middle-aged man

A 55-year-old man presents to his general practitioner with a six-month history of bilateral breast tenderness and swelling. He is otherwise asymptomatic, reporting no nipple discharge, skin changes, or palpable lumps. His medical history includes well-controlled hypertension on amlodipine. He denies illicit drug use or significant alcohol intake. On examination, the finding shown in the image is noted. Given this presentation, what is the most appropriate initial diagnostic step?

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 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 55-year-old man presents with 2 days of left lower quadrant pain and mild constipation. He denies fever, nausea, or vomiting. On examination, he is afebrile, BP 120/70, HR 65, O2 sat 99% on air. There is mild LLQ tenderness without guarding or rebound. Bloods show WCC 11.5, CRP 30. 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 58-year-old man presents to the emergency department with chest pain radiating to his left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate immediate 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 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Following successful management of this acute episode, what is the most appropriate next step regarding long-term assessment of the colon?

A 62-year-old male presents to his general practitioner with a six-month history of a painless swelling in his right groin. He reports that the swelling becomes more prominent when he strains or coughs and reduces when he lies down. On examination, a soft, reducible bulge is palpable in the right inguinal region. The bulge is felt to emerge medial to the inferior epigastric vessels. Which of the following is the most appropriate next step in management, according to current Australian guidelines?

A 55-year-old farmer presents with a week of fever, severe headache, and myalgia. He reports recent exposure to lambing ewes on his property. Physical examination is unremarkable except for mild hepatomegaly and normal vital signs. Considering the patient's occupation, exposure history, and clinical presentation, what is the most likely diagnosis?

A 62-year-old man presents to his general practitioner with a 6-month history of a bulge in his groin that appears when he strains or coughs. He reports mild discomfort but no severe pain. On examination, the GP identifies a soft, reducible mass in the right groin area that appears to emerge through the superficial inguinal ring when the patient coughs. The mass reduces spontaneously when the patient lies down. Which of the following is the most appropriate next step in management, according to Australian guidelines?

A 40-year-old man presents with a solitary, asymptomatic nodule on his nose. Biopsy reveals perivascular eosinophilic infiltrate. What is the MOST likely diagnosis?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Based on the clinical presentation and the provided image, what is the most appropriate setting for this patient's 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 62-year-old male presents with LLQ pain and fever. The provided image was obtained. What is the most appropriate initial management?

A 35-year-old man presents with 3 weeks of anal pain after defecation, blood on wiping, and constipation (firm stool every 2-3 days). What is the likely diagnosis?

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, what is the most appropriate immediate next step in management?

A 58-year-old male presents to the emergency department complaining of right groin pain that started approximately 6 hours ago. He reports noticing a bulge in his groin for several months, which he could usually push back in. However, today he is unable to reduce it, and the pain has become progressively severe. He denies any fever, nausea, or vomiting. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medications. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 80 bpm, respiratory rate 16 bpm, and temperature 37.0°C. Abdominal examination is benign. Examination of the groin reveals the finding shown in the image. The area is tender to palpation. Which of the following is the MOST appropriate next step in the management of this patient?

A 58-year-old male presents with concerns about breast enlargement over the past year. He denies pain or nipple discharge. He takes no medications and has no known medical conditions. Examination reveals the findings in the image. What is the MOST appropriate initial investigation?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Considering the clinical presentation and the findings on the provided image, which of the following investigations is most appropriate to recommend for this patient *after* resolution of the acute episode?

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 62-year-old male with LLQ pain and mild fever has the CT abdomen shown. What is the MOST appropriate next step in management?

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 58-year-old man presents with concerns about breast enlargement. Examination reveals the findings in the image. Which of the following is the MOST appropriate initial investigation?

A 62-year-old man presents with bilateral breast enlargement, as shown. He denies pain or nipple discharge. What is the MOST likely underlying cause?

A 32-year-old male with Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. He denies fever or blood in his stool. An abdominal CT and MRI are performed. Based on the imaging, what 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 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Based on the clinical presentation and the provided image, what is the most appropriate initial management plan?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Considering the clinical context and the findings demonstrated in the provided image, what is the most appropriate recommendation regarding subsequent investigation of the colon following resolution of the acute symptoms?

A 55-year-old man with a history of hypertension and smoking presents for a routine check-up. He is concerned about his risk of cardiovascular disease and asks for advice on lifestyle modifications. Which of the following lifestyle changes would most significantly reduce his risk of cardiovascular events?

A 55-year-old male with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 150/95 mmHg despite lifestyle modifications. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A 58-year-old male with a 15-year history of chronic hepatitis B infection and established cirrhosis presents for a routine surveillance appointment. He reports feeling generally well, with no significant weight loss, abdominal pain, or jaundice. He denies alcohol use. On examination, his vital signs are stable. He has mild palmar erythema but no ascites or peripheral oedema. Liver span is normal. Recent blood tests show platelet count 120 x 10^9/L, albumin 35 g/L, INR 1.2, total bilirubin 20 µmol/L, ALT 40 U/L, AST 55 U/L, creatinine 80 µmol/L. Alpha-fetoprotein (AFP) has risen from 50 µg/L six months ago to 450 µg/L today. A triphasic CT scan of the abdomen was performed as part of the surveillance protocol, axial views of which are provided. Considering the patient's clinical history, laboratory trends, and the findings demonstrated on the provided imaging, which of the following represents the MOST appropriate immediate next step in the management of this patient?

A 55-year-old man with a 15-year history of type 2 diabetes presents with numbness and tingling in his feet. On examination, there is reduced sensation to light touch and vibration in a stocking distribution. What is the most appropriate initial management for his symptoms?

A 35-year-old man presents to the emergency department with severe right-sided flank pain that started suddenly and radiates to the groin. He describes the pain as sharp and colicky. He has had similar episodes in the past but never this severe. He denies fever, dysuria, or hematuria. On examination, he is in obvious distress, with a blood pressure of 140/90 mmHg, heart rate of 110 bpm, and respiratory rate of 22 breaths per minute. Abdominal examination reveals tenderness in the right flank but no guarding or rebound tenderness. Urinalysis shows microscopic hematuria. Which of the following is the most appropriate initial imaging study to confirm the diagnosis?

A 45-year-old male presents with a painless lesion on his nose that has been present for 6 months. He denies any trauma or previous skin conditions. Examination reveals the lesion seen in the image. What is the MOST appropriate next step in management?

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?

A 55-year-old male presents with LLQ pain, fever, and increased WBC. A CT scan is performed, as shown. He is hemodynamically stable. What is the MOST appropriate initial management?

A 60-year-old man, post-chemotherapy, presents with fever and abdominal pain. The images are shown. What is the MOST appropriate initial therapy?

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but no vomiting. Vitals are stable. A focused assessment with sonography for trauma (FAST) exam is performed, with a view obtained as shown. What is the MOST appropriate next step in management?

A 45-year-old male presents to the emergency department with severe chest pain radiating to his left arm, shortness of breath, and diaphoresis. He has a history of hypertension and hyperlipidemia. On examination, he is diaphoretic, and his blood pressure is 90/60 mmHg. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management for this patient?

A 32-year-old male with a 10-year history of Crohn's disease presents with worsening abdominal pain and increased frequency of bowel movements. He reports no fever or weight loss. Physical examination reveals mild tenderness in the right lower quadrant. His inflammatory markers are elevated. Review the provided imaging. What is the MOST appropriate next step in management?

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Considering the patient's presentation and the findings demonstrated in the provided image, the most likely primary mechanism responsible for the severe pain experienced by this patient is:

A 55-year-old man presents to the emergency department with sudden onset severe abdominal pain radiating to the back. He has a history of hypertension and is a smoker. On examination, he is diaphoretic and in distress, with a blood pressure of 90/60 mmHg and a heart rate of 110 bpm. Abdominal examination reveals a pulsatile mass in the midline. What is the most likely diagnosis?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed, the results of which are 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 62-year-old male with a history of poorly controlled diabetes presents with fever, RUQ pain, and recent travel to a rural area. Lab results show elevated ALP and GGT. Imaging is performed. What is the MOST appropriate next step in management?

A 50-year-old man presents to the general practice with a 3-month history of persistent heartburn and regurgitation, especially after meals. He has tried over-the-counter antacids with minimal relief. He denies any weight loss, dysphagia, or gastrointestinal bleeding. What is the most appropriate next step in the management of this patient?

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. A CT scan of the abdomen is performed. Based on the image, 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?

A 58-year-old man presents with concerns about breast enlargement over the past year. He denies pain or tenderness. He takes medication for hypertension. Examination reveals the findings in the image. Which of the following is the MOST appropriate initial investigation?

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?