geriatrics

An old man presents with 6 months of memory decline, falls, visual hallucinations, agitation, and confusion. Which of the following features is relevant to diagnosing his condition?

A 72-year-old male presents to the emergency department complaining of sudden onset shortness of breath and right-sided chest pain. He reports that the pain started acutely this morning and has been gradually worsening. He has a history of atrial fibrillation and has been taking warfarin for the past 5 years. He denies any recent trauma or injury. On examination, his vital signs are: heart rate 110 bpm, blood pressure 100/60 mmHg, respiratory rate 28 breaths per minute, oxygen saturation 88% on room air. Auscultation reveals decreased breath sounds on the right side. The patient is pale and diaphoretic. A chest X-ray was initially performed, followed by the image shown. Given the clinical presentation and the findings on the image, what is the MOST appropriate next step in management?

An 80-year-old woman is brought to the emergency department from a nursing home due to increased lethargy and confusion over the past 24 hours. Her history includes dementia, hypertension, and type 2 diabetes. Nursing staff report poor oral intake for 48 hours and a recent cough. On examination, she is drowsy but rousable. Her vital signs are: BP 85/50 mmHg, HR 110 bpm, RR 22 breaths/min, Temp 37.8°C, SpO2 94% on air. Capillary refill time is 4 seconds. Chest auscultation reveals decreased breath sounds at the bases. Abdomen is soft. Urine dipstick shows leukocytes and nitrites. She is on lisinopril and metformin. What is the most appropriate initial management step?

A 72-year-old male presents with increasing dyspnea. He has a history of GORD. The provided image was taken. What is the most appropriate next step?

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 scan of the abdomen was performed as part of a screening protocol. An axial view is shown. What is the MOST appropriate next step?

A 72-year-old man presents to the clinic with progressive shortness of breath and a chronic cough producing white sputum. He has a 40-pack-year smoking history and worked in construction for most of his life. On examination, he has clubbing of the fingers and crackles at the lung bases. A chest X-ray shows diffuse reticular opacities, particularly at the lung bases. What is the most likely diagnosis?

A 72-year-old woman presents with a long history of heartburn, regurgitation, and recently developed a chronic cough, particularly at night. Physical examination is unremarkable. A chest radiograph is obtained. Considering the radiographic findings in the context of the patient's presentation, what is the most likely pathophysiological mechanism contributing to her chronic cough?

A 70-year-old woman with a history of diabetes presents with fever, cough, and weight loss. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A 72-year-old woman presents with 3 days of worsening right upper quadrant pain, nausea, and vomiting. She has a history of dyspepsia. On examination, she is afebrile (37.2°C), heart rate 95 bpm, blood pressure 130/80 mmHg. Abdominal examination reveals tenderness in the right upper quadrant without guarding or rebound. Bowel sounds are present. Her white cell count is 11 x 10^9/L, CRP 80 mg/L. Liver function tests are normal. The provided imaging was obtained. Considering the clinical presentation and the findings demonstrated in the provided imaging, which of the following complications is this patient at increased risk of developing?

A 75-year-old presents with a 4-month history of increasing dysphagia to solids, occasional regurgitation, and chronic cough, particularly at night. He denies significant weight loss or chest pain. Past medical history includes type 2 diabetes and hypertension. Medications are metformin and perindopril. Physical examination is unremarkable. A chest X-ray is performed as part of the initial assessment. Considering the clinical presentation and the radiographic findings, which of the following investigations is most appropriate at this stage?

An 82-year-old woman from an aged care facility presents with a 2-day history of increased confusion and lethargy. Her baseline is independent living with mild cognitive impairment. She has a chronic cough but no recent change in sputum. Vital signs: T 37.8°C, HR 95 bpm, BP 110/70 mmHg, RR 22 breaths/min, SpO2 92% on room air. Chest examination reveals decreased breath sounds at the right base. Given the clinical presentation and setting, which of the following is the most appropriate initial management step while awaiting the chest X-ray result?

A 68-year-old man presents to the emergency department with a 3-day history of left lower quadrant abdominal pain, associated with mild fever (38.1°C) and constipation. On examination, he has localised tenderness in the left iliac fossa without guarding or rebound. His blood pressure is 130/80 mmHg, heart rate 78 bpm, respiratory rate 16 bpm. Blood tests show a white cell count of 12.5 x 10^9/L (normal range 4-11). A CT scan of the abdomen and pelvis is performed (image provided). Considering the patient's presentation and the findings demonstrated in the image, which of the following represents the most appropriate initial management strategy?

