mksap

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

MKSAP: 64-year-old woman with severe COPD

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Conditions

August 31, 2019

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

A 64-year-old woman is evaluated during a posthospital visit for severe COPD with an FEV₁ of 30% of predicted. She has been admitted three times during the last year with acute exacerbations characterized by cough, increased purulent sputum production, and dyspnea. She is now at baseline of her exertional dyspnea …

MKSAP: 49-year-old-man with right arm weakness

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Conditions

August 24, 2019

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

A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, metformin, and atorvastatin.

On physical examination, blood pressure is 126/68 mm Hg, pulse rate …

MKSAP: 25-year-old woman with chest pain after a motor vehicle accident

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Conditions

August 17, 2019

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

A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks’ gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin.

On physical examination, the patient is afebrile, blood …

MKSAP: 35-year-old man with persistent heartburn

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Conditions

August 10, 2019

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

A 35-year-old man is evaluated during a follow-up appointment for persistent heartburn with chronic cough. He has a 1-year history of gastroesophageal reflux disease and takes pantoprazole twice daily. He reports no nausea, vomiting, or dysphagia. Upper endoscopy performed 1 year earlier showed no abnormal findings.

His vital signs and …

MKSAP: 69-year-old woman with new-onset dependent edema

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Conditions

August 3, 2019

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

A 69-year-old woman is evaluated in the emergency department for new-onset dependent edema that began 3 weeks ago. She says it is difficult to walk, and she has gained 4.5 kg (10 lb) of fluid weight. History is significant for obesity and hypertension. Her only medication is lisinopril.

On physical …

MKSAP: 45-year-old woman with type 2 diabetes mellitus

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Meds

July 27, 2019

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

A 45-year-old woman is evaluated for management of type 2 diabetes mellitus diagnosed 3 months ago. She was asymptomatic at diagnosis with an initial HbA1c value of 9.7%. Her initial interventions included lifestyle modifications with weight loss and metformin. She is motivated to continue to lose weight. Medical history …

MKSAP: 38-year-old woman with fever and flank pain

mksap

Conditions

July 20, 2019

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

A 38-year-old woman undergoes follow-up evaluation in the office. She was evaluated in the emergency department 3 nights ago with fever and flank pain following 2 days of dysuria.

A urine culture and two sets of blood cultures were collected. She was given intravenous ceftriaxone and discharged with a 7-day …

MKSAP: 23-year-old woman with painful lumps on her legs

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Conditions

July 13, 2019

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

A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. She has …

MKSAP: 69-year-old man with chest pressure and dyspnea

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Conditions

July 6, 2019

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

A 69-year-old man is evaluated during a follow-up visit. He initially presented with a 3-month history of chest pressure and dyspnea that occurred primarily with exertion. Despite maximal medical therapy, his symptoms have not abated and adversely affect his quality of life. Medical history is significant for type 2 …

MKSAP: 52-year-old man with progressive weakness

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Conditions

June 29, 2019

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

A 52-year-old man is evaluated for a 1-year history of progressive weakness that began as right foot drop and bilateral tingling in the feet. Within the past 2 months, the patient has developed progressive weakness, which makes walking difficult; he also notes weakness in the hands and burning below …

MKSAP: 62-year-old woman with ovarian cancer

mksap

Conditions

June 22, 2019

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

A 62-year-old woman is evaluated during a follow-up visit for recently diagnosed stage IIIA high-grade serous ovarian cancer. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and completed six cycles of chemotherapy with cisplatin and paclitaxel. The patient’s paternal aunt was diagnosed with breast cancer at age 52 years. …

MKSAP: 63-year-old woman after right hemicolectomy for colon cancer

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Conditions

June 15, 2019

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

A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication.

All physical examination findings, including vital signs, are …

MKSAP: 35-year-old woman with constipation

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Meds

June 8, 2019

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

A 35-year-old woman is evaluated for constipation. She reports passage of hard stool every 3 to 4 days and associated bloating. Her symptoms have been present for more than 10 years and have progressed gradually. Trials of over-the-counter fiber supplementation and polyethylene glycol worsened the bloating, prompting discontinuation. Senna …

MKSAP: 48-year-old woman with elevated liver chemistry tests

mksap

Conditions

June 1, 2019

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

A 48-year-old woman is evaluated at a follow-up appointment for elevated liver chemistry tests over the preceding 6 months. She reports no symptoms. She has type 2 diabetes mellitus and hypertension. Her family history is unremarkable. She drinks two glasses of wine one or two times per month. Her …

MKSAP: 60-year-old woman with persistent constipation

mksap

Meds

May 25, 2019

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

A 60-year-old woman is evaluated for persistent constipation symptoms of 2 years’ duration. She has reflex sympathetic dystrophy syndrome involving the right arm and neck that began 3 years earlier and requires chronic opioid analgesic therapy. She reports passing two hard bowel movements per week. Trials of several fiber …

MKSAP: 44-year-old man with HIV, hypertension, and hyperlipidemia

mksap

Conditions

May 18, 2019

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

A 44-year-old man is evaluated in the office during a routine visit. Medical history is significant for HIV diagnosed at age 25 years, hypertension, and hyperlipidemia. He is a current smoker. Medications are chlorthalidone, tenofovir-emtricitabine, and raltegravir.

On physical examination, the patient is afebrile, and blood pressure is 126/74 mm …

MKSAP: 53-year-old man with recurrent gout attacks

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Conditions

May 11, 2019

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

A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The …

MKSAP: 28-year-old woman with decreased exercise tolerance and ice cravings

mksap

Conditions

May 4, 2019

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

A 28-year-old woman is evaluated for decreased exercise tolerance and ice cravings for the past several weeks. Medical history is notable for Crohn colitis diagnosed 6 years ago. Her symptoms flared 3 months ago with increased abdominal pain and diarrhea, and she began therapy with azathioprine and infliximab. Her …

MKSAP: 62-year-old woman with hypertension

mksap

Conditions

April 27, 2019

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

A 62-year-old woman is evaluated during a routine examination. She feels well and has no exercise limitations. Medical history is significant for hypertension treated with enalapril. She does not smoke. At her last examination 4 years ago, her blood pressure was 122/76 mm Hg. Laboratory studies at that time …

MKSAP: 39-year-old woman with fatigue, intermittent rectal bleeding, and abdominal pain

mksap

Conditions

April 20, 2019

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

A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or …

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