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weight loss

Practice targeted AMC-style multiple-choice questions on weight loss.

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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 55-year-old man with a history of renal transplant on long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed as shown. Based on the findings and clinical context, what is the most appropriate next diagnostic step?

A. Repeat CT scan with intravenous contrast
B. Liver biopsy of the lesion
C. Percutaneous drainage and culture of the lesion
D. Serological testing for Echinococcus species
E. Empirical broad-spectrum antibiotic therapy
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue and weight loss. The provided image was obtained. Which of the following is the MOST appropriate next step in management?

A. Initiate palliative care consultation
B. Percutaneous ethanol ablation of selected lesions
C. Referral to medical oncology for systemic therapy
D. Surgical resection of the largest lesion
E. Repeat imaging in 3 months to assess progression
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 45-year-old male presents with a 3-month history of cough and unintentional weight loss. He is a former smoker. Physical examination is unremarkable. A chest X-ray showed a nodule, and a PET-CT was performed for further characterisation, an axial view is shown. Considering the imaging findings and clinical presentation, what is the MOST appropriate next diagnostic step?

A. Initiate empirical anti-tuberculous therapy
B. Repeat sputum studies for acid-fast bacilli
C. Thoracic surgical referral for wedge resection
D. CT-guided percutaneous biopsy
E. Follow-up PET-CT in 3 months
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A 62-year-old man presents with a 4-month history of increasing fatigue, unintentional weight loss of 7 kg, and intermittent upper abdominal discomfort. He reports no change in bowel habits, dysphagia, or vomiting. His past medical history includes hypertension and osteoarthritis. He is a non-smoker and drinks alcohol occasionally. On examination, he is pale. His vital signs are stable. Abdominal examination reveals mild epigastric tenderness but no masses or organomegaly. There is no peripheral lymphadenopathy. Initial blood tests show haemoglobin 92 g/L (reference range 130-170), MCV 74 fL (80-95), ferritin 12 mcg/L (30-300), and CRP 18 mg/L (<5). Liver function tests and renal function tests are within normal limits. Which of the following is the most appropriate initial investigation?

A. Abdominal and pelvic CT scan
B. Faecal occult blood testing
C. Gastroscopy and colonoscopy
D. Upper gastrointestinal barium study
E. Bone marrow biopsy
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A 45-year-old man presents with chronic cough, weight loss, and night sweats. Chest X-ray shows apical infiltrates. Sputum smear for AFB is negative. What is the most appropriate next step in management?

A. Perform a bronchoscopy with lavage.
B. Order a CT scan of the chest.
C. Start empirical anti-tuberculosis treatment.
D. Discharge with symptomatic treatment and review.
E. Repeat sputum smear and culture, including nucleic acid amplification test (NAAT).
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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 58-year-old male presents with vague abdominal pain and unintentional weight loss. He has a history of working on a sheep farm. The provided imaging was obtained. Which of the following serological tests is MOST appropriate?

A. Amoebic serology
B. Hepatitis B surface antigen
C. Echinococcus IgG antibody
D. Strongyloides IgG antibody
E. Alpha-fetoprotein
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A 30-year-old woman presents to her GP with a 2-week history of a persistent cough, night sweats, and unintentional weight loss. She has recently returned from a trip to Southeast Asia. On examination, she appears thin and has crackles in the upper zones of her lungs. A chest X-ray shows cavitary lesions in the right upper lobe. What is the most likely diagnosis?

A. Chronic obstructive pulmonary disease (COPD)
B. Pulmonary tuberculosis
C. Pneumonia
D. Sarcoidosis
E. Lung cancer
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A 70-year-old woman with a history of diabetes presents with fever, cough, and weight loss. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A. Sarcoidosis
B. Lung cancer
C. Tuberculosis
D. Lung abscess
E. Pneumocystis pneumonia
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Imaging is performed. Considering the clinical presentation and the provided images, which of the following represents the most appropriate next step in this patient's management?

A. Provide symptomatic relief and arrange follow-up in the outpatient clinic.
B. Surgical consultation for assessment of operative management.
C. Repeat cross-sectional imaging in three months to monitor disease progression.
D. Perform a colonoscopy to assess disease activity and extent.
E. Initiate a course of oral corticosteroids and optimise immunosuppression.
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 65-year-old patient with a history of smoking presents with a chronic cough and mild weight loss over three months. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray revealed a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging was performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided, which of the following is the most appropriate next step in the management of this patient?

