general practice

A 55-year-old man, non-smoker, presents for a health check. BP 135/85 mmHg, total cholesterol 5.5 mmol/L, HDL 1.2 mmol/L. No personal history of CVD or diabetes. Family history of premature CVD in father. BMI 28. Based on Australian guidelines, what is the most appropriate initial management step?

Warts on the left hand for 2 months, no treatment yet. What is the best evidence-based treatment for warts?

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 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 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 72-year-old male presents to his general practitioner for a routine check-up. He reports a history of hypertension, hyperlipidemia, and a 40-pack-year smoking history. He denies any abdominal pain, back pain, or lower extremity claudication. On physical examination, his vital signs are within normal limits. Auscultation of the abdomen is unremarkable, and peripheral pulses are palpable and symmetric. As part of his cardiovascular risk assessment, a contrast-enhanced CT scan of the abdomen and pelvis is performed. An axial view from the scan is shown. Based on the image and the patient's clinical presentation, which of the following is the MOST appropriate next step in management?

A 28-year-old woman with a mother diagnosed with colorectal cancer at 45 and a maternal uncle at 50 seeks advice. She is otherwise well. What is the most appropriate next step in her management?

A 30-year-old immigrant presents with chronic cough and night sweats. Sputum is negative for AFB. What is the MOST appropriate next step in management?

A 3-year-old child is presented to the general practitioner by their parents who are concerned about the appearance of their child's umbilicus, as depicted in the accompanying image. The child is reported to be entirely asymptomatic, feeding and playing normally, with no history of pain, discomfort, or vomiting. Physical examination reveals normal vital signs and a soft, non-tender abdomen with no signs of obstruction. Considering the clinical presentation and the finding shown, what is the most appropriate initial management plan for this child?

A 48-year-old woman, who emigrated from Southeast Asia 5 years ago, presents to her general practitioner with a 3-month history of a slowly enlarging lump in her neck. She reports mild fatigue and has lost approximately 3 kg unintentionally over the same period. She denies cough, fever, or night sweats. Her past medical history includes well-controlled type 2 diabetes mellitus managed with metformin. She is a non-smoker and drinks alcohol occasionally. On examination, she has a firm, non-tender, mobile mass measuring approximately 3x4 cm in the left anterior cervical chain. There are no other palpable lymph nodes. Chest auscultation is clear. Abdominal examination is unremarkable. Initial blood tests show a haemoglobin of 118 g/L (normal 120-150), white cell count 7.8 x 10^9/L (normal 4-11), neutrophils 4.5 x 10^9/L, lymphocytes 2.8 x 10^9/L, CRP 15 mg/L (normal <5). Liver and renal function tests are within normal limits. A neck ultrasound confirms a cluster of enlarged, hypoechoic lymph nodes in the left cervical region, the largest measuring 3.5 cm, with some central necrosis noted. A chest X-ray is clear. Given the clinical presentation and investigation findings, what is the most appropriate next diagnostic step?

A 62-year-old male with a history of poorly controlled diabetes presents with right upper quadrant pain, fever, and night sweats for 3 weeks. He is on immunosuppressants following a renal transplant 5 years ago. Blood cultures are pending. Imaging is performed, as 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 that started a few weeks ago. She reports that it began on her wrists and ankles and has now spread to her elbows and knees. She denies any new medications, travel, or changes in personal care products. On examination, you observe symmetrical, excoriated papules and plaques on her wrists, elbows, knees, and upper back. Some of the papules have small blisters. Which of the following is the most appropriate initial investigation?

A 32-year-old woman, G1P1, presents to her general practitioner at 34 weeks gestation complaining of a new, intensely itchy rash. The rash started on her abdomen around the umbilicus and has now spread to her thighs and buttocks. On examination, there are erythematous papules and plaques, some with vesicles, located within the striae distensae of her abdomen. She denies any personal or family history of eczema or other skin conditions. She is otherwise well, with normal blood pressure and no proteinuria. Fetal movements are normal. Which of the following is the most appropriate initial management?

