elderly patient

A 72-year-old female presents with right leg pain and skin changes after starting warfarin for atrial fibrillation. Her INR is 3.5. Examination reveals the findings in the image. What is the MOST appropriate next step in management?

A 72-year-old woman is admitted to the hospital with increasing confusion and generalized weakness over the past week. Her medical history includes hypertension, for which she takes hydrochlorothiazide 25mg daily. On examination, she is lethargic and disoriented. Her blood pressure is 110/70 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Neurological examination reveals decreased reflexes. Initial laboratory investigations reveal the following: Sodium: 118 mmol/L Potassium: 3.8 mmol/L Chloride: 85 mmol/L Bicarbonate: 24 mmol/L Blood Urea Nitrogen (BUN): 25 mg/dL Creatinine: 1.1 mg/dL Glucose: 95 mg/dL Urine osmolality is 600 mOsm/kg. Serum osmolality is 250 mOsm/kg. Which of the following is the most appropriate initial management strategy?

A 62-year-old woman presents to her GP with a 6-month history of increasing fatigue, generalised bone aches, and constipation. She has no significant past medical history and takes no regular medications. Physical examination is unremarkable. Initial laboratory investigations reveal a corrected serum calcium level of 3.1 mmol/L (reference range: 2.1-2.6 mmol/L) and an elevated parathyroid hormone (PTH) level of 180 pg/mL (reference range: 10-65 pg/mL). A 24-hour urine calcium excretion is 12 mmol/day (reference range: 2.5-7.5 mmol/day). She is referred for further imaging, the results of which are shown. Based on the available information, what is the MOST appropriate next step in the management of this patient?

A 75-year-old male presents with worsening dysphagia. An X-ray is performed (shown). What is the most appropriate initial investigation?

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 72-year-old male with a history of smoking and hyperlipidemia presents for a health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed as part of a screening protocol. An axial view is shown. Besides optimizing medical management, what is the MOST appropriate next 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 reports the pain is severe and worsening rapidly. 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 therapeutic intervention?

A 67-year-old man with a history of hypertension and type 2 diabetes is scheduled for elective cholecystectomy due to symptomatic gallstones. During the preoperative assessment, he mentions experiencing mild chest discomfort during exertion over the past few weeks. What is the most appropriate next step in his preoperative management?

A 68-year-old male presents to the emergency department with a 12-hour history of severe, constant left groin pain. He reports a bulge in his groin that has been present for several years, which he can usually reduce himself. However, today he has been unable to push it back in, and the pain has become excruciating. He denies any fever, nausea, or vomiting. On examination, his vital signs are stable: temperature 37.0°C, heart rate 88 bpm, blood pressure 130/80 mmHg, respiratory rate 16 breaths/min, and oxygen saturation 98% on room air. Abdominal examination is unremarkable. Palpation of the left groin reveals a firm, tender mass that is non-reducible. The overlying skin is erythematous, but there is no crepitus. A CT scan of the abdomen and pelvis is performed, and an axial slice is shown. Given the clinical scenario and the imaging findings, what is the MOST appropriate next step in management?

A 64-year-old woman presents for review in the outpatient clinic. She reports a history of intermittent, self-resolving episodes of right upper quadrant colicky pain over the past year, but is currently asymptomatic. She denies fever, jaundice, or other systemic symptoms. Her physical examination is unremarkable, and recent liver function tests are within the normal reference range. An elective abdominal ultrasound was performed, yielding the image shown. Based on the clinical presentation and the findings demonstrated, what is the most appropriate next step in her management?

A 72-year-old male presents to his general practitioner for a routine check-up. He reports a history of hypertension, hyperlipidemia, and a 40-pack-year smoking history. He denies any abdominal pain, back pain, or lower extremity claudication. On physical examination, his vital signs are within normal limits. Auscultation of the abdomen is unremarkable, and peripheral pulses are palpable and symmetric. As part of his cardiovascular risk assessment, a contrast-enhanced CT scan of the abdomen and pelvis is performed. An axial view from the scan is shown. Based on the image and the patient's clinical presentation, which of the following is the MOST appropriate next step in management?

