middle-aged man

A 45-year-old man presents to the emergency department with severe epigastric pain radiating to the back. He has a history of alcohol use disorder and has been drinking heavily over the past week. On examination, he is febrile, tachycardic, and has abdominal tenderness. Laboratory tests reveal elevated serum lipase and amylase levels. What is the most appropriate initial management for this patient?

A 55-year-old man, non-smoker, presents for a health check. BP 135/85 mmHg, total cholesterol 5.5 mmol/L, HDL 1.2 mmol/L. No personal history of CVD or diabetes. Family history of premature CVD in father. BMI 28. Based on Australian guidelines, what is the most appropriate initial management step?

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most likely underlying cause?

A 45-year-old male presents to his GP with a lesion on his nose that has been slowly enlarging over the past six months. He reports no pain, itching, or bleeding. He has no significant past medical history and takes no regular medications. On examination, vital signs are stable. The image shows the appearance of the lesion. Given the clinical presentation and morphology, what is the most appropriate initial step in management?

A 67-year-old man with a history of type 2 diabetes mellitus and hypertension presents to the emergency department with sudden onset of right-sided weakness and slurred speech that began 2 hours ago. He has no history of atrial fibrillation or previous strokes. On examination, his blood pressure is 180/95 mmHg, heart rate is 88 bpm, and he is afebrile. Neurological examination reveals right-sided hemiparesis and expressive aphasia. A non-contrast CT scan of the head shows no evidence of hemorrhage. Which of the following is the most appropriate next step in the management of this patient?

A 62-year-old male presents to his general practitioner with a six-month history of a painless bulge in his right groin. On examination, a soft swelling is palpable in the right inguinal region, which increases in size on coughing or straining. The swelling is located medial to the inferior epigastric vessels. Which of the following is the most appropriate initial management strategy according to current Australian guidelines?

A 35-year-old male presents to his general practitioner complaining of a persistent, asymptomatic lesion on his nose that has been present for approximately 6 months. He denies any trauma to the area. He reports no other skin issues or systemic symptoms. Physical examination reveals the lesion shown. The patient is concerned about cosmetic appearance and potential for malignancy. What is the MOST appropriate initial management step?

A 45-year-old man presents to the emergency department with sudden onset of severe abdominal pain radiating to the back. He is a smoker and has a history of hypertension. On examination, he is diaphoretic, with a heart rate of 120 bpm and blood pressure of 90/60 mmHg. Abdominal examination reveals a pulsatile mass in the midline. What is the most likely diagnosis?

A 45-year-old male presents to the ED with left flank pain radiating to his groin. He reports nausea but denies fever or dysuria. Vitals are stable. A point-of-care ultrasound is performed, with the image shown. Assuming no contraindications, what is the MOST appropriate next step in management?

A 45-year-old male with a known history of Blue Rubber Bleb Naevus Syndrome, characterised by recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions, presents to the emergency department with acute onset severe, colicky abdominal pain, nausea, and vomiting. On examination, his abdomen is distended and diffusely tender with reduced bowel sounds. Vital signs are within normal limits. An urgent abdominal CT scan is performed. Based on the clinical presentation and the findings demonstrated in the image, what is the most appropriate immediate next step in management?

A 62-year-old male presents to the emergency department complaining of left lower quadrant abdominal pain for the past three days. He describes the pain as constant and sharp, rating it an 8 out of 10. He also reports nausea, decreased appetite, and subjective fevers. His past medical history is significant for hypertension and hyperlipidemia, both well-controlled with medications. He denies any recent travel or sick contacts. On physical examination, his abdomen is tender to palpation in the left lower quadrant with guarding. Bowel sounds are present but diminished. The remainder of his examination is unremarkable. His vital signs are: Temperature 38.2°C, Heart Rate 98 bpm, Blood Pressure 140/90 mmHg, Respiratory Rate 18 breaths per minute, and Oxygen Saturation 98% on room air. Laboratory results show a white blood cell count of 14,000/µL with a neutrophilic predominance. A CT scan of the abdomen and pelvis with intravenous contrast is performed, and a representative image is shown. Assuming the patient has no allergies, what is the MOST appropriate initial management strategy?

A 63-year-old man presents with iron deficiency anemia. The provided CT was performed. What is the MOST likely cause of his anemia?