A. Refer for surgical resection
B. Bronchoscopy with biopsy or fine needle aspiration
C. Prescribe a course of inhaled corticosteroids
D. Initiate empirical broad-spectrum antibiotics
E. Repeat PET-CT scan in three months
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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. Perform a Mantoux test and Interferon-Gamma Release Assay (IGRA)
B. Order a PET-CT scan to assess for other sites of disease or malignancy
C. Excisional biopsy of the lymph node for histopathology and culture
D. Fine needle aspiration of the lymph node for Ziehl-Neelsen stain, culture, and PCR
E. Initiate empirical treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). The provided image was obtained as part of his staging workup. Which of the following is the MOST appropriate next step in management?

A. Surgical resection of the affected liver segments
B. Initiation of palliative care and symptom management
C. Observation with serial imaging every 3 months
D. Percutaneous radiofrequency ablation of the largest lesion
E. Referral to medical oncology for systemic chemotherapy
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 65-year-old male presents with a 3-month history of unintentional weight loss and early satiety. Gastroscopy and biopsy confirmed a gastric mixed adenoneuroendocrine carcinoma. Staging CT imaging is shown. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate initial management strategy?

A. Commence somatostatin analogue therapy.
B. Proceed with surgical resection of hepatic lesions.
C. Monitor with serial CT scans and symptomatic management.
D. Initiate systemic chemotherapy.
E. Plan for palliative external beam radiotherapy to the liver.
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old male presents with dysphagia and weight loss. Gastroscopy and biopsy confirm gastric adenocarcinoma. Staging CT imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?

A. Proceed with total gastrectomy and D2 lymphadenectomy
B. Refer for liver transplantation assessment
C. Plan palliative radiotherapy to the gastric primary
D. Initiate systemic chemotherapy
E. Consider transarterial chemoembolisation for hepatic lesions
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening colicky abdominal pain, bloating, and occasional non-bilious vomiting, associated with a 3kg weight loss. She reports reduced stool frequency. She is currently managed with mesalazine and azathioprine. Her vital signs are stable (BP 120/75, HR 82, Temp 36.8), and physical examination reveals mild right lower quadrant tenderness without guarding or rebound. Bowel sounds are hyperactive. Imaging is performed. Considering the clinical presentation, her current therapy, and the findings suggested by the provided images, which of the following represents the most appropriate next step in this patient's management?

A. Performing a colonoscopy with attempted balloon dilation
B. Recommending a high-fibre diet and increased fluid intake
C. Initiating therapy with an anti-TNF agent such as infliximab
D. Increasing the dose of azathioprine and adding oral corticosteroids
E. Referral for surgical consultation regarding potential resection
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 72-year-old woman presents with a 3-month history of worsening constipation, occasional bright red rectal bleeding, and unintentional weight loss of 4 kg. She reports feeling increasingly tired. Her past medical history includes hypertension and osteoarthritis. On examination, her vital signs are stable. Abdominal examination is soft, non-tender, with no palpable masses. Digital rectal examination reveals no palpable lesion. Blood tests show a haemoglobin of 108 g/L, MCV 78 fL, and ferritin 12 µg/L. A colonoscopy was performed, and the image provided was captured during the procedure. Considering the clinical presentation and the finding observed during the colonoscopy, which of the following investigations is most crucial for determining the extent of disease and guiding definitive treatment planning within the multidisciplinary team framework?

A. Repeat colonoscopy in 3 months
B. Commencement of iron supplementation and review in 4 weeks
C. Urgent surgical consultation for immediate resection
D. CT scan of chest, abdomen, and pelvis
E. Referral for palliative care assessment
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A 35-year-old man presents to the clinic with a 3-month history of persistent cough, night sweats, and weight loss. He has a history of travel to Southeast Asia six months ago. On examination, he appears thin and has crackles in the upper zones of his lungs. A chest X-ray shows cavitary lesions in the right upper lobe. What is the most likely diagnosis?

