fatigue

A 28-year-old female presents with a chronic cough and fatigue. She has no significant past medical history but reports recent travel to Southeast Asia. A chest PET-CT was performed. What is the MOST appropriate next step in the management of this patient?

A 58-year-old woman presents with fatigue, muscle weakness, and abdominal pain. Labs show serum calcium 3.2 mmol/L and PTH 190 pg/mL. Renal function is normal. Imaging studies are shown. Based on the clinical presentation, laboratory findings, and imaging studies, what is the MOST appropriate next step in managing this patient?

A 32-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. She has no significant past medical history and is not on any medications. On examination, her blood pressure is 120/80 mmHg, heart rate is 60 bpm, and she has a slightly enlarged thyroid gland. Laboratory tests reveal a low free T4 level and an elevated TSH level. Which of the following is the most appropriate initial treatment for this patient?

A 45-year-old man presents to the clinic with a 2-month history of fatigue, weight loss, and night sweats. He has a history of smoking and works as a miner. On examination, he has cervical lymphadenopathy and hepatosplenomegaly. A chest X-ray shows bilateral hilar lymphadenopathy. What is the most likely diagnosis?

A 72-year-old man with a history of hypertension, type 2 diabetes, and chronic kidney disease (CKD) presents to his general practitioner for a routine check-up. His current medications include metformin, insulin glargine, amlodipine, and aspirin. His blood pressure today is 150/90 mmHg. Laboratory results show a serum creatinine of 2.5 mg/dL (baseline 2.0 mg/dL), potassium of 5.4 mEq/L, and a urine albumin-to-creatinine ratio (ACR) of 350 mg/g. The GP decides to add an ACE inhibitor to his medication regimen to help manage his blood pressure and proteinuria. One week later, the patient returns complaining of fatigue and muscle weakness. Repeat laboratory testing reveals a serum creatinine of 3.1 mg/dL and a potassium of 6.2 mEq/L. Which of the following is the most appropriate next step in managing this patient?

A 45-year-old woman presents to the emergency department with a 3-day history of progressive shortness of breath, dry cough, and fatigue. She has a history of systemic lupus erythematosus (SLE) and is currently on hydroxychloroquine and low-dose prednisone. She denies fever, chest pain, or recent travel. On examination, her temperature is 37.2°C, blood pressure is 110/70 mmHg, heart rate is 95 bpm, respiratory rate is 22 breaths per minute, and oxygen saturation is 89% on room air. Lung auscultation reveals bilateral basal crackles. Laboratory tests show a hemoglobin level of 10.5 g/dL, white blood cell count of 4,000/mm³, and platelets of 150,000/mm³. Arterial blood gas analysis reveals a pH of 7.45, PaCO2 of 35 mmHg, and PaO2 of 55 mmHg. A chest X-ray shows bilateral interstitial infiltrates. Which of the following is the most appropriate next step in management?

A 45-year-old man presents to the general practice clinic with a 3-month history of fatigue, weight loss, and night sweats. He has a history of smoking and works as a construction worker. On examination, he has cervical lymphadenopathy and hepatosplenomegaly. Blood tests reveal anemia and elevated lactate dehydrogenase (LDH). A chest X-ray shows a mediastinal mass. What is the most appropriate next step in the management of this patient?

A 32-year-old woman presents to her general practitioner with a 2-week history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) and anti-double-stranded DNA antibodies. What is the most likely diagnosis?

A 45-year-old woman presents to her general practitioner with a 3-month history of progressive fatigue, weight gain, and cold intolerance. She also reports constipation and dry skin. On examination, her blood pressure is 110/70 mmHg, heart rate is 60 bpm, and she has a delayed relaxation phase of her deep tendon reflexes. Laboratory tests reveal a low free T4 level and an elevated TSH level. Which of the following is the most appropriate initial 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 45-year-old woman presents to the clinic with a 6-month history of fatigue, weight gain, and feeling cold all the time. She also reports hair loss and constipation. On examination, her skin is dry, and her reflexes are delayed. Her blood pressure is 110/70 mmHg, and her heart rate is 60 bpm. Laboratory tests reveal a low free T4 and elevated TSH. What is the most likely diagnosis?

