Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated for a 2-year history of infertility. He and his wife have been unable to conceive since marrying 2 years ago. Analysis of a semen sample provided 3 weeks ago during an infertility evaluation showed azoospermia. The patient has a strong libido …
MKSAP: 25-year-old man is evaluated for infertility
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for a 6-month history of a sensation of dryness in his eyes. He notes that it feels as though there is sand in his eyes.
On physical examination, the eyes are red, and trichiasis (ingrown eyelashes) and symblepharon (adhesions of the eyelid …
MKSAP: 68-year-old man with a sensation of dryness in his eyes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time he …
MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 years …
MKSAP: 72-year-old woman with fatigue and decreased exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old woman is evaluated for a sudden loss of vision in the left eye that began 30 minutes ago. She has a 2-week history of fatigue; malaise; and pain in the shoulders, neck, hips, and lower back. She also has a 5-day history of mild …
MKSAP: 75-year-old woman with a sudden loss of vision
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated for the gradual onset and progression of memory loss over the past year. He says he has difficulty recalling the names of familiar people, has misplaced his wallet on numerous occasions, and is slower to find his car in large, crowded …
MKSAP: 81-year-old man is evaluated for the gradual onset and progression of memory loss
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated in the emergency department for swelling of the feet and legs. He has a 5-year history of HIV infection for which he has refused treatment.
On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 88/min, and …
MKSAP: 25-year-old man with swelling of the feet and legs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication is an oral contraceptive agent.
On physical examination, the patient appears ill. Temperature is 38.8 °C (101.8 °F), blood pressure is 90/45 mm …
MKSAP: 20-year-old with fever, myalgia, headache, and a rash
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man is evaluated for increasing fatigue of 2 months’ duration. The patient has hypertension and hyperlipidemia treated with lisinopril and atorvastatin. A sister has hypothyroidism.
On physical examination, temperature is normal, blood pressure is 135/80 mm Hg, pulse rate is 72/min, and respiration rate …
MKSAP: 58-year-old man is evaluated for increasing fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 89-year-old woman is evaluated for dizziness that she has had for the past year, mainly while standing and ambulating. The dizziness is described as a sense of unsteadiness. The symptoms can last for minutes to hours, and she has at least 4 to 5 episodes …
MKSAP: 89-year-old woman is evaluated for dizziness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for a 3-month history of abdominal bloating and mid-epigastric discomfort associated with a 6.8-kg (15-lb) weight loss. The patient has no significant medical history and takes no medications.
On physical examination, vital signs are normal, and the only significant finding is mild …
MKSAP: 64-year-old man with abdominal bloating and epigastric discomfort
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has a history of hypertension, atrial fibrillation, gastroesophageal reflux disease, and depression. Current medications are metoprolol, amiodarone, warfarin, omeprazole, and sertraline.
On physical examination, …
MKSAP: 76-year-old woman with abnormal thyroid function tests
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a history of long-standing psoriasis that at times has involved much of his body, including his intertriginous areas. His topical treatments include tar-containing …
MKSAP: 33-year-old man with stretch marks in his groin
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated regarding treatment of his coronary artery disease. He had a myocardial infarction 8 years ago and was treated with a coronary stent placed in his right coronary artery. Over the last 8 years he did well with medical therapy, with only …
MKSAP: 52-year-old man with coronary artery disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 69-year-old woman is evaluated for a 5-day history of pain and swelling in the right knee that developed after a prolonged period of gardening in her backyard. Her pain worsens when she walks and is relieved with rest. She has no morning stiffness.
On physical examination, …
MKSAP: 69-year-old woman with pain and swelling in the knee
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.
On physical examination, he is not ill appearing. Temperature …
MKSAP: 75-year-old man with a draining chronic ulcer on the foot
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old man is evaluated in the office for a 6-month history of progressive weakness of the lower extremities. He says he has difficulty rising from a seated position and walking up stairs and also has episodes of dry eyes, dry mouth, and erectile dysfunction. The …
MKSAP: 61-year-old man with progressive weakness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old woman with advanced multiple myeloma diagnosed 6 months ago undergoes a follow-up visit. Treatment includes daily oral thalidomide and pulse dexamethasone. The patient now feels well.
Laboratory studies indicate a serum monoclonal protein concentration of 3.0 g/dL (30 g/L). Hemoglobin concentration, serum calcium level, and …
MKSAP: 50-year-old woman with advanced multiple myeloma
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has no history of hypertension, diabetes mellitus, stroke, or transient ischemic attack. He has no claudication. He is being treated for hyperlipidemia. There …
MKSAP: Healthy 68-year-old man with a cigarette smoking history
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 …
MKSAP: 32-year-old man with crampy abdominal pain
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