A 55-year-old farmer presents with a week of high fever, severe retro-orbital headache, and profound muscle aches. He denies cough, sore throat, or rash. On examination, temperature is 39.5°C, pulse 90, BP 120/80. Lungs are clear to auscultation. Abdomen is soft, non-tender. Initial bloods show mildly elevated transaminases. What is the most likely diagnosis?

A 35-year-old man presents with a painless lesion on his nose, present for 6 months. Examination reveals the image shown. What is the MOST likely diagnosis?

A 55-year-old farmer presents with a week of severe retro-orbital headache, fever, and myalgia. He reports recent exposure to birthing sheep on his property. On examination, he is febrile (39.5°C) and mildly jaundiced. Liver enzymes are elevated (ALT 250 U/L). Chest X-ray is clear. What is the most likely diagnosis?

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most appropriate next step in management?

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

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, what is the most appropriate immediate next step in management?

A 45-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. He has a history of hypertension and is a smoker. On examination, his blood pressure is 180/110 mmHg in the right arm and 160/100 mmHg in the left arm. His heart rate is 110 bpm, and he has diminished pulses in the left radial artery. A chest X-ray shows a widened mediastinum. Which of the following is the most appropriate next step in management?

A 63-year-old man presents with increasing postprandial fullness and epigastric discomfort. He reports occasional regurgitation of undigested food. A CT scan of the abdomen is performed. Based on the image, what is the MOST appropriate next step in management?

A 58-year-old male presents to the emergency department complaining of right groin pain that started approximately 6 hours ago. He reports noticing a bulge in his groin for several months, which he could usually push back in. However, today he is unable to reduce it, and the pain has become progressively severe. He denies any fever, nausea, or vomiting. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medications. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 80 bpm, respiratory rate 16 bpm, and temperature 37.0°C. Abdominal examination is benign. Examination of the groin reveals the finding shown in the image. The area is tender to palpation. Which of the following is the MOST appropriate next step in the management of this patient?

A 32-year-old male with a history of Crohn's disease presents with worsening abdominal pain, diarrhea, and a low-grade fever. He reports that his symptoms have been progressively worsening over the past few weeks despite being compliant with his prescribed mesalamine. A CT scan of the abdomen and pelvis is performed, as shown. What is the MOST appropriate next step in management?

A 62-year-old man presents with a painless lesion on his nose, present for 8 months. He denies trauma or fever. Examination reveals the image shown. Histopathology is MOST likely to show which of the following?

A 60-year-old man presents with a reducible right groin bulge, as seen in the image. He reports mild discomfort. What is the most appropriate initial management?

A 55-year-old man presents to his GP complaining of a long-standing, intermittent swelling in his right groin that becomes more noticeable when he coughs or lifts heavy objects. It is usually painless and he can push it back in. His vital signs are normal. Considering the clinical presentation and the appearance shown, what is the most appropriate initial management?

A 58-year-old male presents with acute onset LLQ pain, low-grade fever, and mild nausea. His vitals are stable. An abdominal CT scan was performed, the axial view is shown. What is the MOST appropriate initial management strategy?

A 62-year-old man presents with bilateral breast enlargement, as shown. He denies pain or nipple discharge. What is the MOST likely underlying cause?

A 32-year-old male with Crohn's disease presents with worsening abdominal pain and diarrhea despite being on maintenance infliximab. He denies fever or blood in his stool. An abdominal CT and MRI are performed. Based on the imaging, what is the MOST appropriate next step in management?

A 45-year-old man presents with the finding shown. He denies pain but is concerned about its appearance. What is the MOST appropriate initial step?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with a low-grade fever (38.1°C) and mild nausea. He denies vomiting, diarrhoea, or rectal bleeding. On examination, he has localised tenderness in the left iliac fossa. His vital signs are stable: BP 130/80 mmHg, HR 78 bpm, RR 16/min, SpO2 98% on air. Blood tests show a white cell count of 12.5 x 10^9/L and CRP 45 mg/L. An abdominal CT scan is performed (image provided). Based on the clinical presentation and the provided image, what is the most appropriate initial management plan?

A 40-year-old Aboriginal man presents for a health check. He reports feeling well but has a strong family history of diabetes and cardiovascular disease. What is the most appropriate initial screening test?

A 48-year-old man with multiple cutaneous hemangiomas presents with crampy abdominal pain and guaiac-positive stools. The provided image was obtained. What is the MOST appropriate initial diagnostic test to identify the source of bleeding?