A. Sarcoidosis
B. Pneumonia
C. Lung cancer
D. Chronic obstructive pulmonary disease (COPD)
E. Pulmonary tuberculosis
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Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 4-year-old presents with abdominal distension, pain, and weight loss over several weeks. On examination, a firm, irregular abdominal mass is palpable. Blood tests show mild anaemia. The provided image is an axial CT slice of the abdomen. Considering the clinical presentation and the findings demonstrated in the image, which of the following investigations is the MOST appropriate initial step to establish a definitive diagnosis?

A. Image-guided biopsy of the abdominal mass.
B. Whole-body 123I-MIBG scintigraphy.
C. Measurement of urinary catecholamine metabolites.
D. Bone marrow aspirate and trephine biopsy.
E. Laparoscopic exploration and mass excision.
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old man presents with a 3-month history of progressive dysphagia, early satiety, and unintentional weight loss of 8 kg. He has a background of well-controlled hypertension. Physical examination reveals mild epigastric tenderness. Initial blood tests show a normocytic anaemia. An urgent upper endoscopy identified a large, ulcerated mass in the gastric body, and biopsies were taken. A staging CT scan of the abdomen and pelvis was subsequently performed. Considering the clinical presentation and the findings demonstrated in the provided imaging, which of the following statements best reflects the likely prognosis and primary management strategy for this patient?

A. Curative surgical resection of the gastric mass is the priority, followed by adjuvant chemotherapy.
B. The findings suggest a benign process, and symptomatic management is sufficient.
C. Liver transplantation should be considered given the extent of hepatic involvement.
D. The disease is likely incurable, and management will primarily focus on systemic therapy and palliative care.
E. Further investigation with a PET-CT scan is mandatory before determining the management plan.
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 65-year-old patient with a history of smoking presents with a chronic cough and mild weight loss over three months. Physical examination is unremarkable, and vital signs are stable. Routine blood tests, including full blood count and inflammatory markers, are within normal limits. A chest X-ray revealed a solitary pulmonary nodule in the right upper lobe. Subsequent PET-CT imaging was performed as part of the diagnostic workup. Considering the findings demonstrated in the image provided in the context of this patient's presentation, which of the following is the most appropriate next step in the management of this patient?

A. Refer for surgical consultation for lobectomy
B. Obtain tissue diagnosis via biopsy
C. Initiate empirical anti-tuberculosis therapy
D. Schedule follow-up CT scan in three months
E. Perform sputum microscopy and culture for acid-fast bacilli
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his general practitioner with a several-year history of worsening symptoms. He describes significant heartburn and regurgitation, particularly when lying down, which is only partially relieved by high-dose proton pump inhibitors. He has also noticed increasing difficulty swallowing solid food and occasionally liquids, sometimes accompanied by coughing fits after eating. He reports feeling full very quickly after starting a meal and has lost approximately 5 kg unintentionally over the past year. His past medical history includes osteoarthritis and benign prostatic hyperplasia. He is a non-smoker and drinks alcohol occasionally. Physical examination is unremarkable. Routine blood tests, including full blood count, electrolytes, and liver function tests, are within normal limits. A CT scan of the chest and upper abdomen was performed as part of the workup for his symptoms, and a representative axial image is shown. Considering the clinical presentation and the findings demonstrated in the image, which of the following represents the MOST appropriate definitive management strategy for this patient?

A. Referral for a barium swallow study and oesophageal manometry.
B. Long-term, high-dose proton pump inhibitor therapy and dietary modifications.
C. Endoscopic balloon dilation of the oesophagus.
D. Placement of a percutaneous endoscopic gastrostomy (PEG) tube for nutritional support.
E. Laparoscopic repair of the diaphragmatic defect with fundoplication and mesh reinforcement.
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A 45-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal pain. He has a history of type 2 diabetes and hypertension. On examination, he has a palpable mass in the left upper quadrant of the abdomen. Laboratory tests reveal anemia and elevated serum lactate dehydrogenase (LDH). A CT scan of the abdomen shows splenomegaly and multiple hypodense lesions in the spleen. What is the most likely diagnosis?

