general practice

A 32-year-old woman presents to the clinic with a 2-week history of a persistent cough and shortness of breath. She has no significant past medical history and is a non-smoker. On examination, she has bilateral wheezing and reduced breath sounds. A chest X-ray shows hyperinflation of the lungs. What is the most likely diagnosis?

A 62-year-old male presents to his general practitioner with a six-month history of a painless bulge in his right groin. On examination, a soft swelling is palpable in the right inguinal region, which increases in size on coughing or straining. The swelling is located medial to the inferior epigastric vessels. Which of the following is the most appropriate initial management strategy according to current Australian guidelines?

A 3-year-old child is brought to the GP by their parents who are worried about the appearance of their child's abdomen, as shown in the image. The child is otherwise well, active, and has no pain, vomiting, or changes in bowel habits. On examination, the finding is soft and easily reducible. Vital signs are normal. Based on this presentation and the image, what is the most appropriate initial management?

A 48-year-old man presents to his GP reporting an intermittent swelling in his right groin over the past six months. He notes it is more prominent when he is upright or coughing and disappears when he lies down. He experiences occasional mild discomfort but denies any acute pain, nausea, or vomiting. His past medical history is unremarkable, and vital signs are stable. Physical examination reveals the finding shown in the image. Considering the patient's history and the physical examination finding depicted, what is the most appropriate recommendation regarding definitive management for this patient?

A 58-year-old woman attends a routine mammography screening. She reports no palpable lumps, pain, or nipple discharge. Her family history is unremarkable. The image shows the findings of the current mammogram. What is the MOST appropriate next step in the management of this patient?

A 30-year-old woman presents to her GP with a 2-week history of a persistent cough, night sweats, and unintentional weight loss. She has recently returned from a trip to Southeast Asia. On examination, she appears thin and has crackles in the upper zones of her lungs. A chest X-ray shows cavitary lesions in the right upper lobe. What is the most likely diagnosis?

A 45-year-old woman presents with RUQ pain, fever, and nausea. The image shows the likely cause. What is the MOST appropriate next step in management?

A 45-year-old woman presents to the clinic with a 2-week history of a painful, swollen right calf. She recently returned from a long-haul flight from Europe. On examination, her right calf is warm, erythematous, and tender to touch. A D-dimer test is positive. What is the most appropriate next step in management?

A 42-year-old woman, nulliparous, presents to her general practitioner with a palpable lump in her left breast, noticed two weeks ago. She reports some mild, intermittent tenderness associated with the lump, which she initially attributed to her menstrual cycle, but it has persisted. She has no significant family history of breast cancer. On examination, there is a 1.5 cm, firm, mobile lump in the upper outer quadrant. No skin changes or nipple discharge are noted. Axillary nodes are not palpable. She is otherwise well. Which of the following represents the most appropriate initial management step?

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, which have since resolved. An abdominal ultrasound was performed, the image of which is shown. Liver function tests are within normal limits. Which of the following is the MOST appropriate next step in management?

A 32-year-old male, recent immigrant from a high-TB prevalence country, presents with a persistent cough and night sweats for the past two months. He denies fever or weight loss. Physical examination is unremarkable except for mild, diffuse rhonchi on auscultation. Sputum cultures are pending. A PET-CT scan of the chest was performed, the axial view is shown. Given the clinical context and imaging findings, what is the MOST appropriate next step in 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 32-year-old woman presents to her general practitioner with a 3-month history of intermittent abdominal pain and bloating. She reports that the pain is crampy, occurs mainly in the lower abdomen, and is often relieved by defecation. She also notes a change in her bowel habits, alternating between constipation and diarrhea. She denies any weight loss, fever, or blood in her stool. Her medical history is unremarkable, and she is not on any medications. On examination, her abdomen is soft with mild tenderness in the lower quadrants but no palpable masses. Blood tests, including a complete blood count and C-reactive protein, are normal. What is the most appropriate next step in the management of this patient?

