Stroke Prevention in Atrial Fibrillation

A 68-year-old male presents for a routine check-up. He has a history of hypertension and well-controlled Type 2 Diabetes Mellitus. His pulse is irregular, and an ECG confirms new onset Atrial Fibrillation (AF). He has no other history of heart disease, stroke, or vascular disease. He is otherwise asymptomatic, what is the most appropriate step regarding stroke prevention for this patient?

A 60-year-old patient has recently been diagnosed with a form of Glomerulonephritis. The General Practitioner (GP) is collaborating with a specialist on the patient’s long-term management plan, which management area is primarily identified as belonging to the General Practitioner’s crucial role in the ongoing care of a patient with Glomerulonephritis?

ECG Recognition and Acute Management

You are posted as GP in a 3 days rural health camp, a 62-year-old female with no known cardiac history presents with 90 minutes of ongoing, severe, crushing central chest pain and diaphoresis. An immediate 12-lead ECG is performed and is shown above. Given the clinical presentation and the ECG findings, what is the single most urgent next step in the patient’s management?

A 34-year-old male is brought to the Emergency Department 2 days after sustaining a deep puncture wound to his right thigh while working on a farm. He complains of excruciating pain in the leg that has worsened significantly over the last 4 hours and now feels “unbearable.” On examination, the patient looks unwell and anxious. Vital Signs: Temperature: 39.2°C (102.6°F), Heart Rate: 125 bpm, Blood Pressure: 94/60 mmHg, Respiratory Rate: 24/min, O2 Saturation: 96% on room air. The right thigh is swollen, tense, and pale. There is a brownish serous discharge oozing from the wound site. The skin surrounding the wound feels cool to the touch. On palpation, distinct crepitus is felt in the soft tissues. The pain elicited during the examination appears disproportionate to the visible size of the wound. What is the most appropriate immediate management step?

A 66-year-old woman is 24 hours post-PCI for an anterior STEMI. She develops sudden onset of palpitations. The monitor shows a wide-complex tachycardia at a rate of 130 bpm. She is conscious, her BP is 125/80 mmHg, and she has no chest pain. What is the most appropriate management?

A 62-year-old male with Type 2 Diabetes (diagnosed 12 years ago) presents for review. His latest HbA1c is 7.8%, BP is 145/90 mmHg, and he is a current smoker. His eGFR is 55 mL/min/1.73m² and his urine ACR is 15 mg/mmol. He is not currently on any BP or lipid-lowering medication. What is his 5-year CVD risk category?

Now                                          10 months ago

A 75-year-old retired gardener presents with a non-healing sore on his cheek that has been slowly growing over the past 18 months. The lesion is approximately 1.5 cm in diameter, centrally ulcerated and crusted, and has a firm, raised, rolled border with visible telangiectasias around the periphery. The appearance is consistent with the image provided, What is the MOST appropriate initial diagnostic procedure for the General Practitioner?

A 45-year-old patient presents to your general practice with a newly noticed, solitary, pigmented lesion (8 mm diameter) on their forearm. Dermoscopy shows features highly suspicious for a Superficial Spreading Melanoma. The General Practitioner is planning the initial diagnostic procedure, which is the most appropriate initial biopsy technique for this lesion?

A 35-year-old woman is distressed by frequent “skipped beats.” A 24-hour Holter monitor confirms frequent Premature Ventricular Contractions (PVCs), accounting for 1% of total beats. She has no structural heart disease, and her symptoms improve with exercise. What is the most appropriate initial management?

A 32-year-old male presents to the Emergency Department with severe nausea, vomiting, and abdominal pain. He admits to consuming “cheap homemade alcohol” at a party 24 hours ago. He complains that his vision is blurry and mentions it looks like he is “standing in a snowstorm.” On examination, his pupils are dilated and sluggish. Fundoscopy reveals hyperemic optic disc edema. An arterial blood gas demonstrates severe metabolic acidosis.  which of the following factors is the strongest predictor of this patient’s final visual acuity outcome?

A 50-year-old female presents with a droopy left eyelid. You are considering the differential diagnosis. You note that the patient has miosis (constricted pupil) on the affected side, along with mild ptosis. There is no evidence of double vision or extraocular muscle weakness.  Based on these findings, which condition is the most likely cause of the ptosis?

A physician is evaluating a two-week-old infant with a newly detected cardiac murmur. According to the primary source, which action is most emphasized as the crucial initial step for the clinician in determining the distinction between an innocent (physiological) murmur and a pathological murmur?

A General Practitioner (GP) is evaluating a 9-year-old child for suspected Attention Deficit Hyperactivity Disorder (ADHD) based on reports from his parents and teacher. According to the core diagnostic criteria (DSM-5 adapted), which combination of elements is essential to confirm a diagnosis of ADHD in this child?

A 34-year-old woman presents to your general practice complaining of a 6-month history of “bad skin” on her face. She describes episodes of flushing that occur when she drinks red wine or exercises. On examination, there is persistent erythema on her nose and cheeks with multiple inflammatory papules and pustules. No comedones are visible. She has sensitive skin and reports a stinging sensation with most cosmetics. Which of the following is the most appropriate initial pharmacological management for this patient?

An 18-year-old patient presents with a new diagnosis of mild asthma, reporting infrequent, mild symptoms and no specific risk factors. What is the recommended initial treatment for this patient, moving away from reliance on Short-Acting Beta2 Agonists (SABA) alone?

A 62-year-old woman presents with intermittent “sharp” chest pain for two days. She has no cardiovascular risk factors and her ECG is normal. You calculate her 5-year CVD risk as low (<5%). She is anxious and requests a “heart scan.” Which imaging modality is most appropriate as the initial screening tool for this patient?

A 4-year-old child is brought to the general practitioner for a routine check-up. The child is asymptomatic, has normal vital signs, and is tracking well on all growth charts. On auscultation, the physician detects a soft, low-pitched, vibratory, Grade 2/6 systolic ejection murmur that is loudest at the left lower sternal border. The intensity of the murmur is noted to significantly decrease when the child changes position from supine to upright. which is the most appropriate diagnosis?

A 75-year-old man is 4 days post-STEMI. He suddenly develops severe shortness of breath and hypotension. Vitals: BP 85/50 mmHg, HR 110 bpm, SpO2 88% on 10L oxygen. On examination, there is a new, loud, harsh holosystolic murmur heard best at the lower left sternal border with a palpable thrill. What is the most likely complication?

A 58-year-old male, who works as a long-haul truck driver (Commercial license), presents to the Emergency Department with sudden onset of vertigo, diplopia, and mild right-sided weakness that resolved completely within 3 hours. He is diagnosed with a Transient Ischemic Attack (TIA). He has an otherwise unremarkable history. According to the Austroads Assessing Fitness to Drive guidelines, what is the minimum non-driving period before he can be considered for return to commercial driving?