A. Splenic lymphoma
B. Renal cell carcinoma with splenic metastasis
C. Chronic pancreatitis
D. Infectious mononucleosis
E. Portal hypertension
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Ovarian Cyst
Image by James Heilman, MD CC BY-SA 3.0 · Source

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. Prescribe a proton pump inhibitor for presumed dyspepsia and review in 4 weeks.
B. Reassure the patient that the mass is likely benign and manage symptomatically.
C. Arrange for a diagnostic laparoscopy by a general surgeon.
D. Referral to a gynaecological oncologist for further assessment.
E. Order serum CA-125 and arrange a repeat CT scan in 3 months.
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A 67-year-old woman presents to her GP with fatigue, weight loss, and night sweats over the past two months. She has a history of smoking and hypertension. On examination, she has palpable lymphadenopathy in the cervical and axillary regions. Blood tests reveal a hemoglobin level of 10 g/dL, elevated lactate dehydrogenase (LDH), and a peripheral blood smear showing atypical lymphocytes. What is the most likely diagnosis?

A. Non-Hodgkin's lymphoma
B. Multiple myeloma
C. Hodgkin's lymphoma
D. Chronic lymphocytic leukemia (CLL)
E. Acute myeloid leukemia (AML)
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 72-year-old male presents with a 4-month history of increasing fatigue, anorexia, and a 10 kg weight loss. He reports occasional nausea but no vomiting or abdominal pain. His vital signs are stable. Physical examination reveals mild jaundice and palpable hepatomegaly. Blood tests show Hb 105 g/L, elevated AST/ALT, and a mildly raised bilirubin. An upper endoscopy showed a large gastric mass, with histology pending. A CT scan of the abdomen and pelvis was performed. Considering the clinical context and the findings on the provided imaging, what is the most likely implication for this patient's overall management strategy?

A. Referral for liver transplantation assessment.
B. Planning for curative surgical resection of the primary tumour and liver lesions.
C. Urgent initiation of aggressive systemic chemotherapy with curative intent.
D. Focus on symptom control and quality of life measures.
E. Further investigation with MRI liver to characterise the lesions.
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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 55-year-old man with a history of renal transplant on long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed. Considering the clinical context and the findings on imaging, which of the following represents the most appropriate next diagnostic step to guide management?

A. Initiate empirical broad-spectrum intravenous antibiotics.
B. Proceed directly to surgical drainage or resection.
C. Perform serological testing for parasitic infections, including Echinococcus species.
D. Percutaneous biopsy of the lesion for histology and microbiological studies.
E. Arrange for a PET-CT scan to assess metabolic activity of the lesion.
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A. Surgical resection of the affected liver segments
B. Initiation of palliative care and symptom management
C. Percutaneous radiofrequency ablation of liver lesions
D. Observation with serial imaging in three months
E. Referral to medical oncology for systemic chemotherapy
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A 45-year-old man presents to the clinic with a 3-month history of progressive difficulty swallowing both solids and liquids. He also reports regurgitation of undigested food and occasional chest pain. He has lost 5 kg over this period. On examination, there are no abnormalities noted. A barium swallow study shows a 'bird-beak' appearance of the lower esophagus. What is the most likely diagnosis?

A. Gastroesophageal reflux disease (GERD)
B. Achalasia
C. Diffuse esophageal spasm
D. Esophageal stricture
E. Esophageal cancer
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 58-year-old male presents with a 3-month history of dyspepsia, early satiety, and unintentional weight loss. Upper endoscopy revealed a large, ulcerated mass in the gastric antrum. Biopsy confirmed adenocarcinoma. Staging investigations were performed, including the provided imaging. His ECOG performance status is 1. Blood tests show mild anaemia and normal liver function tests. Given the clinical presentation and the findings on the provided imaging, which of the following is the most appropriate primary goal of management for this patient?

A. Curative surgical resection of the primary gastric tumour
B. Radiation therapy to the gastric mass
C. Palliation of symptoms and improvement of quality of life
D. Neoadjuvant chemotherapy followed by reassessment for surgery
E. Liver transplantation
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A 45-year-old man presents to the clinic with a 3-month history of persistent cough, night sweats, and weight loss. He has a history of smoking and works as a miner. On examination, he has decreased breath sounds and dullness to percussion over the right upper lobe. A chest X-ray shows a cavitary lesion in the right upper lobe. What is the most likely diagnosis?