A 35-year-old man presents to his general practitioner reporting a lesion on his nose that he first noticed approximately three months ago. He describes it as initially resembling a persistent pimple, but notes it has not resolved and appears to be slowly increasing in size. He denies any associated pain, itching, or bleeding from the site. His past medical history is unremarkable, and he is not currently taking any regular medications. He works outdoors in a role involving significant sun exposure but admits to inconsistent use of sun protection measures. On physical examination, his vital signs are within normal limits. The lesion in question is located on his nose and has the appearance shown in the accompanying image. No other suspicious skin lesions are identified elsewhere on his body, and regional lymph nodes are not palpable. Considering the clinical presentation and the appearance of the lesion depicted, what is the most appropriate initial step in the management of 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, amlodipine, and aspirin. His blood pressure today is 150/90 mmHg. Laboratory results show a serum creatinine of 2.5 mg/dL (221 micromol/L) and a potassium level of 5.4 mEq/L. The GP decides to add an ACE inhibitor to his treatment regimen to help manage his blood pressure and provide renal protection. One week later, the patient returns complaining of fatigue and muscle weakness. Repeat laboratory tests reveal a serum creatinine of 3.1 mg/dL (274 micromol/L) and a potassium level of 6.2 mEq/L. Which of the following is the most appropriate next step in managing this patient?

A 62-year-old male presents with LLQ pain and fever. The provided image was obtained. What is the most appropriate initial management?

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 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 25-year-old woman presents to the clinic with a 3-day history of dysuria, increased urinary frequency, and urgency. She denies fever, flank pain, or vaginal discharge. She is sexually active and uses oral contraceptives. On examination, she is afebrile and her vital signs are stable. Urinalysis shows pyuria and bacteriuria. What is the most appropriate treatment?

A 48-year-old man presents with a 2-year history of progressive, tender breast enlargement causing significant distress. Initial investigations including liver function tests, renal function tests, and basic hormonal assays (LH, FSH, testosterone, oestradiol) were largely within normal limits, except for a mildly elevated oestradiol. He takes no regular medications and denies recreational drug use. He is otherwise well and his physical examination is unremarkable apart from the findings shown in the image. Considering the clinical presentation and the findings, what is the most appropriate next step in his management?

A 55-year-old woman with no palpable breast lumps presents for a routine screening mammogram. The image is shown. What is the MOST appropriate next step?

A 55-year-old non-smoker with no known comorbidities has a consistent office BP of 155/98 mmHg. His 10-year CVD risk is calculated as low. According to Australian guidelines, what is the most appropriate initial management?

A 72-year-old male with a history of hypertension and hyperlipidemia presents for a routine follow-up. He is asymptomatic. A contrast-enhanced CT abdomen, axial view shown, was performed as part of a screening protocol. What is the MOST appropriate next 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 45-year-old man presents to his GP with a lesion on his nose that has been present for several months and seems to be slowly enlarging. He denies pain, itching, or bleeding. He works outdoors but reports using sunscreen inconsistently. His past medical history is unremarkable, and he takes no regular medications. On examination, vital signs are stable. Regional lymph nodes are not palpable. The lesion is as shown in the image. Considering the clinical presentation, risk factors, and the appearance of the lesion, which of the following represents the most appropriate initial step in establishing a definitive diagnosis and guiding management?

A 30-year-old recent immigrant from a high-TB prevalence country presents with a persistent cough and night sweats for 2 months. Sputum cultures are negative for acid-fast bacilli. A PET-CT scan was performed, and an image is shown. What is the MOST appropriate next step in management?

A 32-year-old woman presents to her general practitioner complaining of a persistent, intensely itchy rash on her elbows, knees, and scalp for the past 6 months. She reports that the itching is worse at night and after hot showers. She has tried over-the-counter hydrocortisone cream without relief. On examination, the GP notes symmetrical, excoriated papules and plaques on the extensor surfaces of her elbows and knees, as well as some scaling on her scalp. The patient also mentions a history of recurrent mouth ulcers. Which of the following is the MOST appropriate initial investigation to confirm the suspected diagnosis?