A 48-year-old sheep farmer presents to his GP with a two-week history of persistent fever, severe retro-orbital headache, and profound fatigue. He denies cough, shortness of breath, or rash. On examination, his temperature is 38.5°C, pulse 85 bpm, BP 120/80 mmHg. The remainder of the examination, including chest auscultation, is unremarkable. He has not travelled outside the region recently.

A 68-year-old man presents to the emergency department with fatigue, pallor, and shortness of breath on exertion. His blood tests reveal a hemoglobin level of 7.5 g/dL, mean corpuscular volume (MCV) of 72 fL, and low serum ferritin. He has a history of osteoarthritis and takes ibuprofen regularly. What is the most likely cause of his anemia?

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 62-year-old woman presents to her GP with a 6-month history of increasing fatigue, generalised bone aches, and constipation. She denies polyuria or polydipsia. Her past medical history is unremarkable, and she takes no regular medications. On examination, her vital signs are stable, and there are no palpable neck masses. Initial laboratory investigations show serum calcium 3.1 mmol/L (2.1-2.6), phosphate 0.7 mmol/L (0.8-1.4), PTH 180 pg/mL (10-65), and 24-hour urine calcium 450 mg (100-300). 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 32-year-old woman presents to her GP with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints of her hands. Laboratory tests reveal a positive ANA and anti-dsDNA antibodies. What is the most likely diagnosis?

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 28-year-old female, recently emigrated from Southeast Asia, presents to her general practitioner with complaints of fatigue, a persistent low-grade fever (37.8°C), and a non-productive cough that has been present for approximately one month. She denies any significant past medical history and is not currently taking any medications. Physical examination reveals slightly diminished breath sounds in the upper right lobe, but is otherwise unremarkable. Initial blood work, including a complete blood count and comprehensive metabolic panel, are within normal limits. A chest X-ray revealed a suspicious lesion in the right upper lobe, prompting a PET-CT scan, an axial slice of which is shown. Given the patient's history, clinical presentation, and the findings on the PET-CT scan, which of the following is the MOST appropriate next step in the diagnostic workup?

A 62-year-old woman presents with fatigue, constipation, and bone pain. Serum calcium is elevated. The images are obtained. What is the MOST appropriate next step in management?

A 58-year-old woman presents with persistent fatigue, muscle weakness, and vague abdominal pain. Investigations reveal serum calcium 3.2 mmol/L (2.1-2.6), PTH 190 pg/mL (10-65). Renal function is normal. She denies family history of endocrine disorders. Imaging studies are performed, as shown. Considering the clinical presentation and the findings from the imaging modalities, what is the definitive management strategy for this patient?

A 65-year-old woman presents to her general practitioner with fatigue and pallor. She has a history of rheumatoid arthritis, for which she takes methotrexate and folic acid. She denies any gastrointestinal symptoms or recent changes in her diet. On examination, she appears pale, and her conjunctivae are pale as well. Her blood pressure is 120/75 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Laboratory investigations reveal hemoglobin of 9.0 g/dL, mean corpuscular volume (MCV) of 105 fL, and normal white blood cell and platelet counts. Which of the following is the most likely cause of her anemia?

A 58-year-old male presents with fatigue and microcytic anemia. He denies overt bleeding but reports occasional dark stools. Colonoscopy reveals the image shown. Biopsies confirm adenocarcinoma. What is the MOST appropriate next investigation to stage the cancer?

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. 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 62-year-old woman presents with tiredness and is found to have B12 deficiency. What is the likely associated condition?

A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A 62-year-old woman presents with fatigue, constipation, and bone pain. Serum calcium is elevated. The provided imaging was obtained. What is the MOST likely underlying cause of her presentation?