A. Pulmonary tuberculosis
B. Chronic obstructive pulmonary disease (COPD)
C. Pneumonia
D. Lung cancer
E. Sarcoidosis
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A 60-year-old man presents to the clinic with a 6-month history of progressive difficulty in swallowing both solids and liquids. He also reports unintentional weight loss and occasional regurgitation of undigested food. On examination, there is no lymphadenopathy or abdominal masses. A barium swallow study shows a 'bird-beak' appearance of the lower esophagus. What is the most likely diagnosis?

A. Hiatal hernia
B. Esophageal stricture
C. Achalasia
D. Gastroesophageal reflux disease (GERD)
E. Esophageal cancer
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A 32-year-old woman presents to the clinic with a 2-week history of palpitations, anxiety, and weight loss despite an increased appetite. She also reports feeling hot and experiencing increased sweating. On examination, she has a fine tremor, warm moist skin, and a diffusely enlarged thyroid gland. Her heart rate is 110 bpm. Blood tests reveal suppressed TSH and elevated free T4. What is the most appropriate initial treatment for her condition?

A. Prescribe levothyroxine
B. Refer for radioactive iodine therapy
C. Start propranolol
D. Initiate methimazole
E. Schedule thyroidectomy
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 65-year-old male with recently diagnosed gastric mixed adenoneuroendocrine carcinoma presents with unintentional weight loss. Endoscopy confirmed the diagnosis. Staging imaging is provided. His ECOG performance status is 1. Considering the extent of disease demonstrated, which of the following represents the most appropriate initial therapeutic approach?

A. Gastrectomy with D2 lymphadenectomy
B. Observation with regular imaging surveillance
C. Palliative radiotherapy to the gastric primary
D. Liver resection of dominant lesions
E. Systemic chemotherapy or targeted therapy
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A 35-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He has no significant past medical history and does not take any medications. On examination, he has palpable cervical and axillary lymphadenopathy. A lymph node biopsy reveals Reed-Sternberg cells. What is the most likely diagnosis?

A. Chronic lymphocytic leukemia
B. Sarcoidosis
C. Hodgkin's lymphoma
D. Non-Hodgkin's lymphoma
E. Tuberculosis
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A 59-year-old lady with a past history of Type 2 Diabetes Mellitus and hypertension, and no smoking history, presents with a 3-month history of cough, blood-tinged sputum, night sweats, and a 5 kg weight loss. What are the most appropriate initial investigations for the likely diagnosis?

A. CXR + 3 AFB sputum samples
B. Full blood count and inflammatory markers.
C. Bronchoscopy with biopsy.
D. IGRA
E. CT chest
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A 55-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He has no significant past medical history. On examination, he has palpable lymphadenopathy in the cervical and axillary regions. Blood tests reveal a hemoglobin level of 10 g/dL, white blood cell count of 15,000/mm³ with a predominance of lymphocytes, and a platelet count of 150,000/mm³. A lymph node biopsy is performed, showing small lymphocytic lymphoma. What is the most appropriate initial management for this patient?

A. Surgical excision of lymph nodes
B. Observation and regular follow-up
C. Immediate chemotherapy
D. Radiation therapy to affected lymph nodes
E. Initiation of corticosteroids
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 35-year-old male presents with hemoptysis and weight loss. PET-CT is shown. Bronchoscopy with biopsy is MOST likely to reveal which of the following?

A. Adenocarcinoma in situ
B. Squamous cell carcinoma
C. Granulomatous inflammation with caseous necrosis
D. Small cell carcinoma
E. Mesothelioma
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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?

A. Initiate a gluten-free diet
B. Start a trial of probiotics
C. Order a hydrogen breath test
D. Prescribe iron supplementation
E. Refer for colonoscopy
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
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A 68-year-old male presents to his GP complaining of a change in bowel habit over the past 6 months. He reports increasing constipation alternating with episodes of diarrhea. He also mentions unintentional weight loss of approximately 5 kg during this period. He denies any family history of bowel cancer. A colonoscopy was performed, and a representative image is shown. Assuming the lesion is confirmed as malignant, what is the MOST appropriate next step in the management of this patient?

