young adult

A 32-year-old woman presents to her general practitioner with a 2-week 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 in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) and anti-double-stranded DNA antibodies. What is the most likely diagnosis?

A 40-year-old patient with PTSD is started on sertraline but develops sexual dysfunction as a side effect. What is the next step in management?

An 18-year-old teenage girl presents with a sudden change in behavior at a music festival, appearing confused and aggressive after consuming 5-6 vodkas, with uncertainty about illicit drug use. What is the most appropriate next step in her management in the Australian context?

A 25-year-old man presents to the emergency department with a 2-day history of severe headache, photophobia, and neck stiffness. He has no significant past medical history and is not on any medications. On examination, he is febrile with a temperature of 39°C, and there is a positive Brudzinski's sign. What is the most appropriate initial investigation to confirm the diagnosis?

A 32-year-old woman presents to her GP complaining of a new, intensely itchy rash on her elbows, knees, and scalp. On examination, the GP notes symmetrical, erythematous papules and plaques with overlying silvery scales. The patient reports a family history of similar skin conditions. What is the most likely diagnosis?

A 23-year-old backpacker doing farm work presents with a low-grade fever for 4 days. Q fever is suspected. What is the most appropriate diagnostic method for acute Q fever in Australia?

A 25-year-old gentleman presents with 3 days of rhinorrhea, fever, cough, and abdominal pain. On examination, his temperature is 39.6°C, he has reduced breath sounds, and an enlarged spleen. Which of the following causative pathogens, if identified, would require mandatory notification in Australia?

A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It feels smooth, mobile, and non-tender. No family history of breast cancer. On examination, a 2cm, firm, mobile mass is noted. Considering Australian guidelines for a palpable breast lump in this age group, what is the most appropriate initial investigation?

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, excoriated papules and plaques on her wrists, elbows, knees, and upper back. Some of the papules have small blisters. Which of the following is the most appropriate initial investigation?

A 35-year-old male presents with left flank pain and dysuria. An ultrasound is performed. What is the MOST appropriate next step in management?

A 28-year-old female, recently emigrated from Southeast Asia, presents to her general practitioner with complaints of fatigue, a persistent low-grade fever (37.8°C), and a non-productive cough that has been present for approximately one month. She denies any significant past medical history and is not currently taking any medications. Physical examination reveals slightly diminished breath sounds in the upper right lobe, but is otherwise unremarkable. Initial blood work, including a complete blood count and comprehensive metabolic panel, are within normal limits. A chest X-ray revealed a suspicious lesion in the right upper lobe, prompting a PET-CT scan, an axial slice of which is shown. Given the patient's history, clinical presentation, and the findings on the PET-CT scan, which of the following is the MOST appropriate next step in the diagnostic workup?

A 35-year-old male with a history of multiple cutaneous vascular lesions presents with recurrent episodes of crampy abdominal pain and melena over the past month. His vital signs are stable. An abdominal CT scan is performed. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate next step in the management of this patient?

A 35-year-old man presents to his general practitioner reporting a lesion on his nose that he first noticed approximately three months ago. He describes it as initially resembling a persistent pimple, but notes it has not resolved and appears to be slowly increasing in size. He denies any associated pain, itching, or bleeding from the site. His past medical history is unremarkable, and he is not currently taking any regular medications. He works outdoors in a role involving significant sun exposure but admits to inconsistent use of sun protection measures. On physical examination, his vital signs are within normal limits. The lesion in question is located on his nose and has the appearance shown in the accompanying image. No other suspicious skin lesions are identified elsewhere on his body, and regional lymph nodes are not palpable. Considering the clinical presentation and the appearance of the lesion depicted, what is the most appropriate initial step in the management of this patient?

A 35-year-old male presents to his general practitioner with a lesion on his nose that has been present for approximately 3 months. He initially thought it was a persistent pimple but it has not resolved and seems to be slowly growing. He denies pain, itching, or bleeding from the lesion. He has no significant past medical history and takes no regular medications. He works outdoors but reports using sunscreen inconsistently. On examination, vital signs are stable. The lesion is as shown in the image. There are no other skin lesions noted elsewhere. Regional lymph nodes are not palpable. Based on the appearance of the lesion shown, what is the most appropriate next step in the management of this patient?

A 28-year-old woman presents with pelvic pain that started suddenly 2 days ago. Her periods are regular. She denies fever or vomiting. The shown CT was performed. What is the MOST likely diagnosis?

