middle-aged woman

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 48-year-old woman presents with acute onset severe left flank pain radiating to the groin, associated with nausea. She denies fever or dysuria. Vitals are stable. Urinalysis shows haematuria. Serum creatinine is 75 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 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. Considering the clinical presentation and imaging findings, what is the recommended timing for definitive surgical management?

A 45-year-old woman presents to the emergency department with a 3-day history of progressive shortness of breath, dry cough, and fatigue. She has a history of systemic lupus erythematosus (SLE) and is currently on hydroxychloroquine and low-dose prednisone. She denies fever, chest pain, or recent travel. On examination, her temperature is 37.2°C, blood pressure is 110/70 mmHg, heart rate is 95 bpm, respiratory rate is 22 breaths per minute, and oxygen saturation is 89% on room air. Lung auscultation reveals bilateral basal crackles. Laboratory tests show a hemoglobin level of 10.5 g/dL, white blood cell count of 4,000/mm³, and platelets of 150,000/mm³. Arterial blood gas analysis reveals a pH of 7.45, PaCO2 of 35 mmHg, and PaO2 of 55 mmHg. A chest X-ray shows bilateral interstitial infiltrates. Which of the following is the most appropriate next step in management?

A 57-year-old lady with a chronic cough, a 35 pack-year smoking history, and breathlessness with daily tasks has had spirometry done. What is the likely interpretation of the spirometry results?

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

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 55-year-old woman with no palpable breast lumps presents for a routine screening mammogram. The image is shown. What is the MOST appropriate next step?

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 55-year-old woman presents to her GP with a 3-month history of fatigue, pallor, and shortness of breath on exertion. She has a history of menorrhagia. On examination, she appears pale and has conjunctival pallor. Blood tests reveal a hemoglobin level of 8 g/dL, mean corpuscular volume (MCV) of 70 fL, and low serum ferritin. What is the most appropriate next step in management?

A 38-year-old woman presents with acute onset left flank pain, radiating to the groin. She reports dysuria and hematuria. Vitals: HR 88, BP 130/80, Temp 37.1°C. A bedside ultrasound is performed, as shown. 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 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 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 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 60-year-old female with a history of a posterior cerebral artery aneurysm presents for routine follow-up. Review the image. What is the MOST appropriate management?

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 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 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 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 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 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). Renal function is normal. She denies any family history of endocrine disorders. Imaging studies are performed, as shown. What is the MOST appropriate next step in managing 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 64-year-old woman with past colicky pain had this ultrasound. LFTs are normal. What is the MOST appropriate next step?

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 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 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 55-year-old woman presents to her general practitioner with a 3-month history of increasing abdominal bloating, early satiety, and a vague, intermittent dull ache in her lower abdomen. She reports a 5 kg weight loss over the same period, which she attributes to reduced appetite. Her last menstrual period was 5 years ago. She has a past medical history of well-controlled hypertension and osteoarthritis. She is on perindopril and paracetamol as needed. On physical examination, her vital signs are stable (BP 130/80 mmHg, HR 72 bpm, RR 16/min, Temp 36.8°C). Abdominal examination reveals mild distension and a firm, non-tender mass palpable in the suprapubic and left iliac fossa regions, estimated to be about 8 cm in size. Bowel sounds are normal. Pelvic examination is deferred due to patient discomfort and preference for imaging first. Routine blood tests, including full blood examination, urea and electrolytes, liver function tests, and C-reactive protein, are all within normal reference ranges. A CT scan of the abdomen and pelvis is performed to investigate her symptoms, an axial image from which is shown. Considering the clinical presentation and the findings on the image, what is the most appropriate immediate next step in the management of this patient?

A 32-year-old woman presents to her general practitioner complaining of a persistent, intensely itchy rash that started a few weeks ago. She reports that it began on her wrists and ankles and has now spread to her elbows and knees. She denies any new medications, travel, or changes in personal care products. On examination, you observe symmetrical, intensely pruritic, violaceous, flat-topped papules and plaques on her wrists, ankles, and shins. Some of the lesions show fine, white lines on the surface. There are also a few small, similar lesions on her buccal mucosa. Which of the following is the most appropriate initial management?

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?