A 35-year-old woman presents to her GP with worsening shortness of breath, cough, and wheeze over 2 days, requiring her salbutamol reliever daily and waking her at night. Her PEF is 60% of her personal best. She is alert, speaking in sentences, RR 22, HR 95. Based on Australian guidelines, what is the most appropriate initial management step?

A 60-year-old man presents with a reducible right groin bulge, as seen in the image. He reports mild discomfort. What is the most appropriate initial management?

A 28-year-old woman presents to the clinic with a 3-day history of fever, sore throat, and difficulty swallowing. She has no significant past medical history and is not on any medications. On examination, she has swollen, tender anterior cervical lymph nodes and erythematous tonsils with white exudates. A rapid antigen detection test for group A Streptococcus is positive. What is the most appropriate treatment for her condition?

An Aboriginal woman, 48 years old, attends your general practice for a routine health check. She has a history of gestational diabetes and lives in a rural community. When discussing preventative health screening, which of the following is the MOST culturally appropriate and evidence-based approach?

A patient on warfarin presents with leg pain. INR is 3.5. Given the image, what is the MOST likely underlying cause?

A 50-year-old man presents with a slowly growing, asymptomatic nasal lesion. He reports no trauma or fever. Examination reveals the image shown. What is the MOST likely long-term outcome if left untreated?

A 55-year-old man presents to his GP with a lesion on his nose that has been slowly enlarging over the past 4 months. He reports no associated pain, itching, or bleeding. He is otherwise well, with no significant past medical history. On examination, vital signs are within normal limits. The lesion is as shown in the image. Considering the clinical presentation and the appearance of the lesion, what is the most appropriate initial step in the management of this patient?

Which of the following organs is located primarily in the left upper quadrant (LUQ) of the abdomen?

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 55-year-old male presents with LLQ pain, fever, and increased WBC. A CT scan is performed. He is hemodynamically stable. Based on the image, which of the following is the MOST appropriate initial management strategy?

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 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?

An 68-year-old man attends his GP for a routine check-up. He has a history of well-controlled type 2 diabetes, hypertension, and smoked for 30 years, quitting 5 years ago. He denies any abdominal pain, back pain, or pulsatile sensation. Physical examination is unremarkable. As part of a cardiovascular risk assessment, an abdominal ultrasound is initially performed, which is inconclusive due to bowel gas. A follow-up contrast-enhanced CT scan is arranged. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A 70-year-old male presents with a painful groin mass and constipation. The provided image was taken. What is the most appropriate next step?

A 35-year-old Aboriginal woman presents for a routine health check. She reports feeling tired lately and sometimes short of breath on exertion. She has a history of type 2 diabetes diagnosed 5 years ago, managed with metformin 500mg twice daily, and untreated hypertension. On examination, her blood pressure is 145/90 mmHg. Urinalysis shows 2+ protein. Blood tests reveal creatinine 180 µmol/L, eGFR 35 mL/min/1.73m², HbA1c 8.5%, potassium 4.2 mmol/L. Given these findings, which of the following is the most appropriate initial management step?

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 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 62-year-old male presents with a 6-month history of a painless swelling in his right groin, visible especially when standing. Examination reveals the finding in the image. The mass reduces when lying down. What is the MOST appropriate initial management?

A 20-year-old female medical student arrives late, parties, but is attentive in consultations. What is the next step?

A man presents to his GP complaining of insomnia. He has a history of addiction but is currently doing well. His girlfriend recently left him, and he states he will kill her if he sees her again. What is the most appropriate initial management step?

A 7-year-old boy is brought to the GP by his parents due to poor performance at school. Teachers report that he is inattentive, easily distracted, and frequently interrupts others. What is the most appropriate first-line treatment?

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, but denies any current pain, jaundice, or fever. An abdominal ultrasound is performed, the image is shown. What is the MOST appropriate next step in management?

A 55-year-old man presents with the condition shown. He reports taking spironolactone for hypertension. What is the MOST appropriate next step?