A. Referral for palliative care
B. Repeat colonoscopy in 3 years
C. CT scan of the chest, abdomen, and pelvis
D. Initiate adjuvant chemotherapy with FOLFOX
E. Administer a course of broad-spectrum antibiotics
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 65-year-old male presents with a 3-month history of unintentional weight loss and epigastric discomfort. Endoscopy revealed a gastric mass, and biopsy confirmed a mixed adenoneuroendocrine carcinoma. Staging imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?

A. Refer for surgical assessment for hepatic metastasectomy
B. Evaluate for potential liver transplantation
C. Plan for palliative external beam radiotherapy to the liver
D. Initiate systemic chemotherapy targeting the adenocarcinoma component
E. Commence treatment with a long-acting somatostatin analogue
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 32-year-old male, originally from a high-TB prevalence country, presents to the emergency department with a persistent cough for the past 3 weeks, night sweats, and a 5 kg weight loss. He denies any fever or shortness of breath. Physical examination reveals normal breath sounds bilaterally, with no wheezes or crackles. His vital signs are stable: temperature 37.2°C, heart rate 88 bpm, blood pressure 120/80 mmHg, and oxygen saturation 98% on room air. A chest X-ray was initially interpreted as showing a possible lung mass, prompting further investigation with a PET-CT scan, the axial view of which is shown. Sputum samples have been sent for microscopy and culture, but results are pending. Given the clinical presentation and the imaging findings, what is the MOST appropriate next step in management?

A. Order a bronchoscopy with bronchoalveolar lavage and transbronchial biopsy
B. Schedule a follow-up PET-CT scan in 3 months to monitor for changes in size and metabolic activity
C. Prescribe a course of broad-spectrum antibiotics to cover community-acquired pneumonia
D. Perform a CT-guided needle biopsy of the lesion for definitive diagnosis
E. Initiate a multi-drug anti-tuberculosis therapy regimen
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A 60-year-old man presents to his GP with a 3-month history of fatigue, weight loss, and night sweats. He has a history of smoking and hypertension. On examination, he has palpable lymphadenopathy in the cervical and axillary regions. Blood tests reveal anemia and elevated lactate dehydrogenase (LDH). What is the most appropriate next step in the investigation of this patient?

A. PET scan
B. Excisional lymph node biopsy
C. CT scan of the chest and abdomen
D. Fine needle aspiration of the lymph node
E. Bone marrow biopsy
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 62-year-old male presents to the emergency department complaining of worsening abdominal pain, fatigue, and a 10kg unintentional weight loss over the past 3 months. He reports a history of peptic ulcer disease treated with long-term proton pump inhibitors. Physical examination reveals mild hepatomegaly and trace ascites. Initial laboratory investigations show elevated alkaline phosphatase and gamma-glutamyl transferase (GGT), with normal bilirubin and transaminases. A CT scan of the abdomen and pelvis with contrast is performed, and relevant images are shown. Given the clinical presentation and the findings on the imaging, which of the following is the MOST appropriate next step in management?

A. Initiation of ursodeoxycholic acid for presumed primary biliary cholangitis
B. Observation with serial liver function tests in 3 months
C. Referral to medical oncology for consideration of systemic chemotherapy
D. Laparoscopic cholecystectomy for suspected biliary dyskinesia
E. Percutaneous liver biopsy for histological diagnosis
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A 35-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and night sweats. He also reports a persistent cough that has recently become productive of blood-streaked sputum. He has no significant past medical history and is not on any medications. He recently returned from a trip to Southeast Asia. On examination, he is febrile and has bilateral crackles in the upper lung fields. A chest X-ray shows cavitary lesions in the upper lobes. What is the most likely diagnosis?

A. Community-acquired pneumonia
B. Chronic obstructive pulmonary disease (COPD)
C. Lung cancer
D. Sarcoidosis
E. Pulmonary tuberculosis
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Ileitis terminalis bei langjaehrigem Morbus Crohn 63W - CT und MRT - 001
Image by Hellerhoff CC BY-SA 4.0 · Source

A 63-year-old woman with a 20-year history of Crohn's disease presents with a one-month history of worsening abdominal pain, bloating, and occasional vomiting, associated with a 3kg weight loss. She is currently managed with mesalazine and azathioprine. Her vital signs are stable, and physical examination reveals mild right lower quadrant tenderness. Imaging is performed. Considering the clinical presentation and the findings demonstrated in the provided images, which of the following management approaches is most likely indicated?

