young adult

A 25-year-old man presents to the emergency department with sudden onset of severe testicular pain on the right side. He reports no trauma or previous episodes. On examination, the right testis is swollen, tender, and lies higher in the scrotum compared to the left. The cremasteric reflex is absent on the affected side. What is the most appropriate next step in the management of this patient?

A 28-year-old male presents to the emergency department with severe abdominal pain, fever, and bloody diarrhea for the past 2 days. He has a known history of Crohn's disease, diagnosed 5 years ago, and has been managed with azathioprine. He admits to inconsistent adherence to his medication regimen over the past year due to feeling well. On examination, he is febrile (38.9°C), tachycardic (110 bpm), and hypotensive (90/60 mmHg). His abdomen is distended and tender to palpation, particularly in the lower quadrants, with guarding. Laboratory investigations reveal a white blood cell count of 18,000/mm³ with a left shift, hemoglobin of 10 g/dL, platelets of 450,000/mm³, albumin of 28 g/L, and C-reactive protein (CRP) of 150 mg/L. An abdominal X-ray shows dilated loops of bowel. Which of the following is the MOST appropriate next step in the management of this patient?

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?

A 28-year-old man presents to his general practitioner for a routine health check. He reports being in a non-monogamous relationship for the past year. He states he uses condoms inconsistently, particularly within the primary relationship where his partner's HIV status is unknown. He denies any recent febrile illness, rash, or lymphadenopathy. His last HIV test, performed 6 months ago, was negative. He has no other significant medical history. Considering his presentation and reported risk factors, which of the following is the most appropriate next step in his management according to Australian guidelines?

A 25-year-old Aboriginal man presents to a remote clinic with increasing shortness of breath on exertion and palpitations over the past month. He recalls having a sore throat as a child but no specific diagnosis. On examination, his pulse is 95 bpm, blood pressure 110/70 mmHg, respiratory rate 20 breaths/min. Auscultation reveals a pansystolic murmur loudest at the apex, radiating to the axilla. There are no signs of heart failure currently. Considering the likely diagnosis and the patient's background, which of the following is the most appropriate initial investigation?

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 likely underlying pathology responsible for the patient's symptoms and the observed bowel findings?

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 32-year-old woman presents to the emergency department with a 2-day history of fever, malaise, and a painful, swollen left knee. She denies any recent trauma or travel history. She has no significant past medical history and is not on any medications. On examination, her temperature is 38.7°C, heart rate is 110 bpm, and blood pressure is 120/80 mmHg. The left knee is erythematous, warm, and tender with a moderate effusion, and she has limited range of motion due to pain. Laboratory tests reveal leukocytosis with a left shift. Blood cultures are pending. What is the most appropriate next step in the management of this patient?

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 25-year-old man with Crohn's disease presents with increased abdominal pain and frequent diarrhea. He is on azathioprine. Stool studies are negative for infection. Which of the following is the most appropriate next step?

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 35-year-old man with PTSD is experiencing severe nightmares despite being on an SSRI. What medication can be added to target this symptom?

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 25-year-old man presents with a painless testicular lump on the left side, described as a firm intratesticular mass. What is the likely diagnosis?

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 28-year-old patient with autism spectrum disorder is prescribed risperidone for aggressive behavior. His parents report significant weight gain. What is the most appropriate next step?

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 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 32-year-old woman presents to the emergency department with sudden onset of severe headache, nausea, and photophobia. She has no significant past medical history and is not on any medications. On examination, she is alert but in distress due to the headache. Her vital signs are stable, and there is no neck stiffness. A CT scan of the head is performed and shows no abnormalities. What is the most appropriate next step in the management of this patient?

A 30-year-old man presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. The pain started around the umbilicus and then localized to the right lower quadrant. On examination, he has tenderness and guarding in the right lower quadrant. His temperature is 38.3°C, heart rate is 100 bpm, and blood pressure is 120/80 mmHg. What is the most likely diagnosis?

A 32-year-old woman presents to her general practitioner complaining of a persistent, intensely itchy rash on her elbows, knees, and scalp for the past 6 months. She reports that the itching is worse at night and after hot showers. She has tried over-the-counter hydrocortisone cream without relief. On examination, the GP notes symmetrical, excoriated papules and plaques on the extensor surfaces of her elbows and knees, as well as some scaling on her scalp. The patient also mentions a history of recurrent mouth ulcers. Which of the following is the MOST appropriate initial investigation to confirm the suspected diagnosis?

A 25-year-old man presents to the emergency department with severe abdominal pain that started around his umbilicus and has now localized to the right lower quadrant. He has nausea and has vomited twice. On examination, he has tenderness and guarding in the right lower quadrant. His temperature is 37.8°C, and his white blood cell count is elevated. What is the most 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 35-year-old woman with a family history of BRCA1-associated breast cancer is considering genetic testing. She is asymptomatic and has no personal history of cancer. What is the MOST appropriate initial step in her management?

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 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 28-year-old male with Crohn's disease presents with increased abdominal pain, fever, and bloody stools. He is on azathioprine. What is the most appropriate next step?

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 30-year-old woman presents to her GP with fatigue, weight gain, and cold intolerance over the past 6 months. She also reports constipation and dry skin. On examination, she has a slightly enlarged, non-tender thyroid gland. Her TSH level is elevated, and free T4 is low. What is the most appropriate treatment for this condition?

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 28-year-old woman presents to the emergency department with sudden onset of severe right lower abdominal pain. She reports nausea and vomiting but denies fever or urinary symptoms. Her last menstrual period was two weeks ago, and she is sexually active. On examination, she has tenderness in the right lower quadrant with guarding. A pelvic ultrasound reveals a 5 cm right ovarian cyst with free fluid in the pelvis. What is the most likely diagnosis?

A 28-year-old woman presents to the emergency department with severe lower abdominal pain and vaginal bleeding. She is 8 weeks pregnant by last menstrual period. She reports no fever or chills. On examination, her blood pressure is 100/60 mmHg, heart rate is 110 bpm, and she appears pale and diaphoretic. Abdominal examination reveals tenderness in the lower quadrants without rebound tenderness or guarding. A pelvic examination shows a closed cervical os with moderate bleeding. A bedside transvaginal ultrasound reveals an empty uterus. Which of the following is the most appropriate next step in management?

A 32-year-old male with Crohn's disease presents with increased abdominal pain and diarrhea. Review the imaging. What is the MOST appropriate next step?

A 14-year-old girl who has been living alone presents with a positive urine pregnancy test. She states she was raped 6 months ago and wishes to terminate the pregnancy. What is the next appropriate step?

A 32-year-old woman presents to the emergency department with severe right lower quadrant abdominal pain, nausea, and vomiting. She reports her last menstrual period was 6 weeks ago. On examination, she has tenderness and guarding in the right lower quadrant. A urine pregnancy test is positive. What is the most appropriate next step in management?

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 32-year-old woman presents to her general practitioner with a 2-month history of fatigue, weight gain, and feeling cold all the time. She also reports hair loss and constipation. On examination, her heart rate is 58 bpm, and she has dry skin and a delayed relaxation phase of the deep tendon reflexes. Her thyroid function tests reveal a high TSH level and low free T4. She has no significant past medical history and is not on any medications. Which of the following is the most appropriate initial management for her condition?

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 28-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 in her hands. Laboratory tests reveal a positive antinuclear antibody (ANA) test and elevated anti-double-stranded DNA antibodies. What is the most likely diagnosis?

29-year-old lady with postpartum hair loss, sparse hair, positive pull test, and normal scalp. Diagnosis?