Coagulation factor deficiency due to liver disease is the most likely cause given the spontaneous bleeding and history of liver disease. Haemophilia A or B and von Willebrand disease are inherited conditions. Vitamin C deficiency and idiopathic thrombocytopenic purpura have different presentations. Liver disease can lead to deficiencies in coagulation factors, resulting in bleeding.

Tom’s symptoms of burning pain and tingling localized to the lateral thigh, worsened by tight belts, suggest meralgia paraesthetica. Differential diagnoses include sacroiliac dysfunction, peroneal nerve entrapment, tarsal tunnel syndrome, and acute lower limb ischaemia.

Correct answer is- Basal cell carcinoma. The pearly, telangiectatic appearance and slow growth are characteristic. Differential diagnoses include squamous cell carcinoma, actinic keratosis, sebaceous hyperplasia, melanoma, seborrhoeic keratosis, and trichoepithelioma. B) Squamous cell carcinoma is more scaly and ulcerative. C) Actinic keratosis is rough and scaly. D) Sebaceous hyperplasia is umbilicated. E) Melanoma is pigmented with irregular borders.

The best next step is to prescribe a 5-day course of amoxicillin. Given the duration of symptoms, purulent nasal discharge, and facial tenderness, this is likely acute bacterial sinusitis. If symptoms persist for over 7–10 days and the patient shows signs of a bacterial infection, antibiotics are indicated. Differential diagnoses include viral sinusitis, allergic rhinitis, dental abscess, nasal polyps, upper respiratory infection, vasomotor rhinitis, and foreign body in the nasal cavity.

Once treatment starts the earliest a child can return to school is 2 days provided there is a good response to treatment. Practical knowledge of incubation and quarantine periods will be required and is frequently asked by parents. References: 1. https://www.health.nsw.gov.au/Infectious/factsheets/Pages/childhood-conditions-and-school-exclusion.aspx 2. https://www.racgp.org.au/afp/2013/august/school-exclusion-times 3. https://www.rch.org.au/kidsinfo/fact_sheets/School_exclusion_table/ 4. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-impetigo.htm 5. https://www.mja.com.au/journal/2014/200/2/managing-and-preventing-outbreaks-communicable-diseases-childcare-and-school

Switching to perindopril 5mg daily and addressing constipation is the most appropriate next step. Differential considerations include diuretic-induced electrolyte imbalance, hypothyroidism, and primary aldosteronism. ACE inhibitors can effectively lower BP without exacerbating constipation or hypokalemia. A) Increasing hydrochlorothiazide may worsen hypokalemia and constipation. B) Verapamil can worsen constipation. C) Indapamide may still cause hypokalemia. E) Adding spironolactone without addressing the primary issue is inappropriate.

The most appropriate action for the GP in this situation is to offer support and guidance to the teenager. The GP should establish a trusting relationship with the teenager and explore their concerns and needs. Discussing the potential risks and consequences of drug use is important, but it should be done in a non-judgmental and supportive manner. Confronting the teenager about drug use or arranging a drug test without their consent is likely to damage the relationship and make it more difficult to engage the teenager in treatment. Referral to a specialist mental health service may be necessary if the teenager is experiencing significant emotional or behavioral problems.

Correct answer: Anna's presentation suggests Paget disease of the nipple, often associated with underlying breast cancer. A punch biopsy is necessary to confirm the diagnosis. Differential diagnoses include: 1) Paget disease of the nipple, 2) Eczema, 3) Psoriasis, 4) Contact dermatitis, 5) Inflammatory breast cancer, 6) Nipple candidiasis, 7) Seborrheic dermatitis. A - Topical steroids are not effective for Paget disease. B - Imaging is useful but biopsy is definitive. D - Antifungals are not indicated. E - Self-examinations do not address the underlying issue.

