elderly patient

A 68-year-old male presents with abdominal distension, obstipation, and vomiting. He has a history of prior abdominal surgery. An upright abdominal X-ray is performed. What is the MOST appropriate next step in management?

A 72-year-old woman, status post mastectomy, presents with a lesion. What is the MOST appropriate initial diagnostic test?

An 80-year-old woman is brought to the emergency department from a nursing home due to increased lethargy and confusion over the past 24 hours. Her history includes dementia, hypertension, and type 2 diabetes. Nursing staff report poor oral intake for 48 hours and a recent cough. On examination, she is drowsy but rousable. Her vital signs are: BP 85/50 mmHg, HR 110 bpm, RR 22 breaths/min, Temp 37.8°C, SpO2 94% on air. Capillary refill time is 4 seconds. Chest auscultation reveals decreased breath sounds at the bases. Abdomen is soft. Urine dipstick shows leukocytes and nitrites. She is on lisinopril and metformin. What is the most appropriate initial management step?

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

A 72-year-old woman presents with a long history of heartburn, regurgitation, and recently developed a chronic cough, particularly at night. Physical examination is unremarkable. A chest radiograph is obtained. Considering the radiographic findings in the context of the patient's presentation, what is the most likely pathophysiological mechanism contributing to her chronic cough?

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 65-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus, hypertension, and dyslipidaemia presents with a 6-month history of burning pain in his feet, worse at night, often waking him from sleep. He also reports feeling lightheaded when standing up quickly and has noticed difficulty initiating urination and a weak stream. On examination, his blood pressure is 135/85 mmHg supine and 115/70 mmHg after standing for 3 minutes. Neurological examination reveals decreased sensation to pinprick and light touch in a stocking distribution up to the mid-calf bilaterally. Vibration sense is reduced at the ankles. Ankle reflexes are absent. The remainder of the examination is unremarkable. His most recent HbA1c is 8.9%. Which of the following is the most likely underlying cause of his constellation of symptoms?

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 72-year-old man with a history of type 2 diabetes mellitus, hypertension, and chronic kidney disease (stage 3) presents with a 2-week history of exertional dyspnea and fatigue. He reports no chest pain but has noticed occasional palpitations. On examination, his blood pressure is 150/90 mmHg, heart rate is 110 bpm (irregularly irregular), respiratory rate is 20 breaths per minute, and oxygen saturation is 94% on room air. Cardiovascular examination reveals a variable intensity S1, no S3 or S4, and a soft systolic murmur at the apex. Lung fields are clear. An ECG shows absent P waves and irregularly irregular QRS complexes. Which of the following is the most appropriate next step in management?

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 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 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 72-year-old man with a history of chronic heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation presents to the cardiology clinic for routine follow-up. He reports increased fatigue and occasional palpitations but denies chest pain or syncope. His current medications include lisinopril, carvedilol, furosemide, and digoxin. His blood pressure is 110/70 mmHg, heart rate is 78 bpm, and he has mild peripheral edema. Recent laboratory tests show a serum creatinine of 1.2 mg/dL and potassium of 4.5 mmol/L. An echocardiogram shows an ejection fraction of 35%. Considering his current medication regimen and clinical status, which of the following is the most appropriate next step in his pharmacological management?

A 68-year-old male presents with constant RUQ pain for 3 days. The image was obtained. What is the MOST likely complication if definitive management is delayed?

A 60-year-old non-smoker has a calculated 5-year cardiovascular disease risk of 12%. Based on current Australian guidelines, what is the most appropriate initial management focus?

A 65-year-old asymptomatic woman undergoes a screening mammogram. The image shows the findings. Her previous mammograms have been unremarkable. What is the MOST appropriate next step in the management of this patient?

A 65-year-old man presents with 2 days of left lower quadrant abdominal pain, fever, and nausea. On examination, he is afebrile, haemodynamically stable, with localised tenderness in the LLQ. Blood tests show a WCC of 14.5. A CT scan of the abdomen and pelvis is performed. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate initial management plan?

An 80-year-old presents with cough, fever, and new confusion. Vital signs: T 38.5°C, HR 110, BP 100/60, RR 28, SpO2 90% on air. Chest X-ray shows consolidation. What is the most appropriate initial management step?

A 67-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of hypertension and is currently on amlodipine. On examination, he is drowsy but arousable, with a blood pressure of 210/120 mmHg and a heart rate of 90 bpm. Neurological examination reveals a left-sided hemiparesis and a right-sided facial droop. A CT scan of the head shows a hyperdense lesion in the right basal ganglia with surrounding edema. Which of the following is the most appropriate initial management step?

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?

A 72-year-old man with a history of hypertension and hyperlipidemia presents for a routine health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed, axial view shown. Besides optimizing medical management, what is the MOST appropriate next step?

A 68-year-old male presents to the ED with severe groin pain and a palpable mass. He reports a history of a reducible bulge in the same area, but today it is firm and tender. He denies fever, nausea, or vomiting. Examination reveals stable vital signs. Review the provided image. What is the MOST appropriate next step in management?

