young adult

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 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?

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 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 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 28-year-old woman with a mother diagnosed with colorectal cancer at 45 and a maternal uncle at 50 seeks advice. She is otherwise well. What is the most appropriate next step in her management?

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 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 7-year-old boy is brought to his GP by his parents, who are concerned about his behaviour at school and at home. They report that he has difficulty paying attention in class, often fidgets and squirms in his seat, and frequently interrupts others. At home, he struggles to follow instructions, loses things easily, and seems forgetful. The teacher has also noted that he has difficulty staying on task and often blurts out answers before the question is finished. The parents deny any history of significant medical illness or developmental delay. On examination, the boy appears energetic and talkative, but is cooperative with the assessment. Which of the following is the most appropriate next step in the evaluation of this child?

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 32-year-old male, recent immigrant from a high-TB prevalence country, presents with a persistent cough and night sweats for the past two months. He denies fever or weight loss. Physical examination is unremarkable except for mild, diffuse rhonchi on auscultation. Sputum cultures are pending. A PET-CT scan of the chest was performed, the axial view is shown. Given the clinical context and imaging findings, what is the MOST appropriate next step in management?

A 28-year-old woman presents with a palpable lump in her left breast, noticed two weeks ago. It is slightly tender, especially before her period. On examination, it is mobile, firm, and about 2 cm. No skin changes or nipple discharge. What 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 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 32-year-old woman presents to her general practitioner with a 3-month history of intermittent abdominal pain and bloating. She reports that the pain is crampy, occurs mainly in the lower abdomen, and is often relieved by defecation. She also notes a change in her bowel habits, alternating between constipation and diarrhea. She denies any weight loss, fever, or blood in her stool. Her medical history is unremarkable, and she is not on any medications. On examination, her abdomen is soft with mild tenderness in the lower quadrants but no palpable masses. Blood tests, including a complete blood count and C-reactive protein, are normal. What is the most appropriate next step in the management of this patient?

A 24-year-old woman presents to the emergency department with a 3-day history of fever, sore throat, and fatigue. She also reports a rash that developed after taking amoxicillin prescribed by her GP for a presumed bacterial throat infection. On examination, she has cervical lymphadenopathy, a diffuse maculopapular rash, and mild splenomegaly. Her vital signs are stable. A monospot test is positive. Which of the following is the most likely explanation for the rash?

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 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 patient with PTSD is undergoing therapy. The therapist uses exposure techniques to help the patient confront traumatic memories. What type of therapy is this?

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 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 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 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 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 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 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 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 28-year-old woman presents to her GP with a 3-month history of amenorrhea. She reports occasional headaches and galactorrhea. She is not on any medications and has no significant past medical history. On examination, her vital signs are normal, and there are no visual field defects. A pregnancy test is negative. What is the most appropriate initial investigation?

A 28-year-old woman presents to the clinic with a 3-day history of fever, sore throat, and difficulty swallowing. She has no significant past medical history and is not on any medications. On examination, she has swollen, tender anterior cervical lymph nodes and erythematous tonsils with white exudates. A rapid antigen detection test for group A Streptococcus is positive. What is the most appropriate treatment for her condition?

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 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 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 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 32-year-old woman presents to her general practitioner complaining of severe anal pain during and after bowel movements, along with bright red blood on the toilet paper. She reports constipation and straining during defecation. Examination reveals a visible longitudinal tear in the anal mucosa at the 6 o'clock position. Which of the following is the MOST appropriate initial management strategy, according to Australian guidelines?

A 30-year-old woman presents to the emergency department with a 2-day history of fever, sore throat, and a diffuse rash. She recently started taking a new medication for her epilepsy. On examination, she is febrile at 38.2°C, with a heart rate of 100 bpm and blood pressure of 110/70 mmHg. The rash is erythematous and involves the trunk and extremities, with some areas of desquamation. Laboratory tests reveal leukocytosis with eosinophilia and elevated liver enzymes. Which of the following is the most likely diagnosis?

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

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 25-year-old woman presents to the clinic with a 2-week history of fatigue, sore throat, and swollen glands. She also reports a low-grade fever and mild headache. On examination, she has cervical lymphadenopathy and mild splenomegaly. A monospot test is positive. What is the most appropriate advice regarding her physical activity?

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 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?