A 28-year-old female presents with a chronic cough and fatigue. She has no significant past medical history. A chest PET-CT was performed as part of her workup. The axial view is shown. What is the MOST appropriate next step in management, considering the image and her presentation?

A 25-year-old woman with a history of sexual assault presents with intrusive thoughts, avoidance behaviors, and emotional numbness. She is diagnosed with PTSD. What is the first-line pharmacological treatment for this condition?

A 28-year-old woman presents for a check-up, reporting occasional mild abdominal discomfort. Her father was diagnosed with colorectal cancer at age 48, and his tumour showed microsatellite instability. A paternal aunt had endometrial cancer at 55. Physical exam is normal. What is the most appropriate next step regarding genetic testing?

A 25-year-old woman presents to the clinic with a 3-day history of dysuria, increased urinary frequency, and urgency. She denies fever, flank pain, or vaginal discharge. She is sexually active and uses oral contraceptives. On examination, she is afebrile and her vital signs are stable. Urinalysis shows pyuria and bacteriuria. What is the most appropriate treatment?

A 28-year-old male is brought to the emergency department after a high-speed motor vehicle accident. He is unconscious with a Glasgow Coma Scale (GCS) score of 6. His blood pressure is 90/60 mmHg, heart rate is 120 bpm, and respiratory rate is 28 breaths per minute. On examination, there is bruising over the left chest and decreased breath sounds on the left side. What is the most appropriate immediate management step?

A 28-year-old male with Crohn's presents with increased abdominal pain, non-bloody diarrhea, and fatigue for 3 weeks. He denies fever. Exam shows mild RLQ tenderness. Labs show elevated CRP. Imaging is shown. What is the MOST appropriate next step?

A 28-year-old male presents with a persistent cough and fatigue. A PET-CT scan was performed. What is the MOST likely diagnosis?

A 28-year-old female presents to the ED with acute onset right lower quadrant pain. She reports nausea and vomiting. Her last menstrual period was 6 weeks ago, and she denies any vaginal bleeding. She is hemodynamically stable. A CT scan of the abdomen and pelvis is performed, with a relevant image shown. Considering the clinical presentation and the imaging findings, what is the MOST appropriate next step in the management of this patient?

A 30-year-old veteran presents with recurrent nightmares, flashbacks of combat, and hypervigilance. He avoids crowded places and has difficulty sleeping. His symptoms have persisted for over 6 months and are affecting his daily functioning. What is the most likely diagnosis?

A 35-year-old woman presents to the emergency department with a 3-day history of fever, chills, and a productive cough with greenish sputum. She has a history of asthma and is currently on inhaled corticosteroids. On examination, her temperature is 38.5°C, blood pressure is 120/80 mmHg, heart rate is 110 bpm, and respiratory rate is 24 breaths per minute. Auscultation of the chest reveals wheezing and crackles in the right lower lung field. A chest X-ray shows consolidation in the right lower lobe. What is the most appropriate initial antibiotic therapy for this patient, considering her asthma and current presentation?

A 28-year-old woman using a combined oral contraceptive pill is prescribed carbamazepine for newly diagnosed epilepsy. What is the most appropriate advice regarding her ongoing contraception?

A 30-year-old woman presents with fever, hemoptysis, and night sweats. A chest X-ray shows a round lesion with an air-fluid level. What is the most likely diagnosis?

A 28-year-old with Crohn's presents with new fever and abdominal pain. The patient's CRP is elevated. Review the imaging. What is the MOST appropriate next step?

A 35-year-old woman presents to her GP with worsening shortness of breath, cough, and wheeze over 2 days, requiring her salbutamol reliever daily and waking her at night. Her PEF is 60% of her personal best. She is alert, speaking in sentences, RR 22, HR 95. Based on Australian guidelines, what is the most appropriate initial management step?

A 31-year-old man presents with gradual onset lateral knee pain that worsens with running. There is no history of trauma. The pain is localized above the joint line, and there is no swelling. What is the likely diagnosis?

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

A 28-year-old female presents to her general practitioner with a 6-month history of intermittent abdominal pain, predominantly in the right lower quadrant. She describes the pain as cramping and associated with occasional episodes of non-bloody diarrhea. She denies fever, weight loss, or recent travel. Her past medical history is significant for well-controlled asthma, for which she uses an inhaled corticosteroid as needed. Physical examination reveals mild tenderness to palpation in the right lower quadrant, but is otherwise unremarkable. Bowel sounds are normal. Initial laboratory investigations, including a complete blood count and comprehensive metabolic panel, are within normal limits. Stool studies for ova and parasites, bacterial culture, and Clostridium difficile toxin are negative. Given her persistent symptoms, the GP refers her for further evaluation. A CT enterography is performed, and relevant images are shown. Based on the clinical presentation and imaging findings, which of the following is the MOST likely long-term complication this patient is at increased risk of developing?