Correct answer is- Aromatase excess syndrome. Elevated estradiol and low testosterone with gynecomastia suggest increased conversion of androgens to estrogens. Differential diagnoses include: 1) Klinefelter syndrome - presents with small testes, elevated FSH/LH, and low testosterone. 2) Hyperprolactinemia - causes low testosterone but elevated prolactin. 3) Androgen insensitivity syndrome - presents with female phenotype despite XY karyotype. 4) Congenital adrenal hyperplasia - presents with virilization, not gynecomastia. 5) Testicular tumor - may secrete estrogens causing gynecomastia. 6) Liver disease - impaired estrogen metabolism causing gynecomastia. 7) Drug-induced gynecomastia - caused by medications affecting hormone levels. A) is incorrect due to normal FSH/LH. C) is unlikely without elevated prolactin. D) is incorrect due to male phenotype. E) is unlikely due to lack of virilization.

Correct Answer : Referring the patient to a trauma-informed mental health specialist is crucial for addressing complex psychological and trauma-related issues. Differential Diagnoses: 1. PTSD; 2. Complex trauma; 3. Substance use disorder; 4. Anxiety disorders; 5. Mood disorders; 6. Psychosomatic symptoms; 7. Depression. Incorrect Answers: A) While trauma-informed care is crucial, addressing her immediate psychological needs through specialist referral is a priority. B) Treating symptoms and substance abuse should follow comprehensive psychological support and trauma-informed care. C) Physical examination is part of the process but should follow specialized psychological assessment and support. D) Immediate counseling is important but should be complemented by referral to a trauma-informed specialist.

Correct answer is- Refer to a behavior change program. Such programs are specifically designed to help individuals address and change violent behavior. Differential diagnoses include: 1) Intermittent explosive disorder - characterized by sudden aggressive outbursts. 2) Substance abuse - can exacerbate aggressive behavior. 3) Depression - can manifest as irritability and aggression. 4) Anxiety disorders - can contribute to irritability. 5) PTSD - can cause anger and aggression. 6) Bipolar disorder - can cause mood swings and aggression. 7) Personality disorders - can contribute to relationship issues. A) is not the primary intervention. B) is not the first step without further assessment. D) is not appropriate without addressing individual behavior. E) may be helpful but is not the primary intervention.

Hydrocele is characterized by a smooth, transilluminable swelling in the scrotum. Epididymal cyst is separate from the testis and also transilluminates. Spermatocele is similar to an epididymal cyst but may contain sperm. Varicocele is a "worm-like" mass and does not transilluminate. Testicular cancer is a firm mass within the testis and does not transilluminate. Differential diagnoses include hydrocele, epididymal cyst, spermatocele, varicocele, testicular cancer, scrotal hernia, and infection.

The correct answer is- Chemotherapy to induce remission. Chemotherapy is the primary treatment to induce remission in ALL. Differential diagnoses include iron deficiency anemia, chronic fatigue syndrome, viral infection, depression, aplastic anemia, infectious mononucleosis, and autoimmune hemolytic anemia.

Providing dietary advice, recommending increased fluids and fiber, and considering osmotic laxatives is the most appropriate initial management. Differential diagnoses include: 1) Functional constipation, 2) Hirschsprung's disease, 3) Hypothyroidism, 4) Celiac disease, 5) Cow's milk protein allergy, 6) Spinal cord abnormality, 7) Anal fissure. Sarah's presentation is consistent with functional constipation. A) X-ray is not routinely indicated for uncomplicated constipation. C) Specialist referral is not necessary as the first step. D) Stimulant laxatives are not first-line for chronic constipation in children. E) Withholding food is inappropriate and potentially harmful.

For a squamous cell carcinoma with a non-healing ulcerative appearance, early excision with a 3-5 mm margin is the most appropriate treatment. Cryotherapy, topical 5-fluorouracil, imiquimod, and photodynamic therapy are less appropriate for invasive SCCs, especially in sun-exposed areas. Differentials include basal cell carcinoma, actinic keratosis, keratoacanthoma, and chronic dermatitis.