A 40-year-old patient with schizophrenia is started on risperidone. His GP recommends regular monitoring. What parameters should be monitored?

A 62-year-old male presents with acute onset of LLQ pain, fever, and vomiting. His WBC count is elevated. A CT scan of the abdomen and pelvis is performed. Based on the image, what is the most appropriate next step in management?

A 35-year-old male presents with a painless lesion on his nose that has been present for several months. He denies any trauma or previous skin conditions. Examination reveals the image shown. What is the MOST appropriate initial management step?

A 62-year-old male presents with a 3-month history of rectal bleeding and altered bowel habits. Colonoscopy was performed, and a representative image is shown. What is the MOST appropriate next step in management?

A 45-year-old man presents to the clinic with a 3-month history of persistent cough and shortness of breath. He is a non-smoker and works as a carpenter. On examination, there are bilateral inspiratory crackles at the lung bases. A chest X-ray shows reticular opacities predominantly in the lower lobes. Pulmonary function tests reveal a restrictive pattern. What is the most likely diagnosis?

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 55-year-old male presents with LLQ pain, fever, and increased WBC. A CT scan is performed. He is hemodynamically stable. Based on the image, which of the following is the MOST appropriate initial management strategy?

A 62-year-old male presents with a three-month history of intermittent rectal bleeding and a change in bowel habits. He reports increased constipation alternating with episodes of diarrhea. His family history is significant for a father who had colon cancer at age 70. A colonoscopy was performed, and an image from the procedure is shown. What is the MOST appropriate next step in management?

A 45-year-old male presents to the emergency department with severe chest pain radiating to his left arm, shortness of breath, and diaphoresis. He has a history of hypertension and hyperlipidemia. On examination, he is diaphoretic, and his blood pressure is 90/60 mmHg. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management for this patient?

A 55-year-old male presents to the emergency department with a 2-day history of left lower quadrant abdominal pain, associated with subjective fever and chills. He denies nausea, vomiting, or change in bowel habits. On examination, he is afebrile, heart rate 85 bpm, blood pressure 130/80 mmHg. Abdominal examination reveals tenderness in the left iliac fossa without guarding or rebound. White cell count is 14 x 10^9/L, CRP 80 mg/L. A CT scan of the abdomen and pelvis is performed, the relevant axial image is shown. Considering the patient's presentation and the findings on the provided image, which of the following represents the most appropriate initial management strategy?

A 55-year-old man with type 2 diabetes mellitus presents for a routine follow-up. His HbA1c is 9.0% despite being on metformin 1000 mg twice daily. He has a BMI of 32 kg/m² and no history of cardiovascular disease. What is the most appropriate next step in his management?

A 45-year-old man presents to his GP with a lesion on his nose that he first noticed about 6 months ago. It has slowly increased in size but is not painful or itchy. He has no significant past medical history and takes no regular medications. On examination, vital signs are stable. The image shows the appearance of the lesion. Considering the clinical presentation and the appearance of the lesion shown, what is the most appropriate initial management step?

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, the results of which are shown. What is the MOST appropriate next step in management?

A 55-year-old man presents to the clinic with a 3-month history of worsening cough, weight loss, and night sweats. He has a 30-pack-year smoking history and worked in construction for 20 years. On examination, he has clubbing of the fingers and decreased breath sounds in the right lower lung field. A chest X-ray shows a right lower lobe mass. What is the most appropriate next step in the management of this patient?

A 55-year-old male presents with chest pain that radiates to his left arm and jaw, accompanied by diaphoresis and nausea. ECG shows ST-segment elevation in leads II, III, and aVF. What is the most likely diagnosis?

A 50-year-old man presents to the general practice with a 3-month history of persistent heartburn and regurgitation, especially after meals. He has tried over-the-counter antacids with minimal relief. He denies any weight loss, dysphagia, or gastrointestinal bleeding. What is the most appropriate next step in the management of this patient?

A 45-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. He has a history of hypertension and is a smoker. On examination, his blood pressure is 180/110 mmHg in the right arm and 160/100 mmHg in the left arm. His heart rate is 110 bpm, and he has a new diastolic murmur. An ECG shows left ventricular hypertrophy but no ischemic changes. What is the most appropriate next step in management?

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?