fatigue

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 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 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 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 62-year-old man presents with a 4-month history of increasing fatigue, unintentional weight loss of 7 kg, and intermittent upper abdominal discomfort. He reports no change in bowel habits, dysphagia, or vomiting. His past medical history includes hypertension and osteoarthritis. He is a non-smoker and drinks alcohol occasionally. On examination, he is pale. His vital signs are stable. Abdominal examination reveals mild epigastric tenderness but no masses or organomegaly. There is no peripheral lymphadenopathy. Initial blood tests show haemoglobin 92 g/L (reference range 130-170), MCV 74 fL (80-95), ferritin 12 mcg/L (30-300), and CRP 18 mg/L (<5). Liver function tests and renal function tests are within normal limits. Which of the following is the most appropriate initial investigation?

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 72-year-old man with fatigue and a past myocardial infarction at 55 is breathless on stairs, has a 3 kg weight gain, and ankle marks. What is his likely NYHA functional class for chronic heart failure?

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 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 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 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 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 24-year-old woman presents to the emergency department with a 3-day history of fever, sore throat, and fatigue. She also reports a rash that developed after taking amoxicillin prescribed by her GP for a presumed bacterial throat infection. On examination, she has cervical lymphadenopathy, a diffuse maculopapular rash, and mild splenomegaly. Her vital signs are stable. A monospot test is positive. Which of the following is the most likely explanation for the rash?

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 28-year-old female presents with a chronic cough and fatigue. She has no significant past medical history. A chest PET-CT was performed as part of her workup. The axial view is shown. What is the MOST appropriate next step in management, considering the image and her presentation?

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 28-year-old male presents with a persistent cough and fatigue. A PET-CT scan was performed. What is the MOST likely diagnosis?

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 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 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 68-year-old man with a history of hypertension and coronary artery disease presents to the emergency department with worsening shortness of breath and fatigue over the past week. On examination, he has elevated jugular venous pressure, bilateral lung crackles, and peripheral edema. An echocardiogram reveals reduced ejection fraction and dilated ventricles. Which of the following best explains the pathophysiological mechanism leading to his symptoms?

A 58-year-old woman presents with persistent fatigue, muscle weakness, and vague abdominal pain. Her serum calcium is 3.2 mmol/L (2.1-2.6 mmol/L), and PTH is 190 pg/mL (10-65 pg/mL). She denies any history of fractures or kidney stones. She was referred for imaging, as shown. What is the MOST appropriate next step in managing 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. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA). 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 60-year-old woman presents to her GP with a 3-month history of increasing fatigue and joint pain, particularly in her hands and knees. She also reports morning stiffness lasting over an hour. On examination, there is swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints. Blood tests reveal a positive rheumatoid factor and elevated C-reactive protein. What is the most appropriate initial treatment for her condition?

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 72-year-old man with fatigue, a past myocardial infarction at age 55, breathlessness on stairs, and ankle marks has an LVEF < 40% on echocardiogram. Which of the following medications is known to improve outcomes in Heart Failure with Reduced Ejection Fraction (HFrEF)?

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 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 60-year-old man presents to his GP with a 3-month history of fatigue, weight loss, and night sweats. He has a history of smoking and hypertension. On examination, he has palpable lymphadenopathy in the cervical and axillary regions. Blood tests reveal anemia and elevated lactate dehydrogenase (LDH). What is the most appropriate next step in the investigation of this patient?

A 62-year-old male presents to the emergency department complaining of worsening abdominal pain, fatigue, and a 10kg unintentional weight loss over the past 3 months. He reports a history of peptic ulcer disease treated with long-term proton pump inhibitors. Physical examination reveals mild hepatomegaly and trace ascites. Initial laboratory investigations show elevated alkaline phosphatase and gamma-glutamyl transferase (GGT), with normal bilirubin and transaminases. A CT scan of the abdomen and pelvis with contrast is performed, and relevant images are shown. Given the clinical presentation and the findings on the imaging, which of the following is the MOST appropriate next step in management?

A 35-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He also reports a persistent cough that has recently become productive of blood-streaked sputum. He has no significant past medical history and is not on any medications. He recently returned from a trip to Southeast Asia. On examination, he is febrile and has bilateral crackles in the upper lung fields. A chest X-ray shows cavitary lesions in the upper lobes. What is the most likely diagnosis?

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 55-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal discomfort. He has a history of chronic hepatitis B infection. On examination, he has mild hepatomegaly and jaundice. Blood tests reveal elevated liver enzymes and alpha-fetoprotein levels. An ultrasound of the abdomen shows a 3 cm lesion in the right lobe of the liver. What is the most likely diagnosis?

A 58-year-old farmer presents with a 10-day history of fever, severe retro-orbital headache, myalgia, and profound fatigue. He denies cough or sore throat. Examination reveals mild scleral icterus. Liver function tests show elevated transaminases. He works closely with sheep and cattle. What is the most likely diagnosis?

A 35-year-old male presents with a two-month history of fatigue, unintentional weight loss, and a persistent dry cough. He denies fever or night sweats. A PET-CT scan of the chest was performed (image shown). What is the MOST appropriate next step in management?

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?

A 28-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 in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double-stranded DNA antibodies. What is the most likely diagnosis?