Correct Answer : Immediate basic life support and decontamination are crucial given the collapse and unresponsiveness, combined with recent chemical exposure. Differential Diagnoses: 1. Chemical poisoning; 2. Asthma exacerbation; 3. Anaphylaxis; 4. Hypovolemic shock; 5. Respiratory arrest; 6. Cardiac arrest; 7. Sepsis. Incorrect Answers: B) IV fluids and steroids are not the initial priorities for an unresponsive child. C) Nebulized bronchodilators are not appropriate for a child in collapse. D) Waiting for chemical exposure results is inadequate in an emergency setting. E) Specialist referral is not appropriate before stabilizing and decontaminating the child.

Epigastric hernia; refer for surgical evaluation is the most likely diagnosis and appropriate management. Differential diagnoses include: 1) Umbilical hernia, 2) Omphalomesenteric duct remnant, 3) Urachal cyst, 4) Diastasis recti, 5) Lipoma, 6) Abdominal wall hematoma, 7) Rectus sheath hematoma. Epigastric hernias are unlikely to close spontaneously and may cause pain. A) Umbilical hernias are below the umbilicus and often resolve spontaneously. B) Omphalomesenteric duct remnants are typically at the umbilicus. C) Urachal cysts are usually lower on the abdomen. E) Diastasis recti is a separation of the rectus muscles, not a hernia.

The most likely underlying cause of her stroke is a cardioembolic source, possibly related to her history of deep vein thrombosis. Therefore, the most appropriate investigation to reveal the underlying cause of her stroke is anticardiolipin antibody. Anticardiolipin antibodies are a type of antiphospholipid antibody that can cause thrombosis and are associated with an increased risk of stroke. Patients with a history of deep vein thrombosis, like this patient, are at increased risk for the development of anticardiolipin antibodies. Testing for the presence of anticardiolipin antibodies can help confirm the diagnosis of antiphospholipid syndrome, which is an important cause of thrombotic events, including stroke. While the patient’s history of migraine and joint pains raise the possibility of an underlying autoimmune disorder, such as systemic lupus erythematosus, the presence of anticardiolipin antibodies is a more specific and relevant investigation in the context of her recent stroke.

Coeliac disease is the most likely diagnosis, considering the combination of short stature, poor weight gain, pallor, and distended abdomen. Iron deficiency anemia is a common cause of pallor but does not explain the growth failure or abdominal findings. Crohn’s disease could present similarly but usually includes symptoms like diarrhea and abdominal pain. Chronic kidney disease might cause anemia and growth retardation but typically presents with other systemic signs. Hypothyroidism could cause fatigue and growth failure but does not usually present with a distended abdomen. Differential diagnoses: Coeliac disease, Crohn's disease, Chronic kidney disease, Hypothyroidism, Protein-losing enteropathy, Iron deficiency anemia, Malabsorption syndrome.

The correct answer is- Mental health issues are common and treatable. Emphasizing the treatability of mental health issues can help reduce stigma and encourage the patient to seek help. Differential diagnoses include depression, anxiety disorder, fibromyalgia, chronic fatigue syndrome, adjustment disorder, and somatic symptom disorder.

Oesophageal spasm should be considered given the chest pain precipitated by eating hot or cold foods and relieved by nitroglycerin. Gastro-oesophageal reflux disease and myocardial infarction typically do not have this pattern. Costochondritis and psychogenic chest pain have different characteristics. Oesophageal spasm can mimic cardiac pain and may be relieved by nitrates.

Implementing smoking cessation strategies, starting antihypertensive and statin therapy, and providing lifestyle advice is the most appropriate initial management plan. Differential considerations include white coat hypertension, familial hypercholesterolemia, and chronic kidney disease. This comprehensive approach addresses multiple risk factors in a high-risk individual. A) and B) Addressing single risk factors is inadequate for this high-risk patient. D) Stress ECG is not routinely indicated for asymptomatic individuals. E) Coronary angiography is not appropriate without symptoms or evidence of ischemia.

