general practice

A 35-year-old male presents to his general practitioner with a lesion on his nose that has been present for approximately 3 months. He initially thought it was a persistent pimple but it has not resolved and seems to be slowly growing. He denies pain, itching, or bleeding from the lesion. He has no significant past medical history and takes no regular medications. He works outdoors but reports using sunscreen inconsistently. On examination, vital signs are stable. The lesion is as shown in the image. There are no other skin lesions noted elsewhere. Regional lymph nodes are not palpable. Based on the appearance of the lesion shown, what is the most appropriate next step in the management of this patient?

A 72-year-old male with a history of smoking and hyperlipidemia presents for a health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed as part of a screening protocol. An axial view is shown. Besides optimizing medical management, what is the MOST appropriate next step?

A 45-year-old man presents with a bulge in his right groin that he noticed a few weeks ago. It's more prominent when he coughs or strains. Examination reveals the finding in the image. He denies pain. What is the MOST likely diagnosis?

A 1-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 parents report the bulge is more prominent with crying but is easily reducible. The child is otherwise well, feeding normally, and has no history of pain, vomiting, or constipation. Physical examination reveals normal vital signs and a soft, non-tender abdomen. Considering the clinical presentation and the finding shown, what is the most appropriate advice to give the parents regarding initial management?

A 62-year-old woman presents for routine mammography. She has no palpable lumps or skin changes. Her previous mammogram two years ago was normal. The current mammogram is shown. What is the MOST appropriate next step in management?

A 58-year-old male presents to your GP clinic complaining of a dragging sensation in his right groin, particularly when standing for long periods. He denies any pain, nausea, or vomiting. On examination, you note the finding in the image. Palpation reveals a soft, reducible mass. What is the MOST appropriate next step in management?

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 58-year-old man presents to his general practitioner expressing concern about the appearance of his chest, which he feels has become more prominent over the past 18 months. He denies any pain, tenderness, or nipple discharge. His medical history includes well-controlled hypertension managed with perindopril and occasional use of ibuprofen for mild osteoarthritis. He reports no significant changes in weight, appetite, or energy levels. He is a non-smoker and drinks alcohol socially, approximately 5 standard drinks per week. He works as an accountant and reports no exposure to unusual chemicals or substances. On physical examination, his vital signs are within normal limits. Abdominal examination reveals no hepatosplenomegaly. Testicular examination is normal in size and consistency, with no palpable masses. The image provided shows the appearance of his chest. Considering the patient's presentation and the visual finding, what is the most appropriate initial investigation to pursue?

A 52-year-old man presents with right groin discomfort, worse with standing. Examination reveals the finding in the image. What is the MOST appropriate next step?

A 62-year-old postmenopausal woman presents to her general practitioner with complaints of severe hot flashes that significantly affect her quality of life. She has a history of breast cancer diagnosed three years ago, which was treated with surgery and chemotherapy. Her cancer was estrogen receptor-positive. She is currently on tamoxifen as part of her ongoing treatment. She is concerned about the use of hormone replacement therapy due to her cancer history. What is the most appropriate management option for her hot flashes?

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 68-year-old male presents for routine follow-up. He is asymptomatic. Review the image. What is the most appropriate next step in management?

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 50-year-old Aboriginal man presents for a routine check-up. He has a strong family history of type 2 diabetes. What is the most appropriate initial screening test?

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 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 40-year-old Aboriginal man presents for a health check. He has a strong family history of diabetes and cardiovascular disease. What is the most appropriate initial screening test to assess his risk?

A 65-year-old male presents with groin pain and vomiting. The provided image was taken. What is the most appropriate next step in management?

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 62-year-old man presents to his GP with a history of a bulge in his right groin that has been present for approximately 18 months. He reports it is more prominent with straining or standing and disappears completely when he lies down. He denies any associated pain, nausea, vomiting, or change in bowel habits. He has no significant past medical history. His physical examination reveals the finding depicted in the image. Vital signs are within normal limits. Based on this clinical picture, which of the following represents the most appropriate definitive management strategy for this patient?

