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 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 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 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 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 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 with a suspicious breast mass on mammography undergoes a biopsy, which confirms invasive ductal carcinoma. She is referred to an oncologist for further management. What is the next step in her management?

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 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 to the emergency department with a 2-day history of right upper quadrant abdominal pain, nausea, and vomiting. She reports that the pain started gradually but has become increasingly severe and constant. She denies any fever or chills. Her past medical history is significant for hypertension and hyperlipidemia, both well-controlled with medications. On physical examination, she is afebrile, with a heart rate of 92 bpm, blood pressure of 140/85 mmHg, and an oxygen saturation of 98% on room air. Abdominal examination reveals marked tenderness to palpation in the right upper quadrant with guarding. Murphy's sign is positive. The provided image was obtained. Which of the following is the MOST appropriate next step in the management of this patient?

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 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 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 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 55-year-old female presents to the emergency department with a 24-hour history of severe right upper quadrant pain radiating to the back, associated with nausea, vomiting, and subjective fever. On examination, she is tachycardic (HR 105 bpm) and febrile (38.5°C), with marked tenderness and guarding in the right upper quadrant. 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 obtained. Considering the patient's clinical status and the findings on the provided imaging, which of the following represents the most appropriate definitive management strategy?

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 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 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 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. Based on the clinical context and the imaging findings presented, which of the following represents the definitive management strategy for 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 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 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?

A 32-year-old woman presents to the clinic with a 6-month history of irregular menstrual cycles and excessive facial hair growth. She has gained 5 kg over the past year and reports difficulty losing weight despite regular exercise. On examination, she has acne and hirsutism. Her BMI is 28 kg/m². Blood tests reveal elevated testosterone levels and normal TSH and prolactin levels. What is the most likely diagnosis?

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?

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 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 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 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 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 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 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 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 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 58-year-old woman presents with a 7-year history of chronic cough productive of copious, often purulent, sputum, particularly noticeable in the mornings. She reports requiring 4-5 courses of antibiotics annually for exacerbations of her 'chronic bronchitis'. She is a non-smoker and has no significant past medical history other than childhood measles complicated by pneumonia. On examination, she has scattered coarse crackles bilaterally at the lung bases. Her oxygen saturation is 96% on room air. Spirometry performed 3 months ago showed FEV1 78% predicted, FVC 85% predicted, FEV1/FVC 0.75. A recent chest X-ray was reported as showing 'mild peribronchial thickening'. Given the clinical suspicion, what is the single most appropriate next investigation to establish the diagnosis?