Post-surgical changes from hernia repair surgery are the most likely cause of reduced sperm motility. Klinefelter syndrome would show other symptoms and abnormalities. Hormonal imbalance would need further evaluation with hormonal tests. Genetic abnormalities would typically be investigated with specific testing. Autoimmune response is less likely without additional symptoms or history. Differential diagnoses include post-surgical infertility, varicocele, retrograde ejaculation, obstructive azoospermia, infection-related damage, testicular trauma, and ejaculatory duct obstruction.

Irbesartan is most likely causing the hyperkalaemia due to its potassium-sparing effect, which can lead to elevated potassium levels, especially when combined with chronic kidney disease.

Correct Answer : To determine if Alex can consent independently, assess his maturity, understanding of the procedure, ability to express his wishes, and overall decision-making capacity. Differential Diagnoses: 1. Gillick competence; 2. Age of consent laws; 3. Understanding of medical risks; 4. Decision-making ability; 5. Parental consent laws; 6. Legal requirements for consent; 7. Emotional and cognitive maturity. Incorrect Answers: B) Parental consent is important but does not replace assessing the adolescent’s capacity to consent. C) Legal age and schooling are part of the assessment but not sufficient alone. D) The medical condition and necessity are relevant but should be considered alongside the adolescent’s consent capacity. E) Understanding risks is important, but full decision-making ability and maturity must also be evaluated.

Offering women a choice between clinician-collected or self-collected HPV tests is crucial for increasing participation in cervical screening, especially in populations like Aboriginal and Torres Strait Islander women who may have lower participation rates.

Patient education is crucial in the management of alcohol abuse. The GP should provide information about the risks of alcohol abuse, set realistic goals for reducing alcohol consumption, develop a personalized treatment plan, and encourage support from family and friends. The GP should also empower the patient to make informed decisions about their alcohol use.

Reducing alcohol intake and quitting smoking are key lifestyle changes for managing hypertension. Increasing dietary sodium would exacerbate hypertension. Regular exercise and a healthy diet are critical first-line strategies for hypertension management. Starting home BP monitoring is important but secondary to initial lifestyle changes. Scheduling follow-up without changes does not address immediate management needs. Differential diagnoses include Lifestyle changes for hypertension, Sodium intake for dietary impact, Exercise and diet for lifestyle management, Monitoring for BP management, and Follow-up for ongoing care.

Herpes zoster (shingles) is characterized by severe, burning pain and vesicular lesions in a dermatomal distribution. Differential diagnoses include temporomandibular joint dysfunction, maxillary sinusitis, dental abscess, trigeminal neuralgia, glossopharyngeal neuralgia, and erysipelas.

Correct answer: Max's symptoms are indicative of dyslexia, a specific learning disorder characterized by difficulties in reading and spelling with otherwise normal intelligence. Referral to a dyslexia clinic is essential for a comprehensive assessment and management plan. Differential diagnoses include: 1) Dyslexia, 2) Specific Learning Disorder with Impairment in Reading, 3) ADHD, 4) Visual Processing Disorder, 5) Auditory Processing Disorder, 6) Intellectual Disability, 7) Anxiety Disorder. B - Speech therapy is not typically indicated for dyslexia. C - A psychological assessment might be useful but is not the primary step. D - Delaying further evaluation might postpone necessary interventions. E - Occupational therapy is not directly indicated for dyslexia.

Correct answer is- Excisional biopsy with narrow margins. This is necessary to rule out malignant melanoma. Differential diagnoses include basal cell carcinoma, seborrhoeic keratosis, dysplastic nevus, lentigo maligna, dermatofibroma, blue nevus, and pigmented basal cell carcinoma. A) Observation is not appropriate for suspicious lesions. B) Cryotherapy is not suitable for pigmented lesions. C) Curettage is not adequate for diagnosis. E) Corticosteroids are not indicated.

Chronic Obstructive Pulmonary Disease (COPD) . is suggested by chronic dyspnoea, productive cough, history of smoking, and use of accessory muscles for breathing. These are characteristic features of COPD. Asthma, bronchiectasis, idiopathic pulmonary fibrosis, and heart failure have different symptom profiles. Differential diagnoses include COPD, chronic bronchitis, emphysema, asthma, and lung cancer.