A 55-year-old woman presents to her GP with a 3-month history of fatigue, pallor, and shortness of breath on exertion. She has a history of menorrhagia. On examination, she appears pale and has conjunctival pallor. Blood tests reveal a hemoglobin level of 8 g/dL, mean corpuscular volume (MCV) of 70 fL, and low serum ferritin. What is the most appropriate next step in management?

A 52-year-old woman presents to her general practitioner with fatigue, increased thirst, and frequent urination over the past three months. She has a history of hypertension and hyperlipidemia, for which she takes lisinopril and atorvastatin. Her BMI is 32 kg/m². On examination, her blood pressure is 140/85 mmHg, and her heart rate is 78 bpm. Laboratory tests reveal a fasting plasma glucose of 8.5 mmol/L and an HbA1c of 7.2%. She is diagnosed with type 2 diabetes mellitus. Which of the following is the most appropriate initial management step for this patient according to Australian guidelines?

A 45-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal pain. He has a history of type 2 diabetes and hypertension. On examination, he has a palpable mass in the left upper quadrant of the abdomen. Laboratory tests reveal anemia and elevated serum lactate dehydrogenase (LDH). A CT scan of the abdomen shows splenomegaly and multiple hypodense lesions in the spleen. What is the most likely diagnosis?

A 3-year-old boy presents to the emergency department with a one-week history of abdominal pain, decreased appetite, and irritability. His parents also report that he has been increasingly tired and pale. On examination, the child is noted to have a palpable abdominal mass. A CT scan of the abdomen is performed, the axial view is shown. Based on the image and clinical presentation, which of the following is the MOST appropriate next step in management?

A 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy reveals the lesion shown. Biopsy confirms adenocarcinoma. What is the MOST appropriate next investigation to determine disease stage?

A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On examination, she has dry skin and a delayed relaxation phase of deep tendon reflexes. Her TSH level is elevated, and free T4 is low. What is the most appropriate treatment for her condition?

A 55-year-old man with a history of type 2 diabetes mellitus presents with polyuria, polydipsia, and fatigue. His blood tests reveal a fasting blood glucose level of 15 mmol/L and HbA1c of 9.5%. He is currently on metformin. What is the most appropriate next step in management?

A 72-year-old man with a history of hypertension and atrial fibrillation presents to the emergency department with worsening shortness of breath and fatigue over the past two weeks. He reports occasional palpitations but denies chest pain or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 130 bpm (irregularly irregular), respiratory rate is 22 breaths per minute, and oxygen saturation is 94% on room air. Jugular venous pressure is elevated, and there are bilateral lung crackles. An ECG shows atrial fibrillation with a rapid ventricular response. An echocardiogram reveals moderate mitral regurgitation and left atrial enlargement. Which of the following is the most appropriate initial management step?

A 45-year-old woman presents to her general practitioner with a 3-month history of fatigue, weight gain, and feeling cold all the time. She also reports constipation and dry skin. On examination, her heart rate is 55 bpm, and she has a delayed relaxation phase of her deep tendon reflexes. What is the most likely diagnosis?

A 58-year-old man presents to his general practitioner with a 3-week history of intermittent fever, severe headache, and profound fatigue. He describes the headache as diffuse and often retro-orbital, not relieved by simple analgesia. He also reports generalised muscle aches and occasional night sweats. He denies cough, shortness of breath, or gastrointestinal symptoms. His medical history is unremarkable, and he takes no regular medications. He lives on a rural property in Queensland where he raises sheep and cattle. On examination, he is afebrile at the time of consultation (37.2°C), blood pressure is 130/80 mmHg, pulse is 85 bpm, and respiratory rate is 16 breaths per minute. Physical examination is otherwise unremarkable; specifically, there is no rash, lymphadenopathy, or focal neurological signs. Initial laboratory investigations reveal a white cell count of 7.5 x 10^9/L (neutrophils 65%, lymphocytes 25%), haemoglobin 145 g/L, platelets 250 x 10^9/L. Liver function tests show AST 85 U/L (normal <40), ALT 90 U/L (normal <40), alkaline phosphatase 110 U/L (normal <130), total bilirubin 15 µmol/L (normal <20). C-reactive protein is elevated at 45 mg/L (normal <5). A chest X-ray performed a week prior was reported as normal. Given the clinical presentation and epidemiological context, which of the following is the most appropriate initial diagnostic investigation?