A 62-year-old male presents to his general practitioner complaining of a dragging sensation in his right groin, particularly noticeable when standing for prolonged periods or straining during bowel movements. He denies any acute pain, nausea, vomiting, or changes in bowel habits. His past medical history is significant for benign prostatic hyperplasia (BPH) managed with tamsulosin. On examination, the patient is afebrile with normal vital signs. Palpation of the abdomen is unremarkable. Examination of the groin reveals the finding shown in the image. The swelling increases with coughing. Which of the following is the MOST appropriate next step in the management of this patient?

A 28-year-old female presents with right lower quadrant pain for 3 days. She denies fever, vomiting, or vaginal discharge. Her last menstrual period was 2 weeks ago. The shown CT was performed. What is the MOST likely diagnosis?

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 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 62-year-old woman attends her routine mammogram. She has no palpable lumps or skin changes. Her previous mammograms have been normal. The provided image is from the current study. Which of the following is the MOST appropriate next step in management?

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 55-year-old man presents to his GP with a lesion on his nose that he first noticed about 6 months ago. It has gradually increased in size but is not painful or itchy. He has no significant past medical history and takes no regular medications. On examination, vital signs are stable. The image shows the lesion. Based on the appearance of this lesion, what is the most appropriate next step in management?

A 68-year-old woman presents with 3 days of left lower quadrant pain. She reports mild nausea but no vomiting or fever. On examination, she is afebrile, BP 130/80, HR 78, O2 sat 98% on air. There is localised tenderness in the LLQ. Bloods show WCC 13.2, CRP 45. A CT scan is performed. Considering the clinical presentation and the findings demonstrated in the image, what is the most appropriate initial management plan?

A 68-year-old male presents to the emergency department complaining of abdominal pain, distension, and obstipation for the past 3 days. He reports a history of multiple abdominal surgeries for adhesions. 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 findings on the imaging, what is the MOST appropriate next step in management?

A 68-year-old male presents with right groin pain and a palpable mass. He reports constipation and mild nausea. Vitals are stable. The provided image was obtained. What is the MOST appropriate next step in management?

A 59-year-old male presents with a painful right groin bulge that has progressively worsened over the past week. He denies fever, chills, nausea, or vomiting. Vitals are stable. The provided image was obtained. What is the MOST appropriate next step?

A 45-year-old man presents to his GP with a 3-month history of gradually enlarging, painless swelling in the left side of his neck. He denies fever, night sweats, or weight loss. He emigrated from a region with high tuberculosis prevalence five years ago and has no known history of TB exposure or prior testing. On examination, there are multiple firm, non-tender, discrete lymph nodes in the left posterior triangle of the neck, the largest measuring about 3 cm. There are no other palpable nodes or organomegaly. His chest X-ray is clear. What is the most appropriate next diagnostic step?

A 35-year-old man presents to the clinic with a 3-month history of persistent cough, night sweats, and weight loss. He has a history of travel to Southeast Asia six months ago. On examination, he appears thin and has crackles in the upper zones of his lungs. A chest X-ray shows cavitary lesions in the right upper lobe. What is the most likely diagnosis?

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 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 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 56-year-old gentleman, a gardener and cat owner, presents with 24 hours of pain, swelling, and redness on his right index finger. His temperature is 38.1°C and pulse is 72. Suspected gout. What is the most appropriate next step?

A 14-month-old child is brought to the general practitioner for a routine check-up and immunisations. The parents express mild concern about a bulge they have noticed around the child's navel, which seems more prominent when the child is crying or straining. They report it is easily pushed back in and does not appear to cause the child any pain or discomfort. The child is otherwise thriving, with normal feeding, bowel movements, and developmental progress. On physical examination, the child is alert and interactive. Vital signs are within normal limits for age. Abdominal examination reveals no distension or tenderness. The finding illustrated in the image is noted. Based on this clinical presentation and examination finding, what is the most appropriate initial management plan?

A 45-year-old farmer presents with a 10-day history of fever, severe retro-orbital headache, and myalgia. He denies cough or dyspnoea. Physical examination is unremarkable. What is the most appropriate initial investigation?

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 her GP with a 3-month history of amenorrhea. She reports occasional headaches and galactorrhea. She is not on any medications and has no significant past medical history. On examination, her vital signs are normal, and there are no visual field defects. A pregnancy test is negative. What is the most appropriate initial investigation?

