Mr. Adams, a 60-year-old man, presents with sudden onset of severe dyspnoea, a history of smoking, and cough with hemoptysis. On examination, he has decreased breath sounds and hyperresonance on percussion. What is the most likely diagnosis?

Dr. Johnson is evaluating 7-year-old Amy, who presents with severe anxiety, delayed speech, and a withdrawn demeanor. Her mother reports that Amy has been increasingly aggressive at school and has difficulty making friends. What is the most appropriate initial step for Dr. Johnson to take?

Dr. Taylor is visiting a palliative care patient with pancreatic cancer whose family is requesting more morphine to stop his breathing. Dr. Taylor is considering the ethical implications of the family’s request to increase morphine and is assessing the patient’s symptoms. What is the significance of Cheyne-Stokes respiration in this context?

A 61-year-old man with advanced pancreatic cancer is being cared for at home. Six months ago, he was diagnosed with pancreatic cancer after presenting with painless obstructive jaundice. Despite being referred urgently, surgery was not an option due to the cancer’s advanced stage. His family was distressed, believing that the Medicare had denied treatment for financial reasons. After a faith healer’s intervention, his jaundice temporarily improved, and he seemed to recover slightly. However, the cancer progressed, and he is now again experiencing jaundice, with increased pain and nausea. Current Situation: Pain management has been through oral morphine, but with escalating symptoms, Macmillan nurses have now set up a syringe driver with anti-emetics and diamorphine for better control. The GP arrives at the patient’s home to find the family gathered, with the patient’s wife in tears. The patient appears peaceful and comfortable, although he is visibly jaundiced. His pulse is steady at 68 beats per minute, blood pressure is 118/74 mmHg, and his breathing is irregular, with occasional deep breaths. The patient does not actively respond but squeezes the GP’s hand when prompted. Family Concerns: The oldest son demands more morphine to relieve his father’s suffering, threatening to adjust the syringe driver himself if the request is not met. What are the potential psychological impacts of caring for a dying loved one on the family?

Dr. Laura Green is evaluating a 55-year-old man, David, with a 6-month history of unilateral nasal obstruction, occasional epistaxis, and facial pain. He has no history of allergies. On examination, you note a unilateral grey mass in the right nasal cavity. What is the most appropriate next step in management?

Dr. Williams is treating a 60-year-old man with depression and urinary incontinence. He has just recovered from an acute myocardial infarction. Now 6 months post-radical prostatectomy, presents with persistent urinary incontinence despite pelvic floor exercises and negative urine tests. He has withdrawn socially and is experiencing symptoms of depression. Following his myocardial infarction, the patient’s depression improves as he gains physical strength and stops smoking. What should be assessed regularly to manage his cardiovascular risk effectively?

Dr. White is reviewing a 53-year-old man with well-controlled hypertension on atenolol and bendroflumethiazide. The patient requests a change to ACE inhibitors and statins based on recent articles. What is the most appropriate response?

Ms. Martinez, a 45-year-old woman, presents with a large ulcer on the medial side of her lower leg. The ulcer has a moist base with a yellowish slough and is accompanied by significant leg swelling. She has a history of varicose veins. What is the most appropriate initial management for this type of ulcer?

Emily, a 7-year-old girl, presents with a history of persistent abdominal pain, weight loss, and blood in her stool. Her parents are concerned and ask if she needs further tests. What is the most appropriate next step?

Billy, an active 11-year-old from a busy family, is brought in by his mother with vague symptoms: decreased appetite, increased tiredness, and worsening school performance. His medical history includes typical childhood ailments but no serious conditions. His mother, who has chronic anxiety and depression and is on citalopram, is known to you.
Billy appears generally lively and alert but looks slightly pale compared to his healthy mother. He is apprehensive about the stethoscope and anxious about potential injections. No significant findings are noted during the examination, and you suspect his symptoms might be related to his mother’s anxiety rather than a serious illness.
You recommend a blood test despite Billy’s reluctance due to his fear of needles and his mother’s concerns about its necessity. You convince them to proceed and schedule a follow-up for the next week. The following day, the lab results come in: haemoglobin is 9.5 g/dL, leucocyte count is 24 x 10^9/L, and the morphology suggests acute lymphoblastic leukaemia. What is the prognosis for Billy?