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 70-year-old woman with a history of hypertension presents with fatigue, shortness of breath, and bilateral leg swelling. Echocardiography shows an ejection fraction of 30%. What is the most appropriate first-line treatment?

A 35-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He has no significant past medical history and does not take any medications. On examination, he has palpable cervical and axillary lymphadenopathy. A lymph node biopsy reveals Reed-Sternberg cells. What is the most likely diagnosis?

A 58-year-old male presents with fatigue and iron deficiency anemia. Colonoscopy reveals the image shown. Biopsies are taken. Assuming pathology confirms malignancy, what is the MOST appropriate next investigation to determine disease stage?

A 52-year-old woman presents to her general practitioner with fatigue, increased thirst, and frequent urination over the past three months. She has a history of hypertension and hyperlipidemia, managed with lisinopril and atorvastatin. Her BMI is 32 kg/m². On examination, her blood pressure is 140/85 mmHg, and her heart rate is 78 bpm. Laboratory tests reveal a fasting plasma glucose of 8.5 mmol/L and an HbA1c of 7.2%. She is concerned about her risk of complications and asks about the best initial management strategy. Considering Australian guidelines, what is the most appropriate next step in managing her condition?

A 32-year-old woman presents to her general practitioner with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash, mild synovitis in her hands, and no signs of organomegaly. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA) with a high titer. Which of the following is the most appropriate initial management for this patient?

A 30-year-old woman presents to her GP with fatigue, weight gain, and cold intolerance over the past 6 months. She also reports constipation and dry skin. On examination, she has a slightly enlarged, non-tender thyroid gland. Her TSH level is elevated, and free T4 is low. What is the most appropriate treatment for this condition?

A 62-year-old woman presents with fatigue and bone pain. Serum calcium is elevated. The provided imaging was obtained. What is the MOST likely underlying cause of her hypercalcemia?

A 50-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 delayed relaxation of deep tendon reflexes. Her thyroid function tests show elevated TSH and low free T4 levels. What is the most appropriate treatment for her condition?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history is significant for a recently diagnosed 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 45-year-old male, who recently immigrated from India, presents to his primary care physician with a two-month history of progressive fatigue, unintentional weight loss of 7 kg, and intermittent night sweats. He denies any cough, chest pain, or shortness of breath. He has no significant past medical history and is not currently taking any medications. Physical examination reveals normal vital signs, including a temperature of 37.1°C, and clear breath sounds bilaterally. However, mild cervical lymphadenopathy is noted. Initial laboratory investigations, including a complete blood count and comprehensive metabolic panel, are unremarkable. A chest X-ray reveals a solitary pulmonary nodule in the right upper lobe, which prompts a PET-CT scan for further evaluation. An axial slice from the PET-CT is shown. Given the patient's clinical presentation, immigration history, and the PET-CT findings, which of the following is the MOST appropriate next step in establishing a definitive diagnosis?

A 25-year-old woman presents to the clinic with a 2-week history of fatigue, sore throat, and swollen glands. She also reports a low-grade fever and mild headache. On examination, she has cervical lymphadenopathy and mild splenomegaly. A monospot test is positive. What is the most appropriate advice regarding her physical activity?

A 32-year-old woman presents to her general practitioner with a 2-month history of fatigue, weight gain, and feeling cold all the time. She also reports hair loss and constipation. On examination, her heart rate is 58 bpm, and she has dry skin and a delayed relaxation phase of the deep tendon reflexes. Her thyroid function tests reveal a high TSH level and low free T4. She has no significant past medical history and is not on any medications. Which of the following is the most appropriate initial management for her condition?