mksap

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

MKSAP: 78-year-old man with poor glycemic control

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Conditions

November 11, 2012

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

A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery ward for 3 weeks with a nonhealing foot ulcer.

The patient has an extensive history of arteriosclerotic cardiovascular disease, including peripheral vascular disease, and a 20-year history of type 2 diabetes …

MKSAP: 70-year-old malnourished man with dementia

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Conditions

November 10, 2012

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

A 70-year-old malnourished man with a 4-year history of Alzheimer dementia is admitted to the intensive care unit from the emergency department for treatment of community-acquired pneumonia and impending respiratory failure. He is inattentive and confused and has a weak productive cough. His only medications are donepezil and memantine.

Temperature was 38.3 °C (101.0 °F), …

MKSAP: 25-year-old man with abnormal liver chemistry tests

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Conditions

November 4, 2012

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

A 25-year-old man is evaluated after being turned down as a blood donor because of abnormal liver chemistry tests. The patient is healthy, takes no medications, does not smoke, and drinks alcohol socially. His parents and siblings are alive and healthy; his maternal grandfather developed type 2 diabetes mellitus at age 75 years. The …

MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension

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Conditions

November 3, 2012

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

A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …

MKSAP: 40-year-old woman with a symmetrically distributed rash

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Conditions

October 7, 2012

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

A 40-year-old woman is evaluated for a 4-month history of symmetrically distributed, severely pruritic, grouped erosions on her elbows, knees, back, and buttocks. The skin lesions began as red spots that developed into papules and then vesicles, which broke down as she scratched them. She reports normal bowel habits. She has no other medical …

MKSAP: 72-year-old man is evaluated for fatigue and dyspnea

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Conditions

October 6, 2012

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

A 72-year-old man is evaluated for fatigue and dyspnea. Over the last several months to a year, he has had increasing fatigue, exercise intolerance, and dyspnea on even mild exertion. He becomes short of breath walking across a room, although he is asymptomatic at rest. He denies chest pain, palpitations, syncope, orthopnea, and lower …

MKSAP: 29-year-old woman with systemic lupus erythematosus (SLE)

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Conditions

September 2, 2012

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

A 29-year-old woman with systemic lupus erythematosus (SLE) is evaluated in the office after obtaining positive results on a home pregnancy test. She has a 1-month history of nausea but is otherwise asymptomatic. Her last menstrual period was 2 months ago. This is her first pregnancy. Her SLE is well controlled with hydroxychloroquine, and …

MKSAP: 27-year-old man with a 6-month history of cough

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Conditions

September 1, 2012

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

A 27-year-old man is evaluated for a 6-month history of cough, which is worse at night and after exposure to cold air. Often his cough is brought on by taking a deep breath or by laughter. He does not have postnasal drip, wheezing, or heartburn. He has a strong family history of allergies.

Physical examination, …

MKSAP: 53-year-old woman with a 4 month history of tremor

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Meds

August 19, 2012

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

A 53-year-old woman is evaluated in the office for a 4-month history of tremor. The tremor affects both upper extremities and is present “most of the time.” She has a 15-year history of type 2 diabetes mellitus; she also has a history of hypertension, gastroparesis, and chronic kidney disease. Medications are insulin glargine, insulin …

MKSAP: 62-year-old man with a 2 month history of progressive fatigue

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Conditions

August 18, 2012

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

A 62-year-old man is evaluated for a 2-month history of progressive fatigue, dyspnea on exertion, anorexia, and nausea. He has no other medical problems and takes no medications.

On physical examination, temperature is normal, blood pressure is 157/88 mm Hg, pulse rate is 86/min, and respiration rate is 22/min. BMI is 31. The conjunctivae are …

MKSAP: 37-year-old woman undergoes preoperative evaluation

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Conditions

August 5, 2012

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

A 37-year-old woman undergoes preoperative evaluation prior to a hysterectomy for worsening menstrual bleeding of several years’ duration caused by uterine fibroids. She has a recent history of recurrent epistaxis and bleeding after recent dental work but denies thromboembolism and a family history of unusual bleeding. The patient is otherwise healthy. Her only medication …

MKSAP: 38-year-old man with bilateral lower extremity paralysis

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Conditions

August 4, 2012

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

A 38-year-old man is admitted to the hospital for a 12-hour history of bilateral lower-extremity paralysis. The patient is an injection drug user. Over the past week, he developed lower back pain, which progressed to pain and numbness radiating down both lower extremities. On the day of admission, he was unable to walk but …

MKSAP: 79-year-old man with vertigo

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Conditions

July 21, 2012

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

A 79-year-old man is evaluated in the emergency department for vertigo that began suddenly about 1 hour ago, associated with severe nausea and vomiting. He noticed that he could not seem to sit up straight and could not walk without assistance. The patient denies confusion, motor weakness, hearing loss, dysarthria, diplopia, fever, or paresthesias. …

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MKSAP: 79-year-old man with vertigo

MKSAP: 25-year-old woman with bloating and abdominal cramping

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Conditions

July 15, 2012

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

A 25-year-old woman is evaluated for a 2-year history of almost daily bloating and lower abdominal cramping; the symptoms are associated with constipation, relieved with bowel movements, and seem worse when she is under stress. She has one or two small bowel movements a week and often has a feeling of incomplete evacuation. She …

MKSAP: 45-year-old woman is seen for diabetes follow-up

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Conditions

July 14, 2012

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

A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride. A daily injection of insulin glargine was added to her regimen 1 year ago.

At present, her hemoglobin A_1c value is 8.1%. Mean blood glucose values derived from the past 4 …

MKSAP: 38-year-old man with chronic cutaneous lupus erythematosus

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Conditions

July 7, 2012

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

A 38-year-old man is evaluated for an 18-month history of chronic cutaneous lupus erythematosus. He has lesions on his face and scalp. He has been using topical sunscreen, but he finds it difficult to remember to apply it before leaving for work. He is also being treated with a corticosteroid lotion, and hydroxychloroquine was …

MKSAP: 68-year-old woman with the sudden onset of severe pain

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Conditions

June 24, 2012

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

A 68-year-old woman is evaluated in the emergency department for the sudden onset of severe pain, which began 3 hours ago. The pain is in the middle of her chest and radiates to her back. Medical history includes hypertension treated with hydrochlorothiazide and lisinopril.

On physical examination, …

MKSAP: 62-year-old man with enlargement of the hand joints

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Conditions

June 16, 2012

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

A 62-year-old man is evaluated for a two-year history of enlargement and discomfort of the metacarpophalangeal joints of both hands. He works as a bank manager and leads a sedentary lifestyle. He does not have morning stiffness. He was diagnosed with type 2 diabetes mellitus three …

MKSAP: 59-year-old man with tachycardia and hypertension

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Conditions

May 28, 2012

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

A 59-year-old man is evaluated for tachycardia and hypertension six hours after undergoing an uncomplicated open cholecystectomy under general anesthesia. The patient had intraoperative high blood pressure and was treated postoperatively with metoprolol, 5 mg every 4 hours by intravenous bolus. The patient underwent repair of …

MKSAP: 65-year-old man is evaluated for worsening gait unsteadiness and falls

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Conditions

May 26, 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 worsening gait unsteadiness and falls. He first noticed the unsteadiness 1 year ago while walking and has started to fall recently, falling four times in the past 2 weeks. Approximately 3 years ago, he developed erectile dysfunction and has had …

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