elderly patient
Practice targeted AMC-style multiple-choice questions on elderly patient.
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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 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 72-year-old male presents with increasing dyspnea. He has a history of GORD. The provided image was taken. What is the most appropriate next step?
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 75-year-old male with a history of atrial fibrillation on warfarin presents to the emergency department with acute onset shortness of breath and right-sided chest pain. His vital signs are stable. His INR is found to be 7.2. A chest CT is performed (image attached). Based on the clinical presentation and imaging findings, what is the MOST appropriate immediate management step?
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 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 62-year-old woman presents with fatigue, bone pain, and constipation. Laboratory tests reveal serum calcium 3.1 mmol/L, PTH 180 pg/mL, and elevated 24-hour urine calcium. Imaging studies are shown. Considering the clinical presentation and investigation findings, what is the MOST appropriate next step in the management of this patient?
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 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 with new onset ascites and elevated ALP has the imaging shown. What is the MOST likely primary malignancy?
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, the patient's GCS decreases. What is the MOST likely cause?
A 68-year-old woman presents to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Her vital signs are: temperature 38.5°C, heart rate 110 bpm, blood pressure 110/70 mmHg, respiratory rate 20 breaths per minute, and oxygen saturation 97% on room air. Initial laboratory investigations reveal: white blood cell count 14,000/µL, total bilirubin 6.0 mg/dL, alkaline phosphatase 450 U/L, ALT 300 U/L, and AST 250 U/L. An ERCP is performed, and the image is obtained. Following successful intervention, what is the MOST appropriate next step in managing this patient's condition?
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 68-year-old man with known alcoholic cirrhosis presents for routine surveillance. He reports mild fatigue but no other symptoms. Liver function tests are within his baseline. Alpha-fetoprotein is 150 ng/mL (normal <10). The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, what is the most appropriate immediate next step in this patient's management?
A 65-year-old man with chronic hepatitis C and compensated cirrhosis (Child-Pugh A) presents for routine surveillance. His alpha-fetoprotein is 250 ng/mL. He feels well. The provided images are obtained. Considering the clinical context and the findings demonstrated in the images, which of the following management strategies is most likely to be the initial approach for this patient?
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 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 70-year-old male with known cirrhosis secondary to non-alcoholic fatty liver disease is undergoing routine surveillance. His recent surveillance ultrasound identified a new 3 cm lesion in segment VIII. His alpha-fetoprotein level is 45 ng/mL (previously normal). A contrast-enhanced ultrasound is performed, with representative images shown. Based on the clinical context and the findings demonstrated in the images, what is the most appropriate immediate next step in this patient's management?
A 72-year-old man presents to his GP with a 3-month history of intermittent lower back pain, which is worse with activity. He has a history of hypertension, hyperlipidaemia, and is a former smoker. Physical examination reveals normal vital signs and no abdominal tenderness or pulsatile mass. Routine blood tests are normal. An abdominal CT scan is performed as part of the workup. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?
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 woman with a history of hypertension and hyperlipidemia presented to the emergency department with a sudden onset of left-sided hemianopia and mild right-sided weakness. Her symptoms began approximately 4 hours prior to arrival. Initial neurological examination revealed a left homonymous hemianopia, mild right hemiparesis (4/5 strength), and intact sensation. A CT angiogram was performed, identifying a cerebral aneurysm, and the patient subsequently underwent endovascular coiling. The provided image was obtained immediately following the procedure. Despite the intervention, the patient's left homonymous hemianopia persists, and her right hemiparesis has not improved. Considering the findings on the post-procedure imaging in the context of her ongoing neurological deficits, which of the following is the MOST appropriate immediate management step?
A 72-year-old male presents to his general practitioner with a 3-month history of progressively worsening constipation alternating with episodes of loose stools, associated with occasional bright red blood per rectum and an unintentional weight loss of 4 kilograms over the same period. He denies any significant past medical history or family history of bowel disease. His vital signs are stable, and physical examination, including abdominal palpation and digital rectal examination, is unremarkable. Routine blood investigations reveal a haemoglobin of 105 g/L with a mean corpuscular volume of 78 fL, and normal inflammatory markers. Given the clinical presentation, a colonoscopy is performed. The image provided is a representative view obtained during this procedure. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?
A 72-year-old patient presents with a 4-month history of tenesmus and occasional bright red rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies confirm adenocarcinoma. Considering the likely stage suggested by the endoscopic appearance, which investigation is MOST crucial for pre-operative staging?
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?
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 atrial fibrillation and well-controlled hypertension presents with acute onset expressive aphasia and right-sided facial droop. A CT angiogram reveals a posterior cerebral artery aneurysm, which was promptly treated with endovascular coiling. The provided image shows the post-operative angiogram. Despite the intervention, the patient's aphasia persists, and the facial droop has worsened. What is the MOST likely cause of the patient's continued and worsening symptoms?
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 70-year-old male undergoes a CT scan for investigation of chronic back pain. He has no history of abdominal pain or pulsatile mass. His blood pressure is 130/80 mmHg. The image provided is an axial view from this scan. Based on this finding and the patient's clinical status, what is the most appropriate next step in management according to current guidelines?
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 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. His past medical history includes hypertension and hyperlipidaemia, both well-controlled on medication. On examination, his temperature is 38.5°C, pulse 95 bpm, BP 130/80 mmHg, respiratory rate 18/min, oxygen saturation 98% on room air. Abdominal examination reveals tenderness and guarding in the left iliac fossa, with mild rebound tenderness. Bowel sounds are reduced. Digital rectal examination is unremarkable. Blood tests show a white cell count of 15 x 10^9/L (neutrophils 85%), haemoglobin 145 g/L, platelets 250 x 10^9/L, C-reactive protein of 120 mg/L. Urea, electrolytes, and creatinine are within normal limits. Liver function tests are normal. A CT scan of the abdomen and pelvis is performed (image provided). Considering the clinical presentation and the specific findings demonstrated in the provided image, which of the following interventions is most likely to be required in addition to intravenous antibiotics and supportive care?
A 68-year-old male presents to his GP complaining of a change in bowel habit over the past 6 months. He reports increasing constipation alternating with episodes of diarrhea. He also mentions unintentional weight loss of approximately 5 kg during this period. He denies any family history of bowel cancer. A colonoscopy was performed, and a representative image is shown. Assuming the lesion is confirmed as malignant, what is the MOST appropriate next step in the management of this patient?
A 65-year-old male presents with a 3-month history of unintentional weight loss and epigastric discomfort. Endoscopy revealed a gastric mass, and biopsy confirmed a mixed adenoneuroendocrine carcinoma. Staging imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?
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 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 male presents for a routine check-up. He has a history of smoking and hypertension, well-controlled with medication. 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 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed. Based on the imaging, what is the MOST appropriate next step in management?
A 68-year-old man presents with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and fatigue. He denies significant weight loss. Physical examination is unremarkable. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy was performed, and the image provided is a representative view. Biopsies were taken from the observed lesion. Considering the clinical presentation and the endoscopic finding, what is the most appropriate next investigation to determine the extent of disease and inform definitive management planning?
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 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?