An 8-year-old boy is brought to his GP by his mother after school. He has been feeling unwell for the past 3 days, with intermittent mild headaches, achy limbs, and a slight fever but no vomiting or diarrhoea. Today, he developed a bright red rash on both cheeks while at school. His teacher noticed the rash but did not think it required immediate attention. The boy had contact with a family friend who had similar symptoms about 2 weeks ago. He has had chickenpox and is up to date with all his vaccinations. His mother is worried about him missing school, especially since he has a major role in an upcoming play and is busy with rehearsals. He has a healthy younger sister and the family generally only visits the doctor for vaccinations and check-ups.
The boy has a bright red rash on both cheeks. He is alert and seems well, though a bit tired, with a temperature of 37.6°C. His throat and ears are normal, he has no additional rash, and both chest and abdominal examinations are normal with no neck stiffness. What is the most likely diagnosis?

Dr. Patel is evaluating an 18-month-old infant with depigmented patches on the chest and abdomen. Dr. Patel is considering the management of pityriasis versicolor in the infant and is assessing the bruises on the infant’s shins. What is the most likely explanation for these bruises?

A 6-year-old boy is brought back to the GP by his mother, following a visit a week ago for an acute, widespread rash. At that time, the rash was diagnosed as allergic, with no specific trigger identified, and he was treated with an antihistamine. His mother reports no improvement and notes that he has been playing a lot in the garden due to unseasonably warm weather, but he has no history of hay fever, asthma, or eczema. He hasn’t eaten anything unusual or changed his soap or detergent. No one else in the family or their social circle has a similar rash, and he has no other symptoms, although the rash is slightly itchy.
The boy appears well and has no fever. The rash covers his trunk and, to a lesser extent, his limbs. It consists of oval patches, 1–3 cm in size, some with mild scaling along their edges, and seems to follow the skin creases. His mother recalls that one of the patches appeared on his chest about 5 days before the rash spread. What is the most likely diagnosis?

Dr. Adams is assessing a 50-year-old woman, Lisa, who presents with intense itching and burning of the vulva. She reports that the area feels dry and she has noticed some whitening of the skin around her genital area. Lisa is concerned as her mother had a similar condition and developed vulvar cancer. What is the most appropriate action to take?

Dr. Olivia Turner sees a 35-year-old woman who complains of intense itching and rash around her elbows and knees. She reports that the rash appeared after starting a new laundry detergent. The rash is primarily excoriated and eczematous. What is the most appropriate management?

Ms. Davis, a 50-year-old woman, presents with localized pain and swelling after being bitten by a red-back spider. She has no systemic symptoms and the bite area is swollen but not significantly necrotic. What is the most appropriate treatment?

Dr. Evans is addressing the patient’s concern about tongue cancer. What is the most appropriate reassurance to provide?

A 22-year-old woman from Brisbane presents with intense itching and pain in her right ear that has gradually worsened over several days. She reports hearing difficulties and is an avid surfer. Examination reveals debris in the right ear canal and an obscured tympanic membrane with pain on earlobe traction. What is the most likely diagnosis?

Dr. Patel, practicing in Brisbane, sees Mr. O’Connor, a 60-year-old man with a history of diabetes, who complains of sudden hearing loss in his left ear. He has no pain or discharge. What investigation would be most useful in this case?

Dr. Williams is assessing a 50-year-old man with a history of alcohol use who presents with epigastric pain radiating to the back and elevated lipase levels. What is the most likely diagnosis?

Dr. Smith is considering the next step after initial examination and blood tests. What is the most appropriate action?

Dr. Michael Green evaluates a 25-year-old woman, Susan, who presents with acute onset of severe right lower quadrant pain. She is sexually active and her last menstrual period was 6 weeks ago. On examination, she has guarding and rebound tenderness in the right lower quadrant. What is the most appropriate next step in managing Susan’s condition?

A 70-year-old man asks you about the benefits of colonoscopy for colorectal cancer screening. You explain that the Red Book, a GP resource, considers some tests unsuitable for low-risk populations. Which principle is the Red Book applying in this context?

What is the rationale for starting methotrexate and folic acid in the treatment of this patient’s condition?

Dr. Williams is evaluating a 51-year-old woman with joint pain and morning stiffness. Her rheumatoid factor is negative, but anti-CCP is positive. What does this indicate?

Dr. David Smith sees 45-year-old Carla, who presents with dyspareunia characterized by pain at the vaginal opening and deep pain during intercourse. Carla is postmenopausal and reports that the pain has been worsening over the past year. What is the most appropriate initial management for Carla?

Dr. Lisa Moore evaluates 34-year-old Maria, who has been trying to conceive for over a year. She reports irregular menstrual cycles and mild hirsutism. Her partner’s semen analysis shows normal sperm count and motility. What is the most likely cause of Maria’s infertility?