A 68-year-old male presents for routine follow-up. He is asymptomatic. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medication. Review the provided image. What is the most appropriate next step in management?

A 60-year-old woman presents to her GP with a 3-month history of fatigue, weight gain, and feeling cold all the time. She also reports constipation and dry skin. On examination, she has a slow heart rate and her skin appears dry and coarse. What is the most appropriate initial investigation?

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 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening confusion. What is the MOST appropriate next step?

A 68-year-old woman presents with a persistent rash on her chest wall at the site of a previous mastectomy performed 8 years ago. She denies pain or itching. What is the MOST appropriate next step in management?

A 65-year-old woman presents with a chronic, non-healing lesion at the site of her mastectomy scar, performed 7 years ago. She denies pain but reports occasional itching. What is the MOST appropriate next investigation?

A 65-year-old male with known alcoholic cirrhosis presents for routine HCC screening. His AFP is 25 ng/mL. A CT scan with IV contrast is performed (image attached). What is the MOST appropriate next step in management?

A 68-year-old female presents with right leg pain and skin changes after starting warfarin for atrial fibrillation 5 days ago. Her INR is currently 3.5. Examination reveals the findings in the image. What is the MOST appropriate next step in management?

A 62-year-old woman with osteoporosis and a history of kidney stones presents with a serum calcium of 2.9 mmol/L (2.1-2.6 mmol/L) and PTH of 120 pg/mL (10-65 pg/mL). She denies neck pain or swelling. The provided imaging was obtained. What is the MOST appropriate next step?

A 70-year-old woman presents with a lesion on her chest wall at the site of a mastectomy performed 10 years prior. She reports it started as a small area of redness and has slowly enlarged. What is the MOST likely diagnosis?

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 65-year-old lady weighing 70 kg has an enlarging papule on her right neck, measuring 8 mm, raised with a keratotic horn. A keratinocytic tumor is suspected. What is the maximum safe dose of 1% lidocaine with adrenaline for local anesthesia in this patient?

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 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 65-year-old presents with 2 days of left lower quadrant pain, fever (38.5°C), and nausea. On examination, there is localised tenderness in the LLQ. Vitals: BP 130/80, HR 90, RR 16, SpO2 98%. CRP is 150 mg/L, WCC 18 x 10^9/L. This image is obtained as part of the workup. Based on the clinical presentation and imaging findings, what is the most appropriate initial management step?

A 68-year-old male with a history of chronic hepatitis C presents to the clinic complaining of right upper quadrant abdominal pain and unintentional weight loss of 10 kg over the past 6 months. His past medical history is significant for well-controlled hypertension and hyperlipidemia. Physical examination reveals mild hepatomegaly. Laboratory investigations show elevated alpha-fetoprotein (AFP) levels. A contrast-enhanced ultrasound of the liver is performed, and representative images are shown. Based on the imaging and clinical context, which of the following is the MOST appropriate next step in management?

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 67-year-old woman presents to her GP with fatigue, weight loss, and night sweats over the past two months. She has a history of smoking and hypertension. On examination, she has palpable lymphadenopathy in the cervical and axillary regions. Blood tests reveal a hemoglobin level of 10 g/dL, elevated lactate dehydrogenase (LDH), and a peripheral blood smear showing atypical lymphocytes. What is the most likely diagnosis?

A 65-year-old man with a history of type 2 diabetes mellitus and hypertension presents with exertional dyspnea and fatigue. His physical examination reveals a blood pressure of 150/90 mmHg, a heart rate of 88 bpm, and a soft S4 gallop. There is no peripheral edema. An electrocardiogram shows left ventricular hypertrophy with repolarization abnormalities. Which of the following diagnostic tests would be most appropriate to evaluate for underlying coronary artery disease in this patient?

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

A 72-year-old woman is admitted to the cardiology ward following an episode of syncope. Her past medical history includes hypertension, for which she takes hydrochlorothiazide, and osteoarthritis, managed with regular ibuprofen. An ECG reveals a prolonged QTc interval of 520 ms. She denies any family history of sudden cardiac death or prolonged QT syndrome. Her electrolytes are within normal limits except for a potassium level of 3.4 mmol/L (normal range 3.5-5.0 mmol/L). Which of the following is the MOST appropriate initial step in managing this patient?

