Post Author: mksap

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

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

MKSAP: 65-year-old man is evaluated after a recent colonoscopy

Conditions
November 28, 2015

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

A 65-year-old man is evaluated after a recent colonoscopy, which disclosed a 2.5-cm pedunculated polyp in the sigmoid colon. The polyp was removed in its entirety in a single piece. Biopsy results showed a well-differentiated adenocarcinoma confined to the submucosa without evidence of lymphovascular involvement and a 1-mm margin. There is no family history of …

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MKSAP: 52-year-old woman with a burning sensation on her forehead

Conditions
November 21, 2015

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

A 52-year-old woman had a burning sensation involving the right side of her forehead and the tip of her nose for 2 days, followed by increased redness and the development of lesions involving the tip of her nose. Medical history is significant for hypertension, and her only medication is ramipril.

On physical examination, vital signs are …

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Test your medicine knowledge: 62-year-old man is evaluated during a routine visit

Conditions
November 14, 2015

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

A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.

On physical examination, the patient is afebrile, blood pressure is 130/66 mm Hg, …

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Test your medicine knowledge: 59-year-old man with gout

Conditions
November 7, 2015

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

A 59-year-old man is evaluated for a 6-month history of gout. He was doing well on colchicine and allopurinol but developed hypersensitivity to allopurinol, which resolved with cessation of the agent. He then began to have more frequent gout flares; two flares occurred in the past month and were treated with prednisone. History is also …

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Test your medicine knowledge: 48-year-old woman with type 2 diabetes mellitus

Conditions
October 31, 2015

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

A 48-year-old woman is evaluated during a follow-up visit. She has a 5-year history of type 2 diabetes mellitus. She has no other significant medical history. Medications are atorvastatin, metformin, and a multivitamin. She works as a mail carrier and has a walking route that takes 3 hours each day. She consumes a diet high …

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Test your medicine knowledge: 67-year-old woman with increasing forgetfulness

Conditions
October 24, 2015

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

A 67-year-old woman is evaluated for a 1-year history of increasing forgetfulness. She reports greater difficulty keeping track of upcoming appointments, recalling details of recent telephone conversations, and remembering names of new acquaintances. She has completed 16 years of formal education, currently works as a teacher’s assistant, and has noticed no change in her ability …

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Test your medicine knowledge: 48-year-old woman with fatigue

Conditions
October 17, 2015

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

A 48-year-old woman is evaluated for fatigue and intermittent abdominal discomfort of 2 months’ duration and occasional dark urine. Medical and family histories are unremarkable. Her only medication is an oral contraceptive pill.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/74 mm Hg, pulse rate is 68/min, and respiration rate is …

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Test your medicine knowledge: 55-year-old man with elevated liver enzymes

Conditions
October 10, 2015

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

A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis.

On physical examination, vital signs are normal; BMI is 24. He …

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Test your medicine knowledge: 58-year-old man with type 2 diabetes

Conditions
October 3, 2015

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

A 58-year-old man is evaluated during a routine appointment. He is asymptomatic. He was diagnosed with type 2 diabetes mellitus 4 years ago and has hypertension, dyslipidemia, and obesity. His medications are enteric-coated low-dose aspirin, lisinopril, fluvastatin (20 mg/d), and metformin.

His calculated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohort Equations is …

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Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash

Conditions
September 26, 2015

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

A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. …

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Test your medicine knowledge: 33-year-old woman with atrial fibrillation

Conditions
September 19, 2015

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

A 33-year-old woman is evaluated as an outpatient following an episode of atrial fibrillation. The episode resolved shortly after she arrived at the emergency department. She has a history of tetralogy of Fallot with repair performed at the age of 4 years.

On physical examination, blood pressure is 110/70 mm Hg, pulse rate is 62/min and …

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Test your medicine knowledge: 22-year-old man with diarrhea and weight loss

Conditions
September 12, 2015

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

A 22-year-old man is evaluated for diarrhea and weight loss. The patient has a 3-week history of foul-smelling, large-volume, watery stools associated with abdominal bloating. There is no visible blood or mucus in the stools. He reports a 4.5-kg (10-lb) weight loss, which he attributes to a poor appetite. One month before …

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Test your medicine knowledge: 84-year-old man with cough and nasal congestion

Conditions
September 5, 2015

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

An 84-year-old man is evaluated for a 5-day history of rhinitis, nasal congestion, sneezing, and nonproductive cough. The symptoms began with a sore throat, which resolved after 24 hours. He has mild ear pain when blowing his nose or coughing. He has a history of coronary artery disease and hypertension. Medications are …

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A patient presents with painless diarrhea. What should you do next?

Conditions
August 29, 2015

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

A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena.

On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse …

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Test your medicine knowledge: 52-year-old man concerned about his weight

Conditions
August 22, 2015

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

A 52-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his weight. Medical history is significant for prediabetes and elevated cholesterol levels. He smokes one or two cigars a week. He drinks one or two alcoholic beverages a few nights each week. He does not get …

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What is the diagnosis in this woman with an enlarging neck mass?

Conditions
August 15, 2015

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

A 78-year-old woman is evaluated for a rapidly enlarging neck mass that has been present for 4 weeks and is associated with neck discomfort, dysphagia, and hoarseness. The patient has had Hashimoto thyroiditis and hypothyroidism since age 24 years and has been taking levothyroxine since that time.

Physical examination reveals an older woman …

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Test your medicine knowledge: 60-year-old asymptomatic man

Conditions
July 18, 2015

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

A 60-year-old asymptomatic man is evaluated during a routine examination. He has a long history of heart murmur. With normal daily activities, he has not experienced shortness of breath, chest discomfort, or palpitations.

Blood pressure is 138/78 mm Hg, pulse rate is 82/min and regular, and respiration rate is 16/min. BMI is 27. …

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Test your medicine knowledge: Reducing the personal risk of developing rheumatoid arthritis

Conditions
July 11, 2015

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

A 29-year-old woman is evaluated during a routine examination. She seeks advice in reducing her personal risk of developing rheumatoid arthritis, because her mother was recently diagnosed with the disorder. The patient is asymptomatic. She has a 10-pack-year history of smoking and consumes six alcoholic beverages per week, usually on weekends. She …

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Test your medicine knowledge: 40-year-old man with headache and epistaxis

Conditions
July 4, 2015

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

A 40-year-old man is admitted to the emergency department with a 1-day history of headache and epistaxis. He has had type 1 diabetes mellitus requiring insulin for 30 years and two episodes of ketoacidosis in the past year.

On physical examination, temperature is 36.0 °C (96.8 °F), blood pressure is 100/70 mm Hg, …

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