A 45-year-old female presents to the emergency department with a 3-day history of right upper quadrant pain, nausea, and subjective fevers. She reports that the pain is constant and worsened by eating. She has no significant past medical history and takes no medications. On examination, she is noted to be uncomfortable, with a temperature of 38.2°C, heart rate of 110 bpm, blood pressure of 130/80 mmHg, and an oxygen saturation of 99% on room air. Abdominal examination reveals marked tenderness to palpation in the right upper quadrant with guarding. Murphy's sign is positive. Laboratory investigations reveal a white blood cell count of 15,000/µL with neutrophilic predominance, total bilirubin of 1.8 mg/dL, alkaline phosphatase of 280 U/L, ALT of 160 U/L, and AST of 130 U/L. The provided image was obtained. Considering the clinical presentation and the findings on the image, which of the following is the MOST appropriate next step in 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 14-month-old child is presented to the general practitioner by their parents, who are concerned about a noticeable protrusion around the navel. They report this bulge is more prominent when the child cries or strains but easily disappears when the child is relaxed or sleeping. There are no reports of pain, discomfort, changes in bowel habits, or feeding difficulties. The child is meeting all developmental milestones and appears well. On examination, vital signs are stable and within age-appropriate ranges. The abdomen is soft and non-tender, with no distension. The finding illustrated in the accompanying image is observed. Based on this clinical presentation and examination, what is the most appropriate initial management plan?

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 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 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 1-year-old child presents to the GP with parental concern about a bulge on the abdomen, as shown in the image. The child is asymptomatic, feeding well, and has normal bowel movements. Examination reveals a soft, reducible finding at the umbilicus; the abdomen is non-tender with normal bowel sounds. Based on this presentation and the image, what is the most appropriate initial management?

A 28-year-old woman presents to the clinic with a 2-week history of fever, night sweats, and a non-productive cough. She has recently returned from a trip to rural Queensland. On examination, she has crackles in the right upper lung field. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely 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 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 woman presents with right upper quadrant pain, fever, and leukocytosis. An abdominal CT scan is performed, as shown. She has a history of similar episodes that resolved spontaneously. What is the MOST appropriate next step in 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 22-year-old lady was wrongly given a B12 prescription for another patient. The error was noticed later at the pharmacy. What is the next step?

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 45-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 smoking and works as a miner. On examination, he has decreased breath sounds and dullness to percussion over the right upper lobe. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A 40-year-old Aboriginal man presents for a health check. He reports feeling well but has a strong family history of diabetes and cardiovascular disease. What is the most appropriate initial screening test?

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 62-year-old woman presents to her general practitioner with a 3-month history of progressive shortness of breath, fatigue, and a persistent dry cough. She has a history of rheumatoid arthritis, for which she takes methotrexate and low-dose prednisone. She denies fever, weight loss, or night sweats. On examination, she has clubbing of the fingers and fine inspiratory crackles at the lung bases. Her oxygen saturation is 92% on room air. A chest X-ray shows reticular opacities predominantly in the lower lung zones. Pulmonary function tests reveal a restrictive pattern with reduced diffusion capacity for carbon monoxide (DLCO). Which of the following is the most appropriate next step in the management of this patient?

A 55-year-old man with a history of hypertension and stable angina is prescribed a new medication. He reports experiencing a persistent dry cough since starting the medication. Which drug is most likely responsible for this side effect?

A patient on warfarin presents with leg pain. INR is 3.5. Given the image, what is the MOST appropriate initial pharmacological intervention?

A 68-year-old woman presents with a persistent rash following a mastectomy 5 years prior. What is the MOST appropriate next step in management?

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 55-year-old man presents to the clinic with a 3-month history of worsening cough, weight loss, and night sweats. He has a 30-pack-year smoking history and worked in construction for 20 years. On examination, he has clubbing of the fingers and decreased breath sounds in the right lower lung field. A chest X-ray shows a right lower lobe mass. What is the most appropriate next step in the management of this patient?

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

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

A 45-year-old man presents to his general practitioner with a 3-month history of persistent cough and occasional wheezing. He is a non-smoker and works as a carpenter. He reports that his symptoms worsen at work and improve on weekends. He has no significant past medical history and is not on any medications. What is the most likely diagnosis?