mksap

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

MKSAP: 77-year-old woman with a left middle cerebral artery ischemic stroke

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Conditions

April 16, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 77-year-old woman is evaluated 4 months following a left middle cerebral artery ischemic stroke. The severity of her stroke required prolonged initial hospitalization and a 3-month stay in a rehabilitation center before returning home. Residual deficits include dense right-sided hemiparesis and dysphagia requiring oral feeding with thickened liquids. Medical history is otherwise significant for …

MKSAP: 30-year-old woman with right antecubital fossa and biceps pain

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Conditions

April 9, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications.

On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate is 120/min, and …

MKSAP: 32-year-old woman is evaluated for anticoagulation management

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Conditions

April 2, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks’ gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after delivery. Medical history …

MKSAP: 48-year-old woman with type 1 diabetes mellitus

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Conditions

March 26, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old woman returns for a follow-up visit for management of type 1 diabetes mellitus. She reports doing well since the last visit. Overall, she believes that most of her blood glucose levels are at goal, but is concerned about occasional episodes of hyperglycemia occurring in the morning before breakfast. She eats a bedtime snack …

MKSAP: 49-year-old man is evaluated during a routine examination

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Conditions

March 19, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 49-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his risk for cardiovascular disease. Medical history is notable for hypertension. He is a nonsmoker, and he works as an executive at a highly successful company. Family history is noncontributory. His only medication is hydrochlorothiazide.

On physical examination, the patient …

MKSAP: 55-year-old man with hepatitis C virus (HCV)

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Conditions

March 12, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated in follow-up after a recent routine screening for antibody to hepatitis C virus (HCV) was positive. His medical history is unremarkable; he has not used illicit drugs or had any history of blood transfusions. He currently feels well and takes no medications.

Vital signs and physical examination are normal.

Laboratory studies reveal …

MKSAP: 53-year-old woman with a skin lesion

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Conditions

March 5, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 53-year-old woman is evaluated for a slowly enlarging, telangiectatic, pearly, ulcerated 1-cm plaque on the left temple. It bleeds periodically when traumatized. Medical history is significant for atrial fibrillation. She takes warfarin daily. She is otherwise in good health.

On physical examination, vital signs are normal. Cardiac examination shows an irregular heart rate but is …

MKSAP: 42-year-old woman with palpitations

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Conditions

February 27, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 42-year-old woman is evaluated for episodes of palpitations that last several seconds in duration. They occur once or twice a month and are accompanied by lightheadedness and mild dyspnea. She has not experienced loss of consciousness. The episodes are not precipitated by any particular activity, including exercise. She takes no medications.

On physical examination, the …

MKSAP: 72-year-old man with acute swelling and severe pain of the right knee

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Conditions

February 20, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which he did not …

MKSAP: 61-year-old man with generalized weakness

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Conditions

February 13, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

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 is 16/min. …

MKSAP: 53-year-old man with right-sided facial weakness

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Conditions

February 6, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 53-year-old man is evaluated for persistent right-sided facial weakness. Three months ago, he first noticed “droopiness” of the right side of his lower face, difficulty closing the right eye and wrinkling the forehead, increased sensitivity to loud noises, and occasional slurred speech. Bell palsy was diagnosed, and he began a 10-day course of prednisone. …

MKSAP: 59-year-old woman with continued substernal chest pain

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Conditions

January 30, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle …

MKSAP: 68-year-old man with dyspnea on exertion

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Conditions

January 23, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old man is evaluated for a 3-year history of dyspnea on exertion. He experiences no headaches or blurred vision. Medical history is notable for a stroke 2 years ago. He is a smoker with an 80-pack-year smoking history. Medications are hydrochlorothiazide, lisinopril, aspirin, and simvastatin.

On physical examination temperature is 36.7 °C (98.0 °F), blood …

MKSAP: 50-year-old man with a large bleeding gastric ulcer

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Conditions

January 16, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen …

MKSAP: 72-year-old man with a laceration on his left index finger

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Conditions

January 9, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 72-year-old man sustains a laceration on his left index finger while preparing chicken. He immediately washes the area and applies neomycin and an occlusive bandage. He changes the bandage and reapplies the medication twice daily. Two days later, he develops itching and redness at the wound site. He has had no fever or other …

MKSAP: 48-year-old man with newly diagnosed hypertension

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Conditions

January 2, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old man with newly diagnosed hypertension is referred for an echocardiogram to assess findings of left ventricular hypertrophy noted on the electrocardiogram. He is asymptomatic, and his medical history is unremarkable other than hypertension. His only medication is chlorthalidone.

On physical examination, blood pressure is 128/70 mm Hg, pulse rate is 60/min and regular, and …

MKSAP: 21-year-old woman with a rash in the lower extremities

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Conditions

December 26, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some relief. History is …

MKSAP: 54-year-old man with a tremor

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Conditions

December 19, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old man is seen for follow-up evaluation of a tremor in his upper extremities that has been present since age 20 years. The tremor was mild for many years and did not interfere with his work but has become more prominent in recent years. He has difficulty writing and using utensils during meals. He …

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MKSAP: 54-year-old man with a tremor

MKSAP: 28-year-old woman with progressive dyspnea and fatigue

mksap

Conditions

December 12, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm Hg, pulse rate …

MKSAP: 60-year-old woman with gastroparesis

mksap

Conditions

December 5, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting …

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