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 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 to the ED with right upper quadrant pain, fever, and nausea for 2 days. Her vital signs are: BP 130/80 mmHg, HR 105 bpm, Temp 38.5°C, RR 18 bpm, SpO2 98% on room air. An abdominal CT scan with contrast is performed, and a slice is shown. What is the MOST appropriate next step in management?

A 45-year-old woman presents to her general practitioner with a 3-month history of progressive fatigue, weight gain, and cold intolerance. She also reports constipation and dry skin. On examination, her blood pressure is 110/70 mmHg, heart rate is 60 bpm, and she has a delayed relaxation phase of her deep tendon reflexes. Laboratory tests reveal a low free T4 level and an elevated TSH level. Which of the following is the most appropriate initial 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 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 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 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 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Review of her prior mammograms shows stable, scattered fibroglandular densities. The current mammogram is shown. What is the MOST appropriate next step in management?

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. Based on the clinical presentation and imaging findings, what is the most appropriate next step in management?

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 32-year-old woman presents to her GP with a 3-month history of fatigue, joint pain, and a facial rash that worsens with sun exposure. She also reports hair loss and oral ulcers. On examination, she has a malar rash and mild swelling of the small joints of her hands. Laboratory tests reveal a positive ANA and anti-dsDNA antibodies. What is the most likely diagnosis?

A 58-year-old woman presents for her scheduled screening mammogram. She reports no breast lumps, pain, or nipple discharge. Her past medical history includes well-controlled hypertension and osteoarthritis. She has no known family history of breast or ovarian cancer. Physical examination reveals no palpable abnormalities in either breast or axillae. The mammogram is performed, and the image provided is a detail from the craniocaudal view of the left breast. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate immediate next step in the management of this patient?

A 58-year-old woman presents for her scheduled screening mammogram. She denies any breast lumps, pain, or nipple discharge. She has no family history of breast cancer. Her physical examination is unremarkable. The image provided is a detail from her left craniocaudal view. Considering this finding, what is the most appropriate immediate next step in her clinical management?

A 58-year-old woman with cholangitis undergoes ERCP. The image is obtained. What intervention is MOST appropriate at this time?

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 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 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 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 42-year-old woman presents with a new, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

A 52-year-old woman presents to her GP with a palpable lump in her right breast. She reports no pain, nipple discharge, or skin changes. She has no family history of breast cancer. On examination, the lump is firm, non-tender, and mobile. There is no axillary lymphadenopathy. What is the most appropriate initial investigation?

A 55-year-old woman undergoes routine screening mammography. She is asymptomatic with no personal or family history of breast cancer. Physical examination is unremarkable. The provided image is a magnified view from the craniocaudal projection of the right breast. Based on the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A 62-year-old woman presents for her routine mammogram. She has no personal or family history of breast cancer. She denies any breast pain, nipple discharge, or palpable lumps. Clinical breast exam is unremarkable. Her previous mammograms have been negative. The current mammogram reveals findings as shown in the image. 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 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 45-year-old woman presents to her GP with a 6-month history of irregular menstrual cycles and hot flashes. She also reports mood swings and difficulty sleeping. Her last menstrual period was 3 months ago. What is the most likely diagnosis?

A 38-year-old woman presents with sudden onset, severe left flank pain radiating to her groin. She reports associated nausea but denies fever or dysuria. On examination, she is afebrile, blood pressure 125/75 mmHg, heart rate 80 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most likely underlying mechanism causing the patient's pain?

A 52-year-old female presents with right upper quadrant pain, fever, and leukocytosis. The image shows the likely cause. What is the MOST appropriate initial management?

A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On examination, she has dry skin and a delayed relaxation phase of deep tendon reflexes. Her TSH level is elevated, and free T4 is low. What is the most appropriate treatment for her condition?

A 62-year-old woman with a 15-year history of type 2 diabetes mellitus presents to her general practitioner with complaints of worsening vision over the past six months. She also reports intermittent tingling and numbness in her feet, which has been progressively worsening. Her diabetes has been poorly controlled, with recent HbA1c levels consistently above 9%. She has a history of hypertension and hyperlipidemia, both of which are managed with medication. On examination, her blood pressure is 140/85 mmHg, and her BMI is 32 kg/m². Fundoscopic examination reveals microaneurysms and cotton wool spots. Urinalysis shows microalbuminuria. Which of the following interventions is most likely to address the underlying pathophysiological mechanism of her visual symptoms?

A 16-year-old boy is diagnosed with Type 1 diabetes mellitus after presenting with polyuria, polydipsia, and weight loss. His blood tests show elevated blood glucose levels and the presence of autoantibodies against pancreatic beta cells. In contrast, a 55-year-old woman is diagnosed with Type 2 diabetes mellitus, characterized by insulin resistance and obesity. Which of the following best describes the pathophysiological differences between Type 1 and Type 2 diabetes?

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 32-year-old woman presents to her general practitioner with a 6-month history of worsening dysmenorrhea and pelvic pain, particularly on the left side. She reports no fever, weight loss, or abnormal vaginal bleeding. Her last menstrual period was 2 weeks ago and was normal. Physical examination reveals mild left adnexal tenderness. A CT scan of the pelvis was performed, the relevant image is shown. Given the clinical context and the 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 55-year-old woman attends for her routine screening mammogram. She has no breast symptoms and no family history of breast cancer. Her physical examination is unremarkable. The mammogram is performed, and a finding is noted in the upper outer quadrant of the left breast, as shown in the image. Based on the appearance of the finding demonstrated in the image, what is the most appropriate next step in her 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 current mammogram reveals new findings compared to her prior images from the last 5 years. The image is shown. What is the MOST appropriate next step?

A 35-year-old female presents with chronic pelvic pain. The provided CT was performed. What is the MOST appropriate 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 32-year-old woman presents to the clinic with a 3-week history of joint pain, morning stiffness lasting over an hour, and swelling in her hands and wrists. She has no significant past medical history and is not on any medications. On examination, there is synovitis in the metacarpophalangeal and proximal interphalangeal joints bilaterally. What is the most likely diagnosis?

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 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 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 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 GP with recurrent episodes of biliary colic. An ultrasound confirms the presence of multiple gallstones. She is otherwise healthy with no significant past medical history. After discussing management options, she opts for a laparoscopic cholecystectomy. Which of the following is the MOST appropriate next step in her preoperative assessment, according to Australian guidelines?

A 55-year-old lady presents with a painless, white, lacy pattern on her buccal mucosa that has been present for several weeks. She feels well and has no significant medical history. What is the likely diagnosis?