A 62-year-old male presents with left lower quadrant pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed (image attached). Assuming the diagnosis, which of the following is the MOST appropriate initial management?

A 55-year-old man presents to his GP complaining of a long-standing, intermittent swelling in his right groin that becomes more noticeable when he coughs or lifts heavy objects. It is usually painless and he can push it back in. His vital signs are normal. Considering the clinical presentation and the appearance shown, what is the most appropriate initial management?

A 28-year-old female presents to her general practitioner with a 6-month history of intermittent abdominal pain, predominantly in the right lower quadrant. She describes the pain as cramping and associated with occasional episodes of non-bloody diarrhea. She denies fever, weight loss, or recent travel. Her past medical history is significant for well-controlled asthma, for which she uses an inhaled corticosteroid as needed. Physical examination reveals mild tenderness to palpation in the right lower quadrant, but is otherwise unremarkable. Bowel sounds are normal. Initial laboratory investigations, including a complete blood count and comprehensive metabolic panel, are within normal limits. Stool studies for ova and parasites, bacterial culture, and Clostridium difficile toxin are negative. Given her persistent symptoms, the GP refers her for further evaluation. A CT enterography is performed, and relevant images are shown. Based on the clinical presentation and imaging findings, which of the following is the MOST likely long-term complication this patient is at increased risk of developing?

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 scattered rhonchi on auscultation. Sputum cultures are negative for acid-fast bacilli. A PET-CT scan of the chest is performed, the axial view is shown. Given the clinical context and imaging findings, what is the MOST appropriate next step in management?

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, as shown, was performed. Liver function tests are normal. Which of the following is the MOST appropriate next step in management?

A 62-year-old man with a history of poorly controlled hypertension and type 2 diabetes mellitus presents to his general practitioner for a routine check-up. His current medications include metformin, gliclazide, and amlodipine. His blood pressure today is 160/95 mmHg. His creatinine is 140 umol/L (previously 110 umol/L). His electrolytes are normal. The GP decides to add an ACE inhibitor to his regimen. Which of the following investigations is MOST important to repeat within 1-2 weeks of commencing the ACE inhibitor?

A 45-year-old Aboriginal man from a remote community presents to the clinic for a routine health check. He has a history of smoking (20 pack-years) and reports drinking alcohol occasionally (3-4 standard drinks per week). He denies any chronic medical conditions. His blood pressure is 145/95 mmHg. BMI is 32 kg/m2. Fasting blood glucose is 6.5 mmol/L. Which of the following is the MOST appropriate initial management strategy, considering the principles of culturally safe care?

A 58-year-old male presents to your GP clinic complaining of a dragging sensation in his groin, noticeable especially when standing for long periods. On examination, you observe the finding in the image. He denies any pain. What is the MOST appropriate initial management?

A 65-year-old man presents to his GP with a 2-day history of constant, dull aching pain in the left lower quadrant of his abdomen. He reports mild nausea but no vomiting. His bowel movements have been normal. He denies fever or chills. His past medical history includes well-controlled hypertension. On examination, he is afebrile (37.2°C), blood pressure is 135/85 mmHg, heart rate 72 bpm, respiratory rate 16 bpm. Abdominal examination reveals mild tenderness on deep palpation in the left iliac fossa, without guarding or rebound tenderness. Bowel sounds are normal. Digital rectal examination is unremarkable. Laboratory investigations show a white cell count of 10.5 x 10^9/L (normal range 4-11) and a C-reactive protein of 25 mg/L (normal <5). A CT scan of the abdomen and pelvis is performed (image provided). Considering the patient's clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate initial management strategy?

A 60-year-old Aboriginal man presents for a routine check-up. He has a history of smoking and lives in a remote community. Which screening is MOST important, considering higher prevalence in this population?

A 62-year-old woman presents for routine mammography. The image is shown. What is the MOST appropriate next step?

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

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

A 72-year-old male presents with abdominal distension, vomiting, and inability to pass flatus for 48 hours. He has a history of prior bowel resection. Examination reveals a tympanitic abdomen and tenderness to palpation. His vitals are stable. An abdominal X-ray is performed, as shown. What is the MOST appropriate next step in the management of this patient?