smoking and hypertension presents to his GP with mild, intermittent lower back pain. Physical examination is unremarkable. Routine blood tests are normal. A CT scan of the abdomen is performed to investigate the back pain. Considering the findings demonstrated in the provided image in the context of this patient's presentation, what is the most appropriate next step in management?

A 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since, reporting no new systemic symptoms such as unexplained weight loss, fatigue, or bone pain. Her last mammogram of the contralateral breast and clinical examination at her previous visit six months ago were unremarkable. During the current consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or significant discomfort. Her vital signs are stable (BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 36.8°C). Physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history, the duration and nature of the symptoms, and the clinical presentation, what is the most appropriate initial diagnostic step to investigate this new finding?

A 68-year-old man with a history of smoking and hypertension presents with intermittent claudication in his right leg. Ankle-brachial index (ABI) is 0.6 on the right and 0.9 on the left. He has been on a supervised exercise program and optimal medical therapy for 6 months with no improvement in symptoms. What is the most appropriate next step in management?

A 72-year-old male presents to the ED with sudden onset shortness of breath and right-sided chest pain. He has a history of atrial fibrillation and has been taking warfarin for the past 5 years. His INR is currently 6.5. A CT scan of the chest is performed (image attached). What is the MOST appropriate immediate next step in the management of this patient?

A 65-year-old male presents with a 2-month history of fatigue, poor appetite, and 5kg weight loss. He reports mild upper abdominal discomfort. Physical examination is unremarkable. Initial blood tests show mild anaemia. An upper endoscopy revealed a suspicious gastric lesion, with biopsy results pending. A CT scan of the abdomen and pelvis was performed. Given the clinical presentation and the findings on the provided imaging, which of the following statements regarding this patient's likely prognosis and management is most accurate?

A 68-year-old woman on warfarin for chronic atrial fibrillation presents with increasing pain in her right leg over the past 48 hours. Her INR is 4.0. Examination reveals the findings in the image. What is the MOST likely underlying cause?

A 65-year-old man presents to the emergency department with a 2-day history of worsening left lower quadrant abdominal pain, associated with fever and chills. He reports a change in bowel habit with increased constipation. On examination, he is febrile at 38.6°C and has significant tenderness and guarding in the left iliac fossa. His white cell count is 18 x 10^9/L. A CT scan of the abdomen and pelvis is performed (image provided). Considering the patient's presentation and the findings on the provided image, which of the following represents the most appropriate initial management step in addition to intravenous antibiotics?

A 70-year-old male with known cirrhosis secondary to NAFLD is undergoing routine surveillance. A new 3 cm lesion was identified in segment VIII on ultrasound, with AFP 45. Contrast-enhanced ultrasound was performed, with representative images shown. Based on the clinical context and the findings demonstrated, what is the most appropriate immediate next step in this patient's management?

A 70-year-old male with cirrhosis secondary to NAFLD presents for routine surveillance. A new 3 cm lesion was found in segment VIII on ultrasound, with AFP 45. Contrast-enhanced ultrasound was performed, with representative images shown. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in this patient's management?