A 78-year-old male on warfarin presents to the ED after a fall. He complains of dyspnea and right-sided chest pain. His INR is 5.0. Vitals: HR 110, BP 100/60, RR 28, SpO2 90% on room air. The provided image was obtained. What is the MOST appropriate next step?

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?

An 82-year-old female presents with a 3-month history of intermittent retrosternal burning pain, worse after meals, and occasional shortness of breath on exertion. Vital signs are stable. Physical exam unremarkable. A chest X-ray is performed. Considering the findings on the image, what is the most appropriate initial management step?

A 78-year-old man with a history of chronic atrial fibrillation and hypertension presents to the emergency department with sudden onset of severe pain, numbness, and coldness in his left leg, starting approximately 3 hours ago. He is currently taking aspirin 100mg daily. On examination, his left foot and lower calf are pale and cool to touch. Pedal pulses are absent, popliteal pulse is weak. Sensation is decreased below the ankle, and motor function is preserved but weak. Capillary refill in the toes is delayed. His heart rate is irregularly irregular at 95 bpm, blood pressure 140/85 mmHg. What is the most appropriate initial management step?

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

A 62-year-old woman presents to the emergency department with confusion and lethargy. Her family reports she has been increasingly forgetful over the past week and has had a decreased appetite. She has a history of type 2 diabetes mellitus and hypertension, for which she takes metformin and lisinopril. On examination, she is disoriented to time and place, with dry mucous membranes and decreased skin turgor. Her blood pressure is 100/60 mmHg, heart rate is 110 bpm, and temperature is 37.2°C. Laboratory tests reveal a serum sodium level of 118 mmol/L, serum osmolality of 260 mOsm/kg, and urine osmolality of 500 mOsm/kg. Which of the following is the most appropriate initial management for this patient?

A 78-year-old female on warfarin for chronic atrial fibrillation presents to the emergency department with a 24-hour history of increasing pain and discolouration in her right lower leg. She reports the pain is severe and worsening rapidly. She denies trauma or recent falls. Her INR this morning was 2.5 (target 2.0-3.0). Vital signs are stable: BP 130/80, HR 75, RR 16, Temp 36.8°C. Examination reveals the findings shown in the image. Considering the patient's history, current medication, and the clinical appearance depicted, the underlying mechanism involves a transient deficiency of which of the following?

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 68-year-old male on warfarin presents post-fall with dyspnea and pleuritic chest pain. INR is 4.8. Vitals: HR 115, BP 95/60, RR 26, SpO2 89% on air. The provided image was obtained. What is the MOST appropriate next step?

A 72-year-old male presents with new onset back pain. His CT is shown. What is the most appropriate initial management?

A 65-year-old patient recently started on warfarin for deep vein thrombosis presents with a painful, expanding skin lesion on their leg. They report the lesion appeared suddenly and has worsened over the past 24 hours. INR is 2.8. Considering the clinical presentation and the appearance of the lesion, what is the most appropriate immediate management step?

A 72-year-old male presents with vomiting and abdominal pain. An abdominal X-ray is performed. What is the MOST likely underlying cause?

An 80-year-old presents with cough, fever, and new confusion. Vital signs: T 38.5°C, HR 110, BP 100/60, RR 28, SpO2 90% on air. Chest X-ray shows consolidation. What is the most appropriate initial management step?

A 72-year-old male presents to the ED with sudden onset shortness of breath and right-sided chest pain. He reports a recent fall but denies any significant trauma. He has a history of atrial fibrillation and is currently taking warfarin. His INR is 6.5. A CT scan of the chest is performed (image attached). What is the MOST appropriate immediate next step in management?

