mksap

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

MKSAP: 64-year-old woman with fever and chills

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Conditions

March 24, 2013

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

A 64-year-old woman is hospitalized for a 2-day history of fever and chills and a 1-day history of hypotension and dyspnea. Medical history is significant for adenocarcinoma of the colon diagnosed 3 weeks ago for which she had a partial colectomy. Her course was complicated by the development of a polymicrobial intra-abdominal abscess. After …

MKSAP: 65-year-old man with daytime somnolence

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Conditions

March 16, 2013

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

A 65-year-old man is evaluated for a 2-year history of daytime somnolence, snoring, and apneic episodes during the night as witnessed by his wife. He does not have blurred vision, tinnitus, or headache. He has no cardiopulmonary symptoms and does not smoke cigarettes. The patient has hypertension for which he takes lisinopril and atenolol.

On …

MKSAP: 54-year-old woman is evaluated during a routine examination

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Conditions

March 9, 2013

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

A 54-year-old woman is evaluated during a routine examination. She is very concerned by her lack of interest in sexual intercourse. The patient feels like she “just doesn’t want to be touched.” She used to enjoy intercourse and does not know why she feels this way now, but she acknowledges that it is causing …

MKSAP: 67-year-old woman with severe muscle weakness

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Conditions

February 24, 2013

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 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …

MKSAP: 28-year-old man with left calf deep venous thrombosis

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Conditions

February 23, 2013

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

A 28-year-old man is evaluated 24 hours after a new diagnosis of a left calf deep venous thrombosis. One week ago, he underwent orthopedic surgery. Two weeks ago, he returned from vacationing in Italy on an 8-hour flight. Current medications are enoxaparin, 80 mg subcutaneously twice daily, and warfarin, 5 mg/d.

On physical examination, temperature …

MKSAP: 76-year-old woman with dizziness, shortness of breath, and palpitations

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Conditions

February 17, 2013

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

A 76-year-old woman is evaluated in the emergency department for dizziness, shortness of breath, and palpitations that began acutely 1 hour ago. She has a history of hypertension and heart failure with preserved ejection fraction. Medications are hydrochlorothiazide, lisinopril, and aspirin.

On physical examination, she is afebrile, blood pressure is 80/60 mm Hg, pulse rate …

MKSAP: 20-year-old man with a 6-month history of low back pain

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Conditions

February 16, 2013

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

A 20-year-old man is evaluated for a 6-month history of low back pain accompanied by prolonged morning stiffness. His symptoms improve over the course of the day, but he is now unable to play recreational soccer. Rest, physical therapy, and acupuncture have not improved his symptoms. Use of ibuprofen or diclofenac provides only partial …

MKSAP: 71-year-old man with new dyspnea on exertion

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Meds

January 27, 2013

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

A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide …

MKSAP: 38-year-old man with ulcerative colitis

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Conditions

January 26, 2013

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

A 38-year-old man is evaluated during a routine examination. He was diagnosed with ulcerative colitis 10 years ago and is currently asymptomatic. His last colonoscopy, performed at the time of diagnosis, showed mildly active extensive colitis extending to the hepatic flexure. There is no family history of colon cancer or colon polyps. His only …

MKSAP: 27-year-old woman is evaluated for a 4-week history of wheals

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Conditions

January 20, 2013

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 4-week history of wheals, characterized by a burning sensation without pruritus. Each individual lesion persists for 48 hours and slowly resolves, leaving a bruise. Current medications are diphenhydramine, hydroxyzine, cetirizine, and oral contraceptives. The patient’s mother has systemic lupus erythematosus.

On physical examination, vital signs are normal. She …

MKSAP: 67-year-old woman is transferred to the ICU

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Meds

January 19, 2013

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

A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year history of type 2 diabetes mellitus.

Her blood glucose level on arrival at the ICU is 289 mg/dL (16.0 mmol/L). Although no longer on a cardiopulmonary bypass pump, she remains intubated …

MKSAP: 50-year-old man with Parkinson disease

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Conditions

December 29, 2012

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

A 50-year-old man is seen for a new-patient evaluation. He reports a recent diagnosis of Parkinson disease made after a 2-year history of stiffness in his right arm, a tendency to posture when walking, an awkward and stiffly inverted step when using the right leg, but no tremor. During this period, his voice became …

MKSAP: 65-year-old man with headaches and blurred vision

mksap

Conditions

December 16, 2012

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

A 65-year-old man is evaluated for a 1-month history of headaches and blurred vision, early satiety, and itching that occurs after showering. He has a 90-pack-year smoking history. He has no history of cardiopulmonary or sleep disorders, no other medical problems, and he takes no medications.

On physical examination, temperature is normal, blood pressure is …

MKSAP: 62-year-old man is evaluated during a routine examination

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Conditions

December 15, 2012

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 examination. Medical history is significant for a myocardial infarction 3 years ago, dyslipidemia, hypertension, tobacco use, and drinking two alcoholic drinks per day. Medications are an ACE inhibitor, a statin, a β-blocker, and aspirin. He participates in cardiac rehabilitation, exercising four to five times per week.

On …

MKSAP: 42-year-old with pain and swelling of the knee

mksap

Conditions

December 9, 2012

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

A 42-year-old woman is evaluated for recurring pain and swelling of the left knee and right ankle that began 5 months ago. At that time, she also had an episode of conjunctivitis as well as dysuria, both of which resolved spontaneously. The joint pain and …

MKSAP: 68-year-old woman with type 2 diabetes mellitus

mksap

Conditions

December 8, 2012

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

A 68-year-old woman comes to the office for a follow-up evaluation. She has had type 2 diabetes mellitus for the past 13 years and has experienced two early-morning hypoglycemic episodes in the past 3 months.

Although her self-monitoring of fasting blood glucose levels over the past …

MKSAP: 42-year-old man with elevated liver chemistry tests

mksap

Conditions

December 2, 2012

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

A 42-year-old man is evaluated in follow-up for elevated liver chemistry tests. He is asymptomatic. He has a 6-year history of type 2 diabetes mellitus, hyperlipidemia, and hypertension. His current medications are metformin, simvastatin, and lisinopril. He does not drink alcohol.

On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 130/74 mm …

MKSAP: 46-year-old woman with an intensely pruritic rash

mksap

Conditions

December 1, 2012

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

A 46-year-old woman is evaluated for a 4-day history of an intensely pruritic rash on her face and neck. She started using a new facial moisturizer about 1 week before the onset of the rash. She has stopped using the moisturizer, but the rash has persisted. She has treated the rash with calamine lotion …

MKSAP: 24-year-old man with aplastic anemia

mksap

Conditions

November 18, 2012

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

A 24-year-old man undergoes follow-up evaluation for treatment of aplastic anemia. Two of his siblings are HLA-identical matches.

Laboratory studies:

Hemoglobin	8.3 g/dL (83 g/L) (following transfusion of 1 unit of irradiated packed erythrocytes last week)
Leukocyte count	500/µL (0.5 × 10⁹/L) with 23% neutrophils, 3% band forms, and 71% lymphocytes
Platelet count	26,000/µL (26 × 10⁹/L)
Reticulocyte count	0.2%

Review of the bone …

MKSAP: 38-year-old man is evaluated during a routine health examination

mksap

Conditions

November 17, 2012

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

A 38-year-old man is evaluated during a routine health examination. He exercises two or three days each week by jogging for 30 minutes without shortness of breath or chest discomfort. During stressful emotional situations, he occasionally feels “skipped heart beats” but has not had prolonged palpitations, presyncope, or syncope. He generally feels in good …

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