The correct answer is- Evidence of impaired professional performance. Reporting should be based on evidence that the colleague's behavior is affecting their professional duties and patient safety. Differential diagnoses include stress-related behavior, substance use disorder, burnout, depression, anxiety, personal coping mechanisms, and recreational use without impairment.

The description of the eruption fits best with bullous impetigo, although this usually occurs in children. Staphylococcus aureus is the most common causative organism, although Streptococcus pyogenes can also be responsible for non-bullous impetigo. E. coli is not expected to cause skin infection. Pseudomonas may be found as a coloniser in chronic wounds but does not cause primary cutaneous infection in immunocompetent individuals. Varicella zoster virus causes chickenpox and subsequently shingles, neither of which fit the clinical picture described here. In Australia, proper antibiotic treatment is needed to manage impetigo and prevent transmission, especially in community settings like schools.

The information indicates that Aboriginal and Torres Strait Islander peoples have a higher incidence of lung cancer compared to non-Indigenous people. While other cancers like breast, colorectal, and prostate cancer are also important, lung cancer has a particularly higher incidence in this population.

Correct answer is- Apply permethrin 5% cream to the whole body. Permethrin is the first-line treatment for scabies, applied to the entire body to eliminate mites. Differential diagnoses include: 1) Atopic dermatitis - typically associated with a visible rash and itch. 2) Contact dermatitis - localized rash due to allergen exposure. 3) Lichen planus - presents with purple, pruritic papules. 4) Urticaria - presents with wheals and itching. 5) Dermographism - can cause pruritus with wheals after scratching. 6) Drug reaction - can cause pruritus with or without rash. 7) Psoriasis - causes scaly plaques, not papular rash. B) is supportive but not primary treatment. C) is not indicated for scabies. D) is supportive but not primary treatment. E) is used for crusted scabies, not typical cases.

Delirium tremens is the most likely diagnosis given the confusion, agitation, and visual hallucinations in a patient with a history of alcohol abuse. Differential diagnoses include Wernicke's encephalopathy, hepatic encephalopathy, acute psychosis, and other causes of delirium. Urgent management with benzodiazepines and thiamine supplementation is indicated.

A semen analysis primarily assesses sperm count, but sperm motility, morphology, and seminal fluid volume are also evaluated. Differential evaluations include: 1) Sperm morphology - assessed, but not the only focus. 2) Sperm motility - assessed, but not singularly. 3) Sperm count - primary parameter but includes overall evaluation. 4) Seminal fluid volume - important but also includes motility and morphology.

A combination of psychological therapy and antidepressant medication is the most appropriate initial management for postnatal depression. Psychological therapies, such as cognitive-behavioral therapy (CBT) or interpersonal therapy, can help the patient to identify and challenge negative thoughts and behaviors. Antidepressant medication can be effective in reducing symptoms of depression. Supportive counseling can provide emotional support and practical advice. Referral to a mental health specialist may be necessary for patients with severe or complex cases of postnatal depression.

Basal cell carcinoma is the most likely diagnosis, especially given the chronic, non-healing ulcer with a raised white margin and the history of prolonged sun exposure in Australia. This type of skin cancer commonly presents with similar features.

Central Retinal Vein Occlusion is the most likely diagnosis given the sudden, painless vision loss and fundoscopic findings of multiple retinal hemorrhages and disc swelling in a patient with vascular risk factors. Differential diagnoses include central retinal artery occlusion, diabetic retinopathy, hypertensive retinopathy, ischemic optic neuropathy, and ocular ischemic syndrome. Urgent referral for ophthalmological evaluation and management is necessary.

There are a number of resources available to support children who have been sexually abused, including child protection services, child sexual abuse helplines, mental health services, and support groups. The GP can refer the child and family to these resources and provide information about the benefits of seeking additional support.