Dr. Michael Green evaluates a 25-year-old woman, Susan, who presents with acute onset of severe right lower quadrant pain. She is sexually active and her last menstrual period was 6 weeks ago. On examination, she has guarding and rebound tenderness in the right lower quadrant. What is the most appropriate next step in managing Susan’s condition?

Dr. Martinez examines a 28-year-old man, Mr. Johnson, who presents with a ring-shaped rash with a central clearing on his arm. He reports that he recently returned from a rural area where he was exposed to animals. What is the most appropriate initial treatment for his condition?

Dr. Michael Green evaluates a 5-year-old girl, Mia, who presents with a rash, fever, and joint pain. Her parents report recent travel to a rural area. On examination, Mia has a maculopapular rash and swollen joints. What is the most appropriate next step in managing Mia’s condition?

Dr. Brown evaluates 55-year-old Ms. Carter, who presents with increasing shortness of breath, a persistent dry cough, and a history of recent travel to a high-altitude location. Her physical exam reveals tachycardia and decreased breath sounds on auscultation. What is the most likely diagnosis?

Dr. Patel is preparing a 5-year-old boy, Jake, for a family trip to South America. Jake has a history of egg allergy. Which vaccination should be approached with caution due to his allergy?

Greg, a 55-year-old man, reports a sudden loss of vision in one eye after a head injury. He notices flashes and black spots and has difficulty seeing through a dark shadow that progresses centrally. What is the appropriate management step?

Dr. Sarah is evaluating a 40-year-old woman, Lisa, who presents with unilateral leg swelling and pain after a recent long-haul flight. She has no significant past medical history. On examination, her left calf is swollen, warm, and tender. A Doppler ultrasound confirms a deep vein thrombosis (DVT) in the left popliteal vein. What is the most appropriate initial treatment for Lisa?

Dr. Wilson is evaluating a 50-year-old woman with a rib fracture sustained from a fall. She reports severe pain on deep inspiration and localized tenderness over the rib cage. What is the most appropriate initial management for this rib fracture?

Dr. Taylor is evaluating a 29-year-old builder with penile sores and systemic symptoms after sexual intercourse with his ex-wife, during which his foreskin tore and bled. Following this, he noticed redness, itching, and wetness on his penis. He also developed headaches, muscle aches, general malaise, and intermittent shivers. Additionally, he experiences irritation in the urethra during and after urination but has not seen any penile discharge. Dr. Taylor thinks it is genital herpes and is addressing the patient’s concern about transmission. What advice should be given regarding sexual activity?

Dr. Lee evaluates a 35-year-old woman named Sarah who presents with symptoms of dizziness, severe right lower abdominal pain, and a history of infertility treatments. On examination, she is in significant distress, with signs of circulatory collapse. What is the most appropriate management?

Dr. Smith is educating a patient with sarcoidosis about the prognosis. What is an important point to convey?

Dr. Brown evaluates a 6-year-old child with snoring, mouth breathing, and daytime hyperactivity. On examination, there are enlarged tonsils. What is the most appropriate management?

Dr. Taylor is counseling a 21-year-old woman after a miscarriage at 8 weeks gestation. She is looking upset and slightly tearful. She explains that she recently experienced a miscarriage at 8 weeks of pregnancy. Although the pregnancy was unplanned, both she and her boyfriend were excited when they found out and are now deeply saddened by the loss. Her mother, who has three other adult children, is also saddened but is more philosophical about the situation, though she was looking forward to another grandchild. Dr. Taylor was unaware of the pregnancy until now and notes that the patient had seen a locum three weeks ago, who had referred her to the local antenatal clinic after confirming the pregnancy.
A few days before the current appointment, the patient started experiencing light bleeding, which escalated to uterine cramps and heavy bleeding with large clots, lasting about six hours overnight. The following morning, her mother took her to the hospital’s Accident and Emergency Department, where she was sent to the early pregnancy assessment unit and diagnosed with a miscarriage. The bleeding has since subsided, and there are no signs of infection or incomplete miscarriage.
The patient is concerned about why the miscarriage occurred and whether there might be something wrong with her or her boyfriend. She worries about whether she will be able to have a baby in the future and if her running or having sex the night before the bleeding started could have caused the miscarriage.
The patient reports being in good health, and this was her first pregnancy. She has been fully immunised, does not smoke, and drinks alcohol moderately (around 10 units per week), while her partner smokes occasionally and drinks about 21 units a week. Dr. Taylor notes that because the miscarriage occurred before 12 weeks, she will not need Anti-D, even if she is Rhesus negative.
On examination, she has a normal weight with a body mass index of 23, and her blood pressure is 110/68 mmHg. Her abdominal examination is unremarkable. What is the most likely cause of this early miscarriage?

