mksap

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

MKSAP: 62-year-old woman with a sun allergy

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Conditions

April 13, 2019

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

A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream.

On physical examination, vital signs are …

MKSAP: 52-year-old woman with shortness of breath

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Conditions

April 6, 2019

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

A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her …

MKSAP: 60-year-old man with constant low-grade epigastric pain radiating to his back

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Conditions

March 30, 2019

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

A 60-year-old man is evaluated for constant low-grade epigastric pain radiating to his back that worsens after he eats fatty foods. He has a 2-year history of chronic pancreatitis. The pain has progressively worsened over the preceding 6 months. His weight is stable. He has a normal bowel movement …

MKSAP: 49-year-old woman with worsening joint symptoms

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Conditions

March 23, 2019

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

A 49-year-old woman is evaluated for recently worsening joint symptoms. She has a 13-year history of Crohn disease characterized by four to six stools daily and mild crampy abdominal pain. She also has a 1-year history of arthritis. She currently has pain in the left knee, right ankle, and …

MKSAP: 79-year-old man with headaches, nausea, visual disturbance, and difficulty speaking

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Conditions

March 16, 2019

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

A 79-year-old man is evaluated for a 2-month history of progressively worsening headaches, nausea, visual disturbance, and difficulty speaking. He also has hypertension and gastroesophageal reflux disease. Medications are lisinopril and omeprazole.

On physical examination, vital signs are normal. Right oculomotor nerve (cranial nerve III) and bilateral abducens nerve (cranial …

MKSAP: 40-year-old man with a new skin rash of 10 days’ duration

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Conditions

March 9, 2019

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

A 40-year-old man is evaluated for a new skin rash of 10 days’ duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable.

On physical examination, vital signs are …

MKSAP: 81-year-old woman with headaches, redness of the face, and itching

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Conditions

March 2, 2019

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

An 81-year-old woman is evaluated for a 1-year history of headaches, redness of the face, and itching. She indicates being otherwise capable of performing her daily activities on her farm. She reports no shortness of breath, chest pain, or difficulty sleeping. Medical history is significant for hypertension; she has …

MKSAP: 75-year-old man with progressive dysphagia

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Conditions

February 23, 2019

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

A 75-year-old man is evaluated for progressive dysphagia of 8 months’ duration for both solid food and water, and the necessity to induce vomiting several times each month to relieve his symptoms. He also has experienced chest pain and heartburn symptoms. He has lost approximately 6 kg (13 lb) …

MKSAP: 60-year-old woman with H. pylori gastritis

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Conditions

February 16, 2019

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

A 60-year-old woman is evaluated 1 month after completing a 14-day course of Helicobacter pylori eradication therapy consisting of amoxicillin, clarithromycin, and omeprazole. Initial upper endoscopy before treatment showed patchy gastric erythema with no ulcers or erosