middle-aged woman

A 48-year-old woman presents to her GP with a 3-month history of increasing fatigue, exertional dyspnoea, and a persistent cough productive of small amounts of mucus. She mentions a history of recurrent 'sinus infections' over the past year, often treated with antibiotics. She has recently felt lightheaded on standing. On examination, her blood pressure is 95/60 mmHg, pulse 88 bpm, respiratory rate 20 breaths/min, and oxygen saturation 96% on room air. Chest auscultation reveals diffuse expiratory wheezes. Blood tests performed last week show haemoglobin 85 g/L (reference range 120-150), MCV 72 fL (reference range 80-100), and normal white cell count and platelet count. Spirometry performed concurrently shows an FEV1/FVC ratio of 0.65 (predicted >0.70) with partial reversibility after bronchodilator. Considering the clinical presentation and investigations, what is the most appropriate next step in management?

A 52-year-old woman with a 10-year history of type 2 diabetes mellitus presents to your clinic for a routine follow-up. She has been experiencing difficulty in controlling her blood glucose levels despite being on metformin and glipizide. Her HbA1c is 8.5%. She has a BMI of 32 kg/m² and a sedentary lifestyle. She reports consuming a diet high in processed foods and sugary beverages. Her blood pressure is 140/85 mmHg, and her lipid profile shows elevated LDL cholesterol. Which of the following dietary and lifestyle modifications is most likely to improve her glycemic control and overall cardiovascular risk profile?

A 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to her back, associated with nausea, vomiting, and subjective fever. On examination, she is febrile (38.5°C) and has marked tenderness and guarding in the right upper quadrant. Her vital signs are otherwise stable. Blood tests reveal a white cell count of 15 x 10^9/L and C-reactive protein of 120 mg/L. Liver function tests, including bilirubin, are within normal limits. She is initiated on intravenous fluids and broad-spectrum antibiotics. Imaging is subsequently performed. Considering the patient's clinical presentation and the findings demonstrated in the provided imaging, what is the most appropriate definitive management strategy?

A 58-year-old woman presents with fatigue, muscle weakness, and abdominal pain. Labs show serum calcium 3.2 mmol/L and PTH 190 pg/mL. Renal function is normal. Imaging studies are shown. Based on the clinical presentation, laboratory findings, and imaging studies, what is the MOST appropriate next step in managing this patient?

A 45-year-old woman presents with a 3-month history of increasing abdominal bloating and occasional pelvic discomfort. She reports normal menstrual cycles and no weight loss or changes in bowel habits. Physical examination is unremarkable except for mild abdominal distension. Routine blood tests, including CA-125, are within normal limits. A CT scan of the pelvis is performed, with a relevant axial image shown. Considering the clinical presentation, the normal CA-125 level, and the findings demonstrated in the image, what is the MOST appropriate next step in the management of this patient?

A 55-year-old woman presents with 2 days of worsening right upper quadrant pain radiating to her back, nausea, and subjective fever. On examination, she is tender in the RUQ. Vitals are stable. Labs show WCC 15.0, CRP 120. This image is obtained. Considering the clinical presentation and imaging findings, what is the recommended timing for definitive surgical management?

A 45-year-old woman presents with a 3-month history of an intensely itchy rash on her wrists and ankles. On examination, you note violaceous, flat-topped papules. What is the most likely diagnosis?

A 58-year-old woman, otherwise healthy with no significant medical history, undergoes a routine screening mammogram. The report notes a new cluster of pleomorphic microcalcifications in the upper outer quadrant of her left breast, measuring approximately 1.5 cm, classified as BI-RADS 4. Clinical examination reveals no palpable mass or skin changes. She has no family history of breast cancer. What is the most appropriate next step in the management of this finding?

A 45-year-old woman presents to her general practitioner with a 3-month history of epigastric pain that is worse at night and occasionally wakes her from sleep. She describes the pain as a burning sensation that improves with food intake but returns a few hours later. She denies any weight loss, vomiting, or changes in bowel habits. She has a history of intermittent use of ibuprofen for chronic back pain. On examination, she appears well-nourished, with normal vital signs and mild epigastric tenderness on palpation. A urea breath test is positive. What is the most appropriate initial management for this patient?

A 45-year-old woman presents to the clinic with a 6-month history of fatigue, weight gain, and feeling cold all the time. She also reports hair loss and constipation. On examination, her skin is dry, and her reflexes are delayed. Her blood pressure is 110/70 mmHg, and her heart rate is 60 bpm. Laboratory tests reveal a low free T4 and elevated TSH. What is the most likely diagnosis?

A 55-year-old woman presents for her routine biennial screening mammogram. She denies any breast lumps, pain, or nipple discharge. Her past medical history is notable only for well-controlled hypothyroidism. There is no family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities. The provided image is a magnified view from the craniocaudal projection of the left breast. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

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 55-year-old woman presents with 2 days of worsening right upper quadrant pain radiating to her back, nausea, and subjective fever. On examination, she is tender in the RUQ. Vitals are stable. Labs show WCC 15.0, CRP 120. This image is obtained. Given the clinical context and imaging findings, what is the most appropriate definitive management strategy?

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 62-year-old woman presents for routine screening mammography. She has no palpable lumps or skin changes. Her mother was diagnosed with breast cancer at age 68. The provided image is from her mammogram. 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 37-year-old lady presents with a sudden right-sided facial droop, with no ear symptoms or dysphagia. She is 16 weeks pregnant. What is the likely diagnosis?

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 45-year-old woman presents to the emergency department with severe right upper quadrant abdominal pain that started suddenly 3 hours ago. She describes the pain as sharp and radiating to her right shoulder. She has a history of gallstones but has never had surgery. On examination, she is febrile with a temperature of 38.5°C, her blood pressure is 110/70 mmHg, and her heart rate is 100 bpm. She has tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory tests reveal leukocytosis and mildly elevated liver enzymes. An abdominal ultrasound shows gallstones and a thickened gallbladder wall with pericholecystic fluid. What is the most appropriate next step in the management of this patient?

A 45-year-old woman has a mother diagnosed with colorectal cancer at age 55 and a maternal aunt with endometrial cancer at age 60. What is the most appropriate initial step regarding genetic testing for hereditary cancer syndrome?

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 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 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 58-year-old woman presents with persistent fatigue, muscle weakness, and vague abdominal pain. Investigations reveal serum calcium 3.2 mmol/L (2.1-2.6), PTH 190 pg/mL (10-65). Renal function is normal. She denies family history of endocrine disorders. Imaging studies are performed, as shown. Considering the clinical presentation and the findings from the imaging modalities, what is the definitive management strategy for this patient?

A 58-year-old woman with poorly controlled diabetes presents with severe RUQ pain, fever, and vomiting for 3 days. The provided CT was performed. What is the MOST appropriate initial management strategy?

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 62-year-old woman with osteoporosis and a history of kidney stones presents for evaluation. Her calcium is 2.9 mmol/L (2.1-2.6 mmol/L), PTH 110 pg/mL (10-65 pg/mL), and creatinine is normal. She denies neck pain or swelling. Given the imaging, what is the MOST appropriate next step?

A 64-year-old woman presents with a history of intermittent RUQ pain. She denies jaundice or fever. An abdominal ultrasound was performed, as shown. What is the MOST appropriate next step in management?

A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 105 bpm, BP 130/80 mmHg, Temp 38.5°C. Physical exam reveals marked tenderness on palpation of the right upper quadrant. An abdominal CT scan is performed, as shown. What is the MOST appropriate next step in management?

A 55-year-old woman presents with 24 hours of severe right upper quadrant pain, fever, and nausea. Examination reveals RUQ tenderness and a positive Murphy's sign. Vitals: T 38.5°C, HR 105, BP 130/80, RR 18, SpO2 98% RA. Labs: WCC 16, CRP 120, LFTs normal. An urgent abdominal CT is performed. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate definitive management strategy for this patient?

A 45-year-old woman presents to her general practitioner with a 3-month history of persistent cough and occasional wheezing. She has a history of asthma, which has been well-controlled with inhaled corticosteroids. She denies any recent respiratory infections or changes in her medication. On examination, her vital signs are normal, and there are scattered wheezes on auscultation. Spirometry shows a reduced FEV1/FVC ratio that improves significantly after bronchodilator administration. What is the most appropriate next step in the management of this patient?

A 45-year-old woman presents to the ED with right upper quadrant pain, fever, and nausea for 24 hours. Her vital signs are: HR 110, BP 130/80, Temp 38.5°C. An abdominal CT scan is performed (image attached). What is the MOST appropriate next step in management?

A 62-year-old woman presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. She describes the headache as the worst she has ever experienced. Her medical history includes hypertension and hyperlipidemia, for which she is on regular medication. On examination, she is alert but in distress, with a blood pressure of 180/100 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. Which of the following is the most appropriate next step in management?

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 58-year-old woman presents with persistent fatigue, muscle weakness, and vague abdominal pain. Her serum calcium is 3.2 mmol/L (2.1-2.6 mmol/L), and PTH is 190 pg/mL (10-65 pg/mL). She denies any history of fractures or kidney stones. She was referred for imaging, as shown. What is the MOST appropriate next step in managing this patient?

A 45-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. She has no family history of breast cancer. On examination, the lump is firm, mobile, and approximately 2 cm. What is the most appropriate initial investigation?

A 50-year-old woman with a breast lump undergoes a mammogram, which shows microcalcifications. A core biopsy confirms ductal carcinoma in situ (DCIS). What is the most appropriate next step?

A 45-year-old woman presents to her general practitioner with a 3-month history of fatigue, weight gain, and feeling cold all the time. She also reports constipation and dry skin. On examination, her heart rate is 55 bpm, and she has a delayed relaxation phase of her deep tendon reflexes. What is the most likely diagnosis?

A 60-year-old woman presents to her GP with a 3-month history of increasing fatigue and joint pain, particularly in her hands and knees. She also reports morning stiffness lasting over an hour. On examination, there is swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints. Blood tests reveal a positive rheumatoid factor and elevated C-reactive protein. What is the most appropriate initial treatment for her condition?

A 52-year-old woman presents to her general practitioner with concerns about irregular menstrual bleeding over the past six months. She has a history of obesity, with a BMI of 32 kg/m², and was recently diagnosed with type 2 diabetes mellitus. She reports that her periods have been irregular for the past few years, often skipping months. She is not currently on any hormone replacement therapy. On examination, she has no signs of hirsutism or virilization. Her blood pressure is 140/85 mmHg, and her fasting blood glucose level is 8.5 mmol/L. Which of the following groups of women is most at risk for developing endometrial hyperplasia?

A 50-year-old woman presents with increasing abdominal swelling and early satiety. Examination reveals ascites. Which investigation is most crucial to guide initial management?

A 62-year-old woman with a 15-year history of type 2 diabetes mellitus presents to the emergency department with confusion, polyuria, and polydipsia over the past three days. She has been non-compliant with her medications and diet. On examination, she is lethargic and dehydrated, with a blood pressure of 100/60 mmHg, heart rate of 110 bpm, and respiratory rate of 20 breaths per minute. Laboratory tests reveal a blood glucose level of 38 mmol/L, serum sodium of 150 mmol/L, serum potassium of 4.0 mmol/L, serum bicarbonate of 22 mmol/L, and a serum osmolality of 340 mOsm/kg. Urinalysis shows no ketones. Which of the following is the most appropriate initial management 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, 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 50-year-old woman presents to her GP with a 3-month history of fatigue, weight gain, and feeling cold all the time. She also reports constipation and dry skin. On examination, she has a slow heart rate and delayed relaxation of deep tendon reflexes. Her thyroid function tests show elevated TSH and low free T4 levels. What is the most appropriate treatment for her condition?

A 45-year-old woman presents to the emergency department with a 3-day history of fever, productive cough with greenish sputum, and pleuritic chest pain. She has a history of asthma and is currently on salbutamol and fluticasone inhalers. On examination, her temperature is 38.5°C, respiratory rate is 24 breaths per minute, and oxygen saturation is 92% on room air. Auscultation reveals decreased breath sounds and crackles in the right lower lung field. A chest X-ray shows a right lower lobe consolidation. What is the most appropriate initial antibiotic therapy for this patient, considering Australian guidelines?

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

A 35yo woman's mother died of ovarian cancer at 45, and her paternal aunt had breast cancer at 50. She is concerned about her risk. What is the most appropriate initial step regarding genetic testing?

A 32-year-old woman presents with pelvic pain and bloating. Her periods are regular. An abdominal CT scan is performed. Based on the image, what is the MOST appropriate next step in management?

A 31-year-old woman presents with pelvic pain and bloating for 3 months. Her periods are regular. Pelvic exam reveals mild adnexal tenderness. A CT scan is performed, with a relevant image shown. What is the MOST appropriate next step?

A 45-year-old woman presents to her general practitioner with a 3-month history of epigastric pain that is worse at night and occasionally wakes her from sleep. She describes the pain as a burning sensation that improves with food intake but worsens a few hours after eating. She denies any weight loss, vomiting, or changes in bowel habits. She has a history of intermittent use of ibuprofen for chronic back pain. On examination, she appears well-nourished, with normal vital signs and mild epigastric tenderness on palpation. A urea breath test is positive. What is the most appropriate initial management for this patient?