Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 22-year-old man comes for a routine evaluation. He has a history of type 1 diabetes mellitus and began taking insulin glargine and insulin lispro 8 years ago. Two days ago, he participated in a marathon race.
On physical examination, temperature is 36.4 °C (97.5 °F), blood …
MKSAP: 22-year-old man with type 1 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old woman is evaluated because a screening urine culture for an insurance policy grows greater than 105 colony-forming units/mL of Escherichia coli. She does not have fever, dysuria, urinary frequency, or other symptoms. Medical history is unremarkable. She has no allergies and takes no medications. …
MKSAP: 65-year-old woman with E. coli in a urine culture
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman has a 3-month history of increasing fatigue. She has no other medical problems and does not take any medications.
On physical examination, temperature is normal, blood pressure is 130/80 mm Hg, pulse rate is 72/min, and respiration rate is 16/min. The patient appears pale. …
MKSAP: 78-year-old woman with increasing fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated for a 1-year history of progressive exertional dyspnea. She does not smoke cigarettes or use illicit drugs. The patient has a history of obesity and has used various appetite suppressants but takes no other medications. She has no significant family or …
MKSAP: 54-year-old woman with progressive exertional dyspnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura, since age 16 years. She has an average of three attacks each month and consistently experiences an attack 2 days prior to menstruation; this headache is more difficult to …
MKSAP: 36-year-old woman with a history of migraine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.
On physical examination, the patient is uncooperative and …
MKSAP: 32-year-old man is disoriented, combative, and agitated
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old man is evaluated for concerns noted by his wife of a marked change in overall behavior over the past 6 months, including deterioration in his general hygiene and episodes of talking to imaginary people. His employer has also raised concerns about his work performance. The patient has also noted intermittent tingling in the …
MKSAP: 27-year-old man with a marked change in overall behavior
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman presents for evaluation of recurrent, bilateral eye pain and redness. Symptoms began several months ago without a specific inciting event. With each episode, she has deep or boring pain that is constant and has awakened her from sleep. She has had photophobia, tearing, …
MKSAP: 25-year-old woman with bilateral eye pain and redness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
Seven years ago, a 45-year-old man was diagnosed with a biopsy-proven mediastinal germ cell tumor. The patient was treated with combination chemotherapy (bleomycin, etoposide, and cisplatin) and had a complete radiographic response. He has been disease-free since completing therapy, and follow-up serum tumor marker measurements, chest …
MKSAP: 45-year-old man with a mediastinal germ cell tumor
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 35-year-old woman is evaluated for a 6-month history of right upper quadrant abdominal pain that has slowly increased in intensity and is worse on deep inspiration. The patient is otherwise well, and her only medication is an oral contraceptive pill that she has taken for …
MKSAP: 35-year-old woman with right upper quadrant abdominal pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient’s blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more than …
MKSAP: 78-year-old woman is seen for management of her diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical history …
MKSAP: 60-year-old woman with pruritic hives
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.
On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is 88/min, …
MKSAP: 58-year-old woman with acute left-sided flank pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated during a follow-up visit for a 6-month history of diffuse muscle and joint pain above and below the waist, fatigue, and difficulty sleeping. She has a 2-year history of hypothyroidism treated with levothyroxine. Her only other medication is hydrocodone-acetaminophen, which has …
MKSAP: 25-year-old with diffuse muscle and joint pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old man is evaluated in the emergency department for confusion and agitation secondary to malignant hypertension. Initial blood pressure is 230/130 mm Hg, and funduscopic examination reveals papilledema.
He is admitted to the intensive care unit, and therapy with nitroprusside by continuous infusion is begun; the …
MKSAP: 67-year-old man with confusion, agitation, and malignant hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman is evaluated in the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning on awakening. She has recently started keeping a headache diary, which reveals episodes on approximately 25 days of each month. The headache …
MKSAP: 38-year-old woman with increasingly frequent headache
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks in …
MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin is …
MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery
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 3-month history of perineal and suprapubic pain. He has experienced urinary frequency and dysuria for 4 to 6 weeks. The patient reports fatigue, insomnia, and low mood for the past 6 months. He has hypertension. Current medications are hydrochlorothiazide …
MKSAP: 52-year-old man with perineal and suprapubic pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he had one or two bowel movements of well-formed stool …
MKSAP: 32-year-old man with abdominal pain
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