A. Addition of an anti-TNF alpha agent
B. Initiation of a systemic corticosteroid course
C. Switching azathioprine to methotrexate
D. Increasing the dose of mesalazine
E. Surgical consultation for potential intervention
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PET-CT of a tuberculoma
Image by Annemie Snoeckx, Pieter Reyntiens, Damien Desbuquoit, Maarten J. Spinhoven, Paul E. Van Schil, Jan P. van Meerbeeck, Paul M. Parizel CC BY 4.0 · Source

A 45-year-old male, who recently immigrated from India, presents to his primary care physician with a two-month history of progressive fatigue, unintentional weight loss of 7 kg, and intermittent night sweats. He denies any cough, chest pain, or shortness of breath. He has no significant past medical history and is not currently taking any medications. Physical examination reveals normal vital signs, including a temperature of 37.1°C, and clear breath sounds bilaterally. However, mild cervical lymphadenopathy is noted. Initial laboratory investigations, including a complete blood count and comprehensive metabolic panel, are unremarkable. A chest X-ray reveals a solitary pulmonary nodule in the right upper lobe, which prompts a PET-CT scan for further evaluation. An axial slice from the PET-CT is shown. Given the patient's clinical presentation, immigration history, and the PET-CT findings, which of the following is the MOST appropriate next step in establishing a definitive diagnosis?

A. Bronchoscopy with transbronchial needle aspiration of the lesion
B. Administer a purified protein derivative (PPD) skin test
C. Order a CT-guided percutaneous needle biopsy of the lung nodule
D. Repeat PET-CT scan in three months to assess for interval growth
E. Initiate empiric antibiotic therapy with a broad-spectrum antibiotic
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A 55-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal discomfort. He has a history of chronic hepatitis B infection. On examination, he has mild hepatomegaly and jaundice. Blood tests reveal elevated liver enzymes and alpha-fetoprotein levels. An ultrasound of the abdomen shows a 3 cm lesion in the right lobe of the liver. What is the most likely diagnosis?

A. Hepatocellular carcinoma
B. Metastatic liver disease
C. Focal nodular hyperplasia
D. Liver cirrhosis
E. Hepatic adenoma
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 65-year-old male presents with a 2-month history of fatigue, poor appetite, and 5kg weight loss. He reports mild upper abdominal discomfort. Physical examination is unremarkable. Initial blood tests show mild anaemia. An upper endoscopy revealed a suspicious gastric lesion, with biopsy results pending. A CT scan of the abdomen and pelvis was performed. Given the clinical presentation and the findings on the provided imaging, which of the following statements regarding this patient's likely prognosis and management is most accurate?

A. The extensive nature of the findings suggests limited options for curative treatment, with systemic therapy typically employed for palliation or disease control.
B. A watch-and-wait approach with repeat imaging in 3-6 months is recommended.
C. Referral for surgical assessment for potential hepatectomy is the next appropriate step.
D. Liver-directed therapies such as transarterial chemoembolisation (TACE) should be pursued.
E. The findings are likely benign and require no further intervention beyond managing the primary gastric lesion.
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CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with a history of hepatitis C presents with new-onset right upper quadrant pain and a 5kg weight loss over the past 3 months. His liver function tests show elevated ALT and AST. An abdominal CT scan with and without contrast is performed (image attached). What is the MOST appropriate next step in management?

A. Order serum alpha-fetoprotein (AFP) levels and monitor for elevation
B. Recommend lifestyle modifications, including alcohol cessation and weight loss
C. Referral to hepatology for consideration of liver biopsy and further management
D. Initiate empiric antibiotic therapy for suspected cholangitis
E. Schedule a follow-up ultrasound in 3 months to monitor the lesion
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Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed, as shown. Which of the following is the MOST appropriate next step in management?

A. Initiation of immunotherapy
B. Palliative chemotherapy
C. Observation with serial imaging
D. Transarterial chemoembolization (TACE)
E. Surgical resection of the liver lesions
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