A 62-year-old man presents with a 4-month history of bilateral breast enlargement and tenderness. He denies weight loss, fever, or changes in bowel habit. His medical history includes hypertension managed with amlodipine. On examination, vital signs are stable. The physical findings are demonstrated in the image. There is no palpable testicular mass. Given the clinical presentation and the findings shown, which of the following investigations is the most appropriate initial step to determine the underlying cause?

A 72-year-old man presents with sudden onset of severe right groin pain and a firm, non-reducible bulge. He reports mild nausea but denies vomiting or change in bowel habit. Vital signs are stable. A CT scan of the pelvis is performed, as shown. Considering the clinical context and the imaging findings, what is the most appropriate immediate 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 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?

Mr. Arthur Jenkins, a 72-year-old retired accountant, presents to his GP complaining of a change in bowel habit over the past 4 months, now experiencing increased frequency and occasional loose stools mixed with some mucus. He also reports intermittent small amounts of bright red blood on the toilet paper, which he initially attributed to haemorrhoids. He denies significant weight loss or abdominal pain. His past medical history includes hypertension well-controlled on medication and osteoarthritis. On examination, his abdomen is soft and non-tender, and digital rectal examination is unremarkable. Routine blood tests, including FBE and LFTs, are within normal limits. A faecal occult blood test is positive. Given these findings, a colonoscopy is arranged. The image provided was captured during the procedure. Considering the patient's presentation and the findings observed during the colonoscopy as depicted in the image, what is the most appropriate immediate next step in the management plan?

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 68-year-old man with known severe COPD presents with a 3-day history of increased cough, purulent sputum, and worsening dyspnoea. He uses salbutamol more frequently. On examination, he is afebrile, respiratory rate 24, SpO2 90% on air. Scattered wheezes are heard. Which of the following is the most appropriate initial management step?

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 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. Considering the clinical context and the findings on the image, which of the following represents the most appropriate initial management strategy?

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 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 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?

An 82-year-old patient presents to the emergency department with a 3-month history of intermittent retrosternal chest discomfort, worse after meals, and mild shortness of breath on exertion. They report occasional regurgitation but deny significant dysphagia. Past medical history includes hypertension and osteoarthritis. Medications are perindopril and paracetamol. On examination, vital signs are stable, and lung sounds are clear. A chest X-ray is performed. Based on the findings in the image, what is the most appropriate next step in management or investigation?

A 68-year-old male with a history of reflux presents with epigastric pain and vomiting. An X-ray is performed (shown). What is the most likely complication?

A 68-year-old male with a history of multiple abdominal surgeries presents to the emergency department complaining of abdominal pain, distension, and obstipation for the past 3 days. His vital signs are: HR 110 bpm, BP 110/70 mmHg, RR 22 breaths/min, SpO2 97% on room air, and temperature 37.8°C. Physical examination reveals a distended abdomen with high-pitched bowel sounds. An upright abdominal X-ray is performed, as shown. Given the clinical context and the radiographic findings, which demonstrate significant intraluminal gas accumulation proximal to the likely site of obstruction, what is the predominant source of this gas?

A 68-year-old male presents with worsening headaches and blurred vision 3 months post-embolization. The attached image was obtained. Which of the following is the MOST appropriate next step in management?

An 98-year-old lady with cognitive impairment has had 2 episodes of acute delirium, is pacing, and is vomiting blood. What is the immediate management?

A 72-year-old presents with recent onset tenesmus and passage of mucus. He has lost 4kg over 2 months. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but the appearance is highly suspicious for malignancy. What is the MOST appropriate initial investigation to assess for metastatic disease?

A 68-year-old man with moderate COPD (FEV1 55%) on a LAMA reports persistent breathlessness (mMRC 2) and one moderate exacerbation requiring oral steroids last year. What is the most appropriate next step in maintenance therapy?

A 75-year-old man with type 2 diabetes and chronic kidney disease presents with a 3-day history of productive cough, fever, and pleuritic chest pain. On examination, temperature is 38.2°C, HR 105, BP 130/80, RR 22, SpO2 93% on air. Crackles are heard over the right lower lung field. Which initial investigation is most crucial for guiding management?

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 62-year-old woman presents to her general practitioner complaining of fatigue, bone pain, and constipation for the past several months. She denies any significant past medical history and her vital signs are stable. Initial laboratory investigations reveal an elevated 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 also elevated. The patient 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 67-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. His blood pressure is 180/100 mmHg in the right arm and 160/90 mmHg in the left arm. He has a history of hypertension and is a smoker. An ECG shows no acute ischemic changes. What is the most appropriate next step in the management of this patient?

A 68-year-old man presents to his GP with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and a feeling of incomplete evacuation. He reports fatigue but denies significant weight loss. His physical examination, including digital rectal examination, is normal. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy is performed, and the image provided is a representative view from the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, what is the most appropriate immediate next step in the management of this patient?

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 60-year-old man presents with a 6-month history of intermittent aching discomfort in his right groin, exacerbated by standing and lifting. He reports noticing a bulge in the area, similar to the appearance shown, which usually disappears when he lies down. On examination, the bulge is reducible. Vital signs are normal. Considering the clinical presentation and the image, which anatomical structure is the most likely primary site of the fascial defect?