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 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 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 32-year-old woman, currently 28 weeks pregnant, presents to the antenatal clinic for a routine check-up. She has a history of gestational diabetes mellitus (GDM) diagnosed at 24 weeks of gestation. Her current treatment includes dietary modifications and regular blood glucose monitoring. Her recent fasting blood glucose levels have been consistently between 5.5 and 6.0 mmol/L, and her postprandial levels are between 7.5 and 8.0 mmol/L. She reports feeling well and has no symptoms of hypoglycemia. Her obstetric history includes one previous pregnancy complicated by GDM, which was managed with insulin. Her current pregnancy is otherwise uncomplicated. What is the most appropriate next step in the management of her gestational diabetes?

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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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 45-year-old woman presents to her general practitioner with a 6-month history of intermittent diarrhea, abdominal pain, and weight loss. She reports that her symptoms are exacerbated by stress and certain foods, particularly those containing gluten. She has a family history of autoimmune thyroid disease. On examination, she appears pale and has a slightly distended abdomen with mild tenderness in the lower quadrants. Laboratory tests reveal microcytic anemia and elevated tissue transglutaminase antibodies. Which of the following is the most appropriate next step in the management of this patient?

Mrs. Eleanor Vance, a 62-year-old retired teacher, presents for her routine biennial screening mammogram through the BreastScreen Australia program. She has no personal history of breast disease, and her family history is negative for breast or ovarian cancer in first-degree relatives. She is otherwise healthy, with a history of diet-controlled type 2 diabetes and osteoarthritis managed with paracetamol. She denies any breast pain, lumps, nipple discharge, or skin changes. Her last mammogram two years ago was reported as normal (BIRADS 1). Physical examination of both breasts and axillae is unremarkable. The current screening mammogram is performed. The image provided is a magnified view from the craniocaudal projection of the left breast, specifically highlighting an area that has been flagged for further assessment by the reporting radiologist due to a change from the previous study. Based on the appearance of the abnormality demonstrated in the provided image, which is the most appropriate method for obtaining a tissue 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, 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 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 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 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?

A 64-year-old woman presents for a routine health check. She reports intermittent episodes of colicky abdominal pain over the past year, but denies any current pain, jaundice, or fever. An abdominal ultrasound is performed, the image is shown. What is the MOST appropriate next step in management?

A 62-year-old woman presents with right upper quadrant pain, fever, and jaundice. Initial labs show elevated bilirubin and alkaline phosphatase. An ERCP is performed, and the image is obtained. What is the MOST appropriate next step in 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?