A 22-year-old lady was wrongly given a B12 prescription for another patient. The error was noticed later at the pharmacy. What is the next step?

A 34-year-old man presents to the Emergency Department with acute-onset shortness of breath. A CT pulmonary angiogram (CTPA) is ordered, shown in the photograph, confirming a diagnosis of pulmonary embolism. Which of the following is the most appropriate initial treatment option for this patient?

A 25-year-old man presents with a history of recurrent urinary tract calculi. Which of the following is most likely to help him reduce the recurrent rate of calculi?

A 28-year-old female presents with sudden onset severe right lower quadrant pain, associated with nausea and one episode of vomiting. Her last menstrual period was 6 weeks ago. On examination, she is afebrile, heart rate 88, blood pressure 120/70. Abdominal examination reveals tenderness in the right iliac fossa. A CT scan of the abdomen and pelvis is performed, with a relevant axial image shown. Considering the clinical presentation and the findings demonstrated in the image, what is the MOST appropriate immediate next step in the management of this patient?

A 35-year-old woman presents with a 2cm, firm, mobile lump in her left breast, noticed two weeks ago. She is otherwise well. What is the most appropriate initial investigation?

A 30-year-old woman with bipolar disorder is prescribed risperidone for manic episodes. She develops tremors and rigidity. What is the most likely diagnosis?

A 25-year-old man with schizophrenia is started on risperidone. After a few weeks, he develops gynecomastia and galactorrhea. What is the most likely cause of these symptoms?

A 20-year-old female medical student arrives late, parties, and is attentive in consultations. What is the next step?

A 33-year-old lady has an HNPCC gene mutation and two sisters with bowel cancer. She reports no change in bowel habits. What is the best surveillance for bowel cancer in this patient?

A 32-year-old woman presents to her general practitioner 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, mild synovitis in her hands, and no signs of organomegaly. Laboratory tests reveal anemia, leukopenia, and positive antinuclear antibodies (ANA) with a high titer. Which of the following is the most appropriate initial management for this patient?

A 35-year-old healthcare worker has a positive tuberculin skin test (12mm induration) following a known occupational exposure. Her chest X-ray is clear, and she reports no symptoms. Which is the most appropriate next step in management?

A 32-year-old male with a 10-year history of Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. He denies fever or blood in his stool. Physical exam reveals mild tenderness in the right lower quadrant. The provided imaging was obtained. What is the MOST appropriate next step in management?

A 35-year-old woman who recently underwent laparoscopic appendicectomy and completed a 5-day course of cefotaxime presents with a 3-day history of diarrhea and a temperature of 39.5°C. Her vital signs are otherwise normal, and a digital rectal exam is normal. Examination reveals erythematous port sites. Which of the following is the most likely diagnosis?

A 7-year-old boy is brought to the GP by his parents due to poor performance at school. Teachers report that he is inattentive, easily distracted, and frequently interrupts others. What is the most appropriate first-line treatment?

A 24-year-old lady presents with worsening right eye 'ache' and reduced vision. The symptoms worsen with eye movements, and there is no redness or fluorescein uptake. Her vision is 6/12 in the right eye and 6/6 in the left eye. There is a relative afferent pupillary defect (RAPD) on examination. What associated disease could this indicate?

A 32-year-old male presents to his general practitioner with persistent anal pain and bleeding on defecation for the past 8 months. He reports a cycle of pain, relief after bowel movements, followed by throbbing pain lasting several hours. Examination reveals a visible anal fissure at the 6 o'clock position, along with a skin tag. Which of the following is the MOST appropriate next step in management, according to Australian guidelines?

A 32-year-old woman presents to her general practitioner six weeks postpartum with distressing obsessive thoughts about accidentally harming her newborn. She reports spending excessive time checking on the baby and cleaning the nursery, which interferes with her ability to rest and care for herself. She denies any intent to harm her child and feels ashamed of these thoughts. Her past medical history is unremarkable, and she has no history of psychiatric disorders. On examination, she appears anxious but is cooperative and oriented. Which of the following is the most appropriate initial management strategy for her condition?