A 21-year-old woman, accompanied by her mother, visits the GP looking upset and slightly tearful. She explains that she recently experienced a miscarriage at 8 weeks of pregnancy. Although the pregnancy was unplanned, both she and her boyfriend were excited when they found out and are now deeply saddened by the loss. Her mother, who has three other adult children, is also saddened but is more philosophical about the situation, though she was looking forward to another grandchild. The GP was unaware of the pregnancy until now and notes that the patient had seen a locum three weeks ago, who had referred her to the local antenatal clinic after confirming the pregnancy.
A few days before the current appointment, the patient started experiencing light bleeding, which escalated to uterine cramps and heavy bleeding with large clots, lasting about six hours overnight. The following morning, her mother took her to the hospital’s Accident and Emergency Department, where she was sent to the early pregnancy assessment unit and diagnosed with a miscarriage. The bleeding has since subsided, and there are no signs of infection or incomplete miscarriage.
The patient is concerned about why the miscarriage occurred and whether there might be something wrong with her or her boyfriend. She worries about whether she will be able to have a baby in the future and if her running or having sex the night before the bleeding started could have caused the miscarriage.
The patient reports being in good health, and this was her first pregnancy. She has been fully immunised, does not smoke, and drinks alcohol moderately (around 10 units per week), while her partner smokes occasionally and drinks about 21 units a week. The GP notes that because the miscarriage occurred before 12 weeks, she will not need Anti-D, even if she is Rhesus negative.
On examination, she has a normal weight with a body mass index of 23, and her blood pressure is 110/68 mmHg. Her abdominal examination is unremarkable. What are the potential complications of obesity?

Dr. Taylor is visiting a palliative care patient with pancreatic cancer whose family is requesting more morphine to stop his breathing. Dr. Taylor is considering the ethical implications of the family’s request to increase morphine. What principle should guide the GP’s decision?

Dr. White is treating a 70-year-old patient, Mr. Clark, who is experiencing significant dyspnoea due to terminal lung cancer. He is currently on morphine for pain relief. What is the most appropriate additional treatment for managing his dyspnoea?

Dr. Patel is evaluating a 68-year-old Afro-Caribbean man with an eGFR of 53 mL/min. and is explaining the implications of an eGFR result to the patient. Dr. Patel is considering repeating the blood test for eGFR and is reviewing the patient’s medication. Why is this important in the context of CKD?

Dr. Johnson is evaluating a 65-year-old woman with sudden onset of generalized stiffness, particularly in her thighs and shoulders, lasting over an hour in the morning. What is the most likely diagnosis?

Dr. Emily Turner is evaluating a 58-year-old Aboriginal woman, Sarah, with type 2 diabetes and hypertension. Sarah’s recent blood tests show eGFR 45 mL/min/1.73m2 and urine ACR 80 mg/mmol. Her BP is 152/94 mmHg on perindopril 5mg daily. HbA1c is 8.2%. She reports increasing fatigue and nocturia. What is the most appropriate next step in management?

A 15-year-old girl is brought to the GP by her mother, who is concerned about her daughter’s noticeable weight loss and pale appearance over the past few weeks. The girl is typically reserved and often wears baggy clothes during visits, leading the GP to suspect a potential eating disorder in the past, although this has always been denied by both the girl and her mother. Her body mass index (BMI) has hovered around 19, but she now appears thinner than ever before. The girl lives with her parents and younger brother on a local estate and has no history of serious illness, though she has visited the GP for minor ailments like sore throats and colds.
The GP has previously been frustrated by the lack of progress in understanding the underlying issues, even bringing the case to clinical meetings without resolution. Initially, the GP assumes that the girl’s weight loss is due to a worsening of the suspected eating disorder. However, upon further questioning, the GP is surprised when the girl mentions that she has been feeling extremely thirsty and needing to urinate frequently, even waking up at night to go to the toilet. What investigations are necessary to confirm the diagnosis?

Dr. Laura Smith is assessing a 55-year-old male who presents with generalized itching and reports that the itching worsens after taking hot showers. He has also experienced unexplained weight loss and night sweats over the past few months. Which systemic condition is most likely responsible for his pruritus?