An 80-year-old man with known severe COPD and stable ischaemic heart disease presents to the emergency department with a 2-day history of worsening shortness of breath, increased cough productive of yellow sputum, and ankle swelling. He is usually independent but now struggles to walk across a room. On examination: Alert but distressed. BP 130/85 mmHg, HR 110 bpm, RR 28 breaths/min, Temp 37.8°C, SpO2 88% on room air. Chest examination reveals diffuse wheezes and crackles bilaterally, reduced air entry at the bases. JVP is elevated to 5 cm above the sternal angle. Mild pitting edema to the knees. ECG shows sinus tachycardia, no acute ischaemic changes. Chest X-ray shows hyperinflation, flattened diaphragms, increased bronchial markings, and mild interstitial prominence. Given this presentation, what is the most appropriate initial management step?

A 78-year-old male presents with persistent vomiting and epigastric pain. He reports a history of NSAID use for chronic arthritis. An X-ray is performed. Which of the following is the MOST likely complication associated with this finding?

A 68-year-old woman presented to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Initial investigations showed a WCC of 14,000, total bilirubin 6.0, ALP 450, ALT 300. She was diagnosed with acute cholangitis and underwent urgent ERCP, during which the image was obtained. Following successful endoscopic stone extraction and significant clinical improvement with normalising inflammatory markers and liver function tests, what is the MOST appropriate next step in the long-term management of this patient's condition?

A 78-year-old man presents to the emergency department with acute, severe right groin pain and a palpable, non-reducible mass. He reports associated nausea but denies vomiting or changes in bowel habit. His vital signs are within normal limits, and bowel sounds are audible. A CT scan of the pelvis is performed, the findings of which are depicted in the image. Given the clinical context and the information revealed by the imaging study, what is the most appropriate immediate management strategy?

An 82-year-old woman with a history of paroxysmal atrial fibrillation and a recent hospitalisation for pneumonia was discharged 5 days ago on warfarin 5mg daily. She presents to the emergency department complaining of increasing pain and a rapidly evolving lesion on her right lower leg over the past 48 hours. She denies trauma. Her vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, Temp 36.8°C. Physical examination reveals the appearance shown in the image on her right anterior lower leg. Her INR today is 4.5. She has no known history of protein C or S deficiency. Considering the patient's history, current medication, laboratory result, and the clinical appearance depicted, which of the following represents the most appropriate immediate management strategy?

A 75-year-old female presents to the emergency department with a 24-hour history of worsening colicky abdominal pain, nausea, and multiple episodes of bilious vomiting. She reports no passage of flatus or stool for the past 18 hours. Her past medical history includes an open appendectomy 30 years ago and a hysterectomy 10 years ago. On examination, she is afebrile, heart rate 92 bpm, blood pressure 130/80 mmHg, respiratory rate 18/min, oxygen saturation 98% on room air. Her abdomen is distended and diffusely tender to palpation, with high-pitched tinkling bowel sounds on auscultation. A plain abdominal X-ray series, including the image provided, was obtained. Considering the patient's clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate immediate next step in her management?

A 60-year-old woman presents to the clinic with a 2-month history of progressive shortness of breath and a dry cough. She has a history of rheumatoid arthritis and is currently on methotrexate and low-dose prednisone. On examination, she has fine inspiratory crackles at the lung bases. A high-resolution CT scan of the chest shows reticular opacities and honeycombing predominantly in the lower lobes. What is the most likely diagnosis?

A 70-80 year old lady being treated for pulmonary embolism with a therapeutic dose of subcutaneous Enoxaparin is found to have multiple new pulmonary emboli. What is the most appropriate next step?

A 72-year-old male presents to the ED with increasing shortness of breath and epigastric pain, especially when lying down. He has a history of GORD, hypertension and COPD. His vitals are stable. An X-ray is performed. What is the MOST likely underlying cause of his presentation?

An 80-year-old male with a history of smoking and hypertension presents for investigation of mild, intermittent lower back pain. Physical examination is unremarkable. Vital signs are stable. A CT scan of the abdomen is performed. Based on the provided image and clinical context, what is the most appropriate next step in the management of this patient?

A 78-year-old male presents to the emergency department with a 2-day history of intermittent upper abdominal pain radiating to the chest and mild dysphagia. He denies shortness of breath or fever. Vital signs are stable. A chest X-ray is obtained. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate immediate management plan?

A 72-year-old male on warfarin presents with sudden onset shortness of breath and right-sided chest pain after a fall. His INR is 4.5. The provided image was obtained. What is the MOST appropriate next step in management?

