mksap

This content is excerpted from MKSAP with permission from the American College of Physicians (ACP).

MKSAP: 74-year-old woman with peripheral arterial disease

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Conditions

September 3, 2016

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A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. …

MKSAP: 57-year-old man with substernal chest pain

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Conditions

August 27, 2016

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A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as …

MKSAP: 61-year-old man with generalized weakness

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Conditions

August 20, 2016

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A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years.

On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and respiration rate …

MKSAP: 62-year-old man is evaluated for declining exercise capacity

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Conditions

August 13, 2016

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A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. …

MKSAP: 26-year-old woman with recurrent feelings of fear and anxiety

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Conditions

August 6, 2016

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A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the episodes as …

MKSAP: 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia

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Conditions

July 30, 2016

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A 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia of several weeks’ duration. She had otherwise felt well until the onset of her current symptoms. Medical history is significant for autoimmune pancreatitis diagnosed 1 year ago, treated with a prednisone taper that was completed 8 months ago with resolution of her …

MKSAP: 66-year-old man with polyuria and polydipsia

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Conditions

July 23, 2016

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A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random …

MKSAP: 28-year-old man exposed to pulmonary tuberculosis

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Conditions

July 16, 2016

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A 28-year-old man is evaluated after being informed his roommate at a homeless shelter was diagnosed with pulmonary tuberculosis. He reports no fever, cough, night sweats, or weight loss. Medical history is significant for injection drug use, most recently 2 weeks ago, although he reports no known infectious complications in the past. Medical history is …

MKSAP: 52-year-old man is evaluated for low back pain

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Conditions

July 9, 2016

A 52-year-old man is evaluated for low back pain of 3 months’ duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and …

MKSAP: 86-year-old woman with pain

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Conditions

July 2, 2016

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An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is unable to …

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MKSAP: 86-year-old woman with pain

MKSAP: 52-year-old woman with type 2 diabetes mellitus

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Conditions

June 25, 2016

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A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg (7 lb) …

MKSAP: 68-year-old woman with dyspepsia

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Conditions

June 18, 2016

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A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B₁₂.

On physical examination, vital signs are normal, as is the remainder of the physical examination.

Upper endoscopy discloses a 6-mm polyp in the body of the …

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MKSAP: 68-year-old woman with dyspepsia

MKSAP: 54-year-old man with fatigue

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Conditions

June 11, 2016

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A 54-year-old man is evaluated because of fatigue. He also notes constipation and cold intolerance. Medical history is significant for tonsillar squamous cell carcinoma treated with radiation 3 years ago. There is no family history of thyroid disorders.

On physical examination, the skin is dry. Mild periorbital edema is present. The thyroid is of …

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MKSAP: 54-year-old man with fatigue

MKSAP: 32-year-old man with a rash on his face and midchest

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Conditions

June 4, 2016

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A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well.

Medical history is significant for a recent diagnosis …

MKSAP: 44-year-old man with type 2 diabetes mellitus

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Conditions

May 28, 2016

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A 44-year-old man is evaluated for management of type 2 diabetes mellitus. He was diagnosed with diabetes 6 months ago after being admitted to the hospital with diabetic ketoacidosis. He was discharged from the hospital on a basal and preprandial insulin regimen. Medications are regular insulin before meals and neutral protamine Hagedorn (NPH) …

MKSAP: 58-year-old man asks for advice on cardiac risk assessment

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Conditions

May 21, 2016

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A 58-year-old man is evaluated during a routine appointment and asks for advice on cardiac risk assessment. He does not have any current cardiac symptoms, exercises 4 days per week, and has never smoked. He has no chronic health issues and takes no medications. He has no known drug allergies. Results of the physical examination …

MKSAP: 52-year-old man with rheumatoid arthritis

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Conditions

May 14, 2016

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A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing stairs due …

MKSAP: 61-year-old woman with progressive dyspnea and fatigue

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Conditions

May 7, 2016

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A 61-year-old woman is evaluated for a 4-month history of progressive dyspnea and fatigue without chest pain. Eighteen months ago, she was diagnosed with liver cirrhosis due to nonalcoholic steatohepatitis (NASH). Medical history is also significant for obesity. Medications are propranolol, spironolactone, and lactulose.

On physical examination, temperature is 36.4 °C (97.5 °F), blood …

MKSAP: 50-year-old man with increasing urinary frequency and urgency

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Conditions

April 30, 2016

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A 50-year-old man is evaluated for a 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of urinary hesitancy or incomplete emptying. The patient has primary progressive multiple sclerosis. Medications are dalfampridine and vitamin D.

On physical evaluation, temperature is 36.8 °C (98.2 °F), blood pressure is 120/55 mm …

MKSAP: 55-year-old man is evaluated following a screening for type 2 diabetes mellitus

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Conditions

April 23, 2016

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A 55-year-old man is evaluated following a screening for type 2 diabetes mellitus. He is asymptomatic. He has a history of hypertension and hyperlipidemia. There is no history of anemia, liver disease, or kidney disease. Medications are lisinopril and rosuvastatin.

On physical examination, blood pressure is 123/76 mm Hg and pulse rate is 72/min. …