mksap

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

MKSAP: 35-year-old man with nonproductive cough and fever

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Conditions

March 15, 2014

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

A 35-year-old man is evaluated for a 2-week history of nonproductive cough and fever. He has a 20-year history of asthma. Three weeks ago, he visited friends in Indiana. He has no dyspnea, hemoptysis, or worsening of his baseline asthma symptoms. His only medication is an albuterol inhaler as needed.

On physical examination, …

MKSAP: 43-year-old man with severe abdominal pain

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Conditions

March 8, 2014

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

A 43-year-old man is evaluated in the hospital for severe abdominal pain of 2 days’ duration. He is otherwise healthy except for the recent finding of pancytopenia. Family history is noncontributory. His only medication is a daily multivitamin. Following a physical exam and lab results, what test is most likely to establish …

MKSAP: 32-year-old woman with chronic fatigue syndrome

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Conditions

February 22, 2014

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

A 32-year-old woman is evaluated following a diagnosis of chronic fatigue syndrome. She has a several-year history of chronic disabling fatigue, unrefreshing sleep, muscle and joint pain, and headache.

A comprehensive evaluation has not identified any other medical condition, and a screen for depression is normal. Her only medications are multiple vitamins and …

MKSAP: 50-year-old man is evaluated for persistent heartburn

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Conditions

February 15, 2014

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

A 50-year-old man is evaluated for persistent heartburn and regurgitation despite taking a high-dose proton-pump inhibitor twice a day for 6 months. His symptoms have improved, but he continues to have symptoms many times a week. He has not had dysphagia, chest pain or weight loss. He has significantly modified his diet. …

MKSAP: 33-year-old woman with amenorrhea and galactorrhea

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Conditions

February 8, 2014

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

A 33-year-old woman is evaluated for a 5-month history of amenorrhea and a 3-month history of galactorrhea. The patient says her menstrual cycles were normal before onset of amenorrhea. She takes no medication.

On physical examination, vital signs are normal. Visual field findings are normal. Bilateral galactorrhea is noted.

Results of laboratory studies show …

MKSAP: 72-year-old man with diffuse, intractable itching

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Conditions

January 25, 2014

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

A 72-year-old man is evaluated for a 3- to 4-month history of diffuse, intractable itching involving most of the body. He uses emollients regularly. He cannot identify any precipitating causes. He was relatively healthy before the onset of the itch but now feels chronically fatigued. The itch is relentless. He has used …

MKSAP: 68-year-old man with exertional chest pain

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Conditions

January 12, 2014

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

A 68-year-old man is evaluated for exertional chest pain of 3 months’ duration. He describes the chest pain as pressure in the midsternal area with no radiation that occurs with walking one to two blocks and resolves with rest or sublingual nitroglycerin. No symptoms have occurred at rest. Medical history is significant …

MKSAP: 76-year-old woman with left knee pain

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Conditions

January 4, 2014

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

A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. …

MKSAP: 70-year-old man with night sweats, weight loss, and cough

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Conditions

December 21, 2013

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

A 70-year-old man is evaluated for a 3-month history of night sweats, weight loss, and increasing cough. He is a retired miner, and his medical history is significant for a diagnosis of pulmonary silicosis made 15 years ago based on exposure history and characteristic chest radiographic findings. He is a lifelong nonsmoker.

On …

MKSAP: 74-year-old woman with fatigue, anorexia, and weight loss

mksap

Conditions

December 7, 2013

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

A 74-year-old woman is evaluated for a 2-month history of fatigue, anorexia, and a 6-kg (13.2-lb) weight loss. She was treated with chemotherapy for ovarian cancer 6 months ago. She also has hypertension managed with hydrochlorothiazide.

On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 132/75 mm Hg without postural …

MKSAP: 33-year-old woman with whitish spots in the mouth and throat

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Conditions

November 30, 2013

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

A 33-year-old woman is evaluated for a 5-week history of whitish spots in the mouth and the back of the throat and discomfort with swallowing solid foods. This is her first episode of these symptoms. She has had no mouth pain, trouble ingesting liquids or pills, nausea, vomiting, diarrhea, fever, chills, sweats, …

MKSAP: 35-year-old pregnant woman with a history of pulmonary embolism

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Conditions

November 23, 2013

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

A 35-year-old woman undergoes evaluation after home pregnancy testing indicated that she is pregnant. Her medical history includes a previous idiopathic pulmonary embolism. Her only medication is a daily prenatal vitamin.

On physical examination, temperature is 36.2 °C (97.1 °F), blood pressure is 110/65 mm Hg, pulse rate is 70/min, and respiration rate …

MKSAP: 61-year-old woman with hot flushes

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Conditions

November 16, 2013

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

A 61-year-old woman is evaluated for hot flushes, which have been persistent for the last 10 years. They occur at least 7 times per day, last for approximately 60 seconds, and are associated with severe sweating, palpitations, and occasional nausea. She is awakened several times per night. She has tried herbal medications, …

MKSAP: 32-year-old woman with progressive jaundice

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Conditions

November 9, 2013

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

A 32-year-old woman is evaluated for a 10-day history of malaise, right upper quadrant discomfort, and progressive jaundice. She has had no recent travel outside of the United States, does not drink alcohol, and has no recent ingestions of drugs, including acetaminophen or herbal remedies. Up until this time, she has …

MKSAP: 38-year-old woman with increasing fatigue and weight gain

mksap

Conditions

November 2, 2013

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

A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning pituitary macroadenoma, followed 4 months later by radiation therapy because of residual tumor. She started taking hydrocortisone 14 months ago after adrenal insufficiency was diagnosed. The patient developed amenorrhea 1 …

MKSAP: 32-year-old woman is evaluated for a pruritic rash

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Conditions

October 19, 2013

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

A 32-year-old woman is evaluated for a recurrent pruritic rash on her hands. She works as a dental hygienist and notices that it improves when she goes on vacation. Topical corticosteroids alleviate the rash, but it quickly recurs.

On physical examination, she has scaling, erythematous patches on her dorsal hands, fingers, and wrists. She has …

MKSAP: 31-year-old woman with cyanotic congenital heart disease

mksap

Conditions

October 12, 2013

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

A 31-year-old woman with cyanotic congenital heart disease is evaluated during a routine examination. She has Down syndrome and is accompanied by her guardian. She has never had cardiac surgery and has no symptoms.

Her blood pressure is 110/80 mm Hg bilaterally. The cardiac apex is displaced. A left parasternal impulse is present. There is …

MKSAP: 56-year-old woman with Sjögren syndrome

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Conditions

October 5, 2013

A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids.

On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid …

MKSAP: 45-year-old man with a daily cough

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Conditions

September 28, 2013

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

A 45-year-old man is evaluated for a 6-month history of increasing daily cough, sputum production, and dyspnea on exertion. He has been employed as a coal miner for 10 years. He has never smoked and does not have a history of diabetes mellitus, hypertension, or hyperlipidemia. His family history is negative for cardiopulmonary disease.

On …

MKSAP: 47-year-old woman with severe fatigue

mksap

Conditions

September 21, 2013

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

A 47-year-old woman is evaluated for a 6-month history of severe fatigue in the afternoon that is often disabling. The patient has a 15-year history of multiple sclerosis. She states that her mood is good and that she is not feeling depressed or sad. She describes no problems with her sleep, and her partner …

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