Vitamin C deficiency (scurvy) is the most likely diagnosis given the bleeding gums and dietary history lacking in fresh fruits and vegetables. Haemophilia and von Willebrand disease are inherited bleeding disorders. Idiopathic thrombocytopenic purpura and Henoch-Schönlein purpura have different presentations. Vitamin C deficiency can lead to weakened blood vessels and bleeding symptoms.

Calculating absolute cardiovascular risk, performing 24-hour ABPM, and initiating comprehensive cardiovascular risk reduction is the most appropriate initial approach. Differential diagnoses include essential hypertension, white coat hypertension, chronic kidney disease, and metabolic syndrome. This approach provides a comprehensive assessment of cardiovascular risk and confirms the diagnosis of hypertension while addressing multiple risk factors. A) Starting medication immediately may lead to overtreatment if white coat hypertension is present. B) Lifestyle modifications alone are insufficient given the multiple risk factors. D) Renal ultrasound is not routinely indicated without specific renal concerns. E) Cardiology referral is not necessary at this stage.

The most appropriate initial management strategy is to initiate magnesium sulfate and antihypertensives . Magnesium sulfate is crucial for managing pre-eclampsia and preventing seizures, and antihypertensives are used to manage severe hypertension. ACE inhibitors are contraindicated in pregnancy. Calcium-channel blockers may be used but are not the first-line. Diuretics are generally not recommended due to potential complications. Beta blockers can be used but are not the primary choice. Differential diagnoses include Magnesium sulfate for pre-eclampsia, ACE inhibitors as contraindicated, Calcium-channel blockers for additional control, Diuretics for pregnancy complications, and Beta blockers for secondary management.

Milia; provide reassurance and explain self-resolving nature is the most likely diagnosis and appropriate management. Differential diagnoses include: 1) Neonatal acne, 2) Miliaria crystallina, 3) Congenital candidiasis, 4) Sebaceous hyperplasia, 5) Epstein pearls, 6) Transient neonatal pustular melanosis, 7) Neonatal cephalic pustulosis. Milia are common, benign, and self-resolving in neonates. A) Neonatal acne typically appears later and is more inflammatory. B) Miliaria crystallina presents as clear vesicles. C) Congenital candidiasis typically presents at birth with different morphology. E) Extraction is not recommended for milia in neonates.

Using a larger cuff size is crucial for accurate BP measurement in patients with larger arm circumferences. Measuring BP in both arms is useful for accuracy but secondary. Recording the highest reading is not a standard practice. Allowing the patient to rest is important but does not address cuff size issues directly. Checking the device calibration is important for accuracy but secondary to using the correct cuff size. Differential diagnoses include Larger cuff size for accurate measurement, BP in both arms for consistency, Highest reading for monitoring, Rest period for stability, and Device calibration for accuracy.

Correct answer: Postmenopausal bleeding with increased endometrial thickness warrants an endometrial biopsy to rule out malignancy. Differential diagnoses include: 1) Endometrial cancer, 2) Endometrial hyperplasia, 3) Atrophic vaginitis, 4) Uterine fibroids, 5) Polyp, 6) Hormonal imbalance, 7) Cervical cancer. A - Continuing HRT without investigation is inappropriate. B - Monitoring without action is inappropriate. C - Cervical screening does not assess the endometrium. E - Chemotherapy is not indicated without diagnosis.

Starting oral iron supplementation, sodium bicarbonate, and calcitriol, and referring to a nephrologist for comprehensive CKD management is the most appropriate strategy. Differential considerations include renal anemia, metabolic acidosis, and CKD-mineral bone disorder. This approach addresses multiple aspects of advanced CKD management. A) Starting ESA without addressing iron status is premature. C) IV iron is not first-line without trial of oral iron. D) Transfusion is not indicated for chronic, stable anemia. E) Calcium carbonate alone doesn't address all aspects of CKD-MBD.

Explanation: It is crucial to communicate clearly with the patient about the urgency of further investigation for the nodule, given its potential link to prostate cancer. Transparency about the possible seriousness and the need for urgent referral ensures that the patient understands the importance of prompt action and avoids misunderstandings. Ignoring or downplaying the finding would be inappropriate and could lead to missed diagnosis and treatment delays. Differential diagnoses include benign prostatic hyperplasia, prostatitis, prostate cancer, cysts, abscesses, calcifications, and other prostatic abnormalities.

This man has established coronary artery disease and so it is inappropriate to use a cardiovascular primary prevention risk tool. References: 1. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/red-book/prevention-of-vascular-and-metabolic-disease 2. https://www.mja.com.au/journal/2018/209/4/absolute-cardiovascular-disease-risk-and-lipid-lowering-therapy-australia 3. https://www.bmj.com/content/361/bmj.k2137 4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31053-0/fulltext 5. https://www.nejm.org/doi/full/10.1056/NEJMo

Interferon-gamma release assay (IGRA) is the most appropriate initial investigation given the weight loss, fever, night sweats, and history of recent immigration from a high-tuberculosis burden country. Differential diagnoses include tuberculosis, other chronic infections, malignancy, inflammatory bowel disease, and endocrine disorders. A chest X-ray and further investigations may be necessary based on the IGRA result and clinical presentation.

Correct answer: Bronchoscopy and biopsy are necessary to diagnose the nature of the lung mass, likely due to a smoking history. Differential diagnoses include: 1) Lung cancer, 2) Tuberculosis, 3) Pneumonia, 4) Pulmonary embolism, 5) Sarcoidosis, 6) Chronic obstructive pulmonary disease, 7) Lung abscess. A - Antibiotics are not indicated without infection. B - CT scan is useful but biopsy provides diagnosis. D - Smoking cessation is important but not immediate. E - PET scan is for staging, not initial diagnosis.

Heart Failure . is indicated by orthopnoea, paroxysmal nocturnal dyspnoea, and peripheral edema, especially in a patient with a history of ischemic heart disease. These are classic symptoms of heart failure. Asthma, COPD, pulmonary fibrosis, and lung cancer have different presentations. Differential diagnoses include heart failure, COPD, pulmonary edema, chronic kidney disease, and liver cirrhosis.

There are a number of resources available to support teenagers who are struggling with drug use, including schools, youth organizations, mental health services, and drug and alcohol treatment services. The GP can provide information about these resources and help the teenager access the support they need.

The appropriate management for a patient with chronic sinusitis, diffuse nasal polyps, and a history of recurrent infections is to prescribe a short course of oral corticosteroids along with intranasal corticosteroids. This approach helps reduce inflammation and polyp size, improving symptoms. Differential diagnoses include allergic fungal sinusitis, chronic rhinosinusitis with nasal polyps, vasomotor rhinitis, dental infection, deviated septum, chronic otitis media, and nasal septal perforation.

Inadequate caloric intake due to feeding difficulties is the most likely cause in this case, as the history of picky eating and a drop in percentile without other significant medical findings suggests that the child may not be receiving enough calories. Coeliac disease and chronic liver disease would typically present with other symptoms such as diarrhea, jaundice, or malabsorption. Congenital heart disease and hyperthyroidism would usually present with other systemic signs like tachycardia or hyperactivity. Differential diagnoses: Coeliac disease, Chronic liver disease, Congenital heart disease, Hyperthyroidism, Gastroesophageal reflux, Feeding difficulties, Behavioral feeding issues.

Haemophilia A or B is the most likely diagnosis given the frequent nosebleeds, easy bruising, and family history of a bleeding disorder in male relatives, which suggests a sex-linked recessive pattern. Von Willebrand disease is autosomal dominant and affects both genders. Vitamin C deficiency, idiopathic thrombocytopenic purpura, and Henoch-Schönlein purpura have different presentations. Haemophilia typically presents with bleeding in males due to its X-linked inheritance.

Patient consent can be automatically assumed by receipt of the insurers’ request