mksap

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

Test your medicine knowledge: 28-year-old man with recurrent headaches

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Conditions

June 13, 2015

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

A 28-year-old man is evaluated for a 5-year history of recurrent headache that occurs several times per month and lasts 12 to 24 hours. He describes the headache as a bilateral frontal pressure associated with nasal congestion and sensitivity to light, sound, and …

MKSAP: 53-year-old woman with swelling of the face, hands, and feet

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Conditions

May 30, 2015

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 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms.

On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration …

MKSAP: 25-year-old woman is evaluated for redness at mosquito bite

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Conditions

May 23, 2015

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

A 25-year-old woman is evaluated for redness that developed over her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 120/70 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. There …

MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue

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Conditions

May 3, 2015

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 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next?

On physical examination, vital signs are normal. Bilateral ptosis and diplopia are …

MKSAP: 38-year-old pregnant woman with hypertension and diabetes

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Conditions

April 26, 2015

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

A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at 16 weeks’ gestation with her first pregnancy. Prior to conception she was taking lisinopril, which was discontinued in anticipation of the pregnancy, and labetalol was initiated. Other medications …

MKSAP: 48-year-old woman with gradual weight gain

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Conditions

April 25, 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 routine examination. She is concerned about her gradual weight gain over the years and requests counseling on how she can most effectively lose weight.

Over 8 years, she has gained approximately 18 kg (40 lb). With several commercial diets, she has lost weight but always gains …

MKSAP: 46-year-old woman is evaluated before a dental cleaning

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Conditions

April 18, 2015

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

A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and …

MKSAP: 54-year-old woman with shortness of breath

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Conditions

April 12, 2015

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

A 54-year-old woman is evaluated for shortness of breath of 3 months’ duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is …

MKSAP: 28-year-old man with pain on the radial aspect of the right wrist

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Conditions

April 11, 2015

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

A 28-year-old man is evaluated for pain on the radial aspect of the right wrist that occurs with use of the thumb. The pain has been present for 2 weeks. He has never had this pain before and has not had any trauma. He works as a computer programmer and plays video …

MKSAP: 55-year-old man with gastroesophageal reflux symptoms

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Conditions

March 29, 2015

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

A 55-year-old man is evaluated for a 6-year history of typical gastroesophageal reflux symptoms treated on an as-needed basis with a proton pump inhibitor. However, the frequency of his reflux symptoms has recently increased and his episodes do not respond to treatment as completely as in the past. An upper endoscopy is …

MKSAP: 44-year-old man with a family history of diabetes

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Conditions

March 28, 2015

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

A 44-year-old man is evaluated during a routine examination. He is concerned about his general health and risk of diabetes mellitus. He has no medical problems. Both parents and his sister have type 2 diabetes mellitus.

On physical examination, temperature is normal, blood pressure is 130/79 mm Hg, pulse rate is 66/min, and …

MKSAP: 54-year-old woman asking advice about bone health

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Conditions

March 21, 2015

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

A 54-year-old woman comes to the office for advice regarding maintaining bone health. She has no history of fracture. The patient recently had a lumpectomy and radiation therapy to treat breast cancer, is currently taking tamoxifen, and will begin taking an aromatase inhibitor in 2 months. She underwent menopause at age 52 …

MKSAP: 66-year-old man with a persistent rash for 6 years’ duration

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Conditions

March 14, 2015

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

A 66-year-old man is evaluated for a persistent rash for 6 years’ duration. The rash waxes and wanes in severity, and it becomes pruritic only after he becomes hot and sweating, such as when he mows the lawn or exercises. It has always been limited to his back and lower chest. He …

MKSAP: 21-year-old male student is evaluated for a murmur

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Conditions

March 8, 2015

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

A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history is unremarkable and he takes no medications.

On physical examination, the patient is afebrile, blood pressure is 118/76 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. …

MKSAP: 60-year-old man with type 2 diabetes mellitus

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Conditions

March 7, 2015

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

A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. …

MKSAP: 23-year-old woman with stiffness and achiness of the hands

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Conditions

February 28, 2015

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

A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months ago, she experienced a sun-induced rash on the chest and back and patches of discoloration on the hands.

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

MKSAP: 58-year-old woman with Parkinson disease

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Conditions

February 14, 2015

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

A 58-year-old woman is seen for a follow-up evaluation of Parkinson disease, which she has had for 12 years. She was initially treated with ropinirole to which levodopa-carbidopa was added as the disease progressed. After 5 years of good control on medication, she began to experience involuntary generalized twisting and writhing movements …

MKSAP: 72-year-old man with dyspnea at rest

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Conditions

February 7, 2015

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

A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased …

MKSAP: 25-year-old woman comes for a preconception evaluation

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Conditions

January 24, 2015

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

A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …

MKSAP: 74-year-old man with fever and chills

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Conditions

January 17, 2015

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

A 74-year-old man is evaluated in the emergency department for a 3-day history of fever and chills as well as confusion. He has a 5-week history of a nonhealing ulcer on the plantar surface of his left foot. He has diabetes mellitus, hypertension, and peripheral vascular disease for which he takes metformin, …

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