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). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 70-80 year old lady being treated for pulmonary embolism with a therapeutic dose of subcutaneous Enoxaparin is found to have multiple new pulmonary emboli. What is the most appropriate next step?

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, extending below the knee. On examination, the leg is cool to touch, pale, and distal pulses (popliteal, dorsalis pedis, posterior tibial) are absent. Sensation is diminished below the ankle, but he can still move his toes slightly. Capillary refill is delayed. Which of the following is the most appropriate initial diagnostic investigation?

A 72-year-old woman presents with increasing pain in her right leg. She has been on warfarin for atrial fibrillation for the past 5 days. Her INR is currently 3.5. Examination reveals the findings shown. What is the MOST appropriate next step in management?

A 62-year-old woman undergoes routine screening mammography. She is asymptomatic with no relevant family history of breast cancer. Physical examination is unremarkable. The provided image is a detail from her mammogram. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

An 80-year-old male with a history of smoking and hypertension presents for investigation of mild, intermittent lower back pain. Physical examination is unremarkable. Vital signs are stable. A CT scan of the abdomen is performed. Based on the provided image and clinical context, what is the most appropriate next step in the management of this patient?

A 65-year-old male with recently diagnosed gastric mixed adenoneuroendocrine carcinoma presents with unintentional weight loss. Endoscopy confirmed the diagnosis. Staging imaging is provided. His ECOG performance status is 1. Considering the extent of disease demonstrated, which of the following represents the most appropriate initial therapeutic approach?

A 78-year-old male on warfarin for atrial fibrillation presents to the emergency department with sudden onset of severe dyspnoea and right-sided pleuritic chest pain. He denies trauma. On examination, he is tachypnoeic, oxygen saturation is 92% on room air. Blood pressure 110/70 mmHg, heart rate 95 bpm. Chest examination reveals decreased breath sounds on the right. A CT scan of the chest is performed. Considering the patient's clinical presentation, medical history, and the findings demonstrated in the provided image, which of the following interventions is most critical to initiate *before* considering invasive drainage?

An 82-year-old patient presents to their GP with a 3-month history of intermittent retrosternal chest discomfort, often described as a burning sensation, worse after meals and when lying flat. They also report mild shortness of breath on exertion and occasional regurgitation, but deny significant dysphagia or weight loss. Past medical history includes hypertension and osteoarthritis. Medications are perindopril and paracetamol. On examination, vital signs are stable (BP 130/80, HR 75, RR 16, SpO2 97% on air), and lung sounds are clear. A chest X-ray is performed as part of the workup. Based on the clinical context and the findings demonstrated in the image, what is the most appropriate next step in investigation?

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?

A 60-year-old woman presents to the emergency department with sudden onset of severe abdominal pain radiating to her back. She has a history of hypertension and hyperlipidemia. On examination, she is hypotensive and tachycardic. Her abdomen is distended and tender, with guarding and rebound tenderness. An abdominal ultrasound reveals a large abdominal aortic aneurysm. What is the most appropriate 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?

66-year-old man, smoker with mild COPD, on salbutamol and tiotropium, confused regarding usage. Back for GPMP. Care plan?

A 64-year-old woman reports past episodes of transient right upper quadrant pain, now resolved. She is currently asymptomatic with normal liver function tests. An abdominal ultrasound was performed as part of her evaluation. Based on the findings from this imaging study and her clinical history, what is the most appropriate management recommendation?

A 65-year-old male presents with acute LLQ pain. The provided image was obtained. What dietary advice is most appropriate upon resolution of acute symptoms?

A 72-year-old male on warfarin presents with sudden onset dyspnea. His INR is 6.0. The provided image was obtained. What is the MOST appropriate next step?

A 68-year-old male with a history of GERD presents with worsening dysphagia and nocturnal cough. An X-ray is performed. Which of the following is the MOST likely underlying mechanism contributing to the patient's dysphagia?

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?