A 68-year-old patient presents with chronic intermittent upper abdominal discomfort, postprandial fullness, and occasional regurgitation. Physical examination is unremarkable. A chest radiograph is performed as part of the workup. Considering the radiographic findings in the context of the patient's presentation, what is the most appropriate next step in management?

A 75-year-old female presents to the emergency department with a 24-hour history of worsening colicky abdominal pain, nausea, and multiple episodes of bilious vomiting. She reports no passage of flatus or stool for the past 18 hours. Her past medical history includes an open appendectomy 30 years ago and a hysterectomy 10 years ago. On examination, she is afebrile, heart rate 92 bpm, blood pressure 130/80 mmHg, respiratory rate 18/min, oxygen saturation 98% on room air. Her abdomen is distended and diffusely tender to palpation, with high-pitched tinkling bowel sounds on auscultation. A plain abdominal X-ray series, including the image provided, was obtained. Considering the patient's clinical presentation and the findings demonstrated in the provided image, which of the following represents the most appropriate immediate next step in her management?

A 72-year-old patient presents with intermittent chest discomfort and increasing shortness of breath, particularly after meals. Vitals are stable. Physical examination is unremarkable. A chest X-ray is performed. Considering the radiographic findings in the context of the patient's symptoms, what is the most appropriate next step in management?

An 82-year-old patient presents to their GP with a 3-month history of intermittent retrosternal chest discomfort, often described as a burning sensation, worse after meals and when lying flat. They also report mild shortness of breath on exertion and occasional regurgitation, but deny significant dysphagia or weight loss. Past medical history includes hypertension and osteoarthritis. Medications are perindopril and paracetamol. On examination, vital signs are stable (BP 130/80, HR 75, RR 16, SpO2 97% on air), and lung sounds are clear. A chest X-ray is performed as part of the workup. Based on the clinical context and the findings demonstrated in the image, what is the most appropriate next step in investigation?

An 80-year-old man presents with new confusion, cough, and fever. He has a history of COPD. On exam, he is tachypnoeic and has crackles at the right base. His oxygen saturation is 88% on room air. What is the most appropriate initial investigation?

A 70-year-old woman presents with a persistent, slowly enlarging skin lesion on her left chest wall, which she first noticed several months ago. She underwent a left simple mastectomy for invasive ductal carcinoma 12 years prior. Physical examination reveals the findings depicted. A recent biopsy of the lesion confirmed the presence of Paget cells. She has no other new symptoms. Her vital signs are stable. Considering the patient's history and the biopsy findings, which of the following investigations is the most appropriate next step in her management?

A 70-year-old man presents for a routine check-up. He reports occasional mild, non-radiating abdominal discomfort over the past few months, which he attributes to indigestion. He has a history of well-controlled hypertension and hyperlipidaemia, and quit smoking 10 years ago. Physical examination is unremarkable, with no palpable abdominal masses. Routine blood tests are within normal limits. An abdominal CT scan is performed to investigate the abdominal discomfort. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A 70-year-old man presents with a vertebral fracture after a minor fall. Reviewing risk factors for osteoporosis, which of the following is the most likely risk factor?

A 68-year-old male presents to the ED with left lower quadrant abdominal pain, fever, and leukocytosis. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the most appropriate next step in management?

A 68-year-old man with a history of diverticulosis presents with recurrent, large volume rectal bleeding. Initial colonoscopy failed to identify or control the source. He remains haemodynamically stable after resuscitation. What is the most appropriate next step in management?

An 82-year-old woman with a history of paroxysmal atrial fibrillation and a recent hospitalisation for pneumonia was discharged 5 days ago on warfarin 5mg daily. She presents to the emergency department complaining of increasing pain and a rapidly evolving lesion on her right lower leg over the past 48 hours. She denies trauma. Her vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, Temp 36.8°C. Physical examination reveals the appearance shown in the image on her right anterior lower leg. Her INR today is 4.5. She has no known history of protein C or S deficiency. Considering the patient's history, current medication, laboratory result, and the clinical appearance depicted, which of the following represents the most appropriate immediate management strategy?

A 72-year-old man presents with 4 weeks of shortness of breath (SOB), shoulder pain, weight loss, cervical lymphadenopathy, and finger clubbing. What is the likely diagnosis?