Dr. Evans is evaluating a 6-week-old baby with a suspected squint and a family history of squint. Initially, the baby’s eyes did wander, which is normal in newborns, but now the parents have observed that while the baby’s right eye can focus, the left eye tends to turn inward. The baby was born prematurely at 36 weeks following a long labour and spent a few days in the Special Care Baby Unit before being discharged in good health. The baby has been bottle-fed due to the mother’s struggle with breastfeeding, compounded by her postnatal depression. Dr. Evans is performing an eye examination on the baby. Which test is used to assess the alignment of the eyes?

Susan, a 62-year-old woman, reports gradual worsening of her vision, with central vision becoming increasingly blurry over several months. On examination, she has normal peripheral vision but distorted central vision. What is the likely diagnosis?

Dr. Patel is evaluating a 35-year-old woman with a history of Coeliac disease who presents with fatigue and iron deficiency anemia. What is the most likely cause of her symptoms?

A 68-year-old woman in Australia notices a lump in her neck that has been present for 2 months. She feels otherwise well but has palpable small lymph nodes in the cervical, axillary, and inguinal regions. Her blood tests show elevated white cell count with increased lymphocytes and sparse cytoplasm. What is the most likely diagnosis?

Ms. Johnson is evaluating Mr. Liew, a 30-year-old refugee from Myanmar, who presents with fatigue, pallor, and mild jaundice. He has no significant past medical history and denies alcohol use. His blood tests show elevated ALT and AST, with a positive HBsAg. What is the most appropriate next step in management?

Dr. Green is assessing a 55-year-old patient, Sarah, who presents with chest pain and a history of GERD. What investigation can help assess for oesophageal causes of chest pain?

Dr. Johnson is treating a 70-year-old patient, Lisa, who presents with chest pain and suspected aortic dissection. What investigation is most sensitive for this condition?

Dr. Patel is assessing a 45-year-old patient, Emily, who experiences chest pain during exercise. What investigation is most appropriate to define the cardiac origin of the pain?

Dr. Smith evaluates 60-year-old Helen who presents with persistent vaginal discharge and irritation. She has a history of diabetes and is using tampons regularly. What is the most appropriate next step in her management?

A 68-year-old Afro-Caribbean man comes to the clinic for a routine visit. He is anxious after receiving a letter from the surgery about abnormal blood test results indicating Stage 3 Chronic Kidney Disease (CKD). He shares that his mother had kidney disease and required dialysis before she passed away. The GP reviews his medical history and notes that the blood test was part of routine monitoring for his blood pressure treatment. The patient’s blood pressure has been well-controlled with ramipril, and all readings have been below the target of 135/80 mmHg. His prescription records show regular refills of ramipril every 8 weeks. The GP confirms that his blood pressure was first diagnosed 15 years ago and that there are no other recorded medical problems. The patient’s records indicate a family history of diabetes but no details about his mother’s blood pressure. The GP explains that while his previous blood tests showed normal kidney function,  the estimated glomerular filtration rate (eGFR), now indicates a result of 53. An eGFR below 60 is classified as Stage 3 CKD. According to guidelines, patients with CKD Stage 3 or higher should be referred to a kidney specialist. The GP asks if the patient agrees to a referral to a kidney specialist for further evaluation and management. What is the most appropriate action for the GP in this situation?

A 73-year-old man visits his GP with complaints of sleep disruption due to frequent urination at night. Over the past year, he has needed to get up four to five times each night to urinate, struggles to fall back asleep, and feels he cannot completely empty his bladder. He also experiences a delay in starting urination, a weak urine stream with dribbling, and urgency to find a toilet quickly. He has been avoiding long car trips and locating public toilets in town to manage his symptoms.
A rectal examination reveals an enlarged, smooth prostate with a diminished central sulcus, but no tenderness. The GP diagnoses benign prostatic enlargement, which is common with age and not indicative of cancer. The doctor discusses the diagnosis, plans to arrange blood tests, and provides medication to alleviate symptoms, along with a leaflet explaining the condition.
As the patient is about to leave, he mentions a persistent sore on his tongue. The GP reviews the records and finds a note from four weeks ago indicating a “suspicious-looking ulcer on the lateral border of the tongue” in a patient who has smoked a pipe for 40 years. The note suggests a review in two weeks and possible urgent referral if the ulcer does not improve. What is the role of patient education in the management of BPH?

Dr. Rachel Kim is providing care for a 35-year-old Rohingya refugee, Mr. Karim Ullah, who presents with fever, joint pain, and a rash. He has a history of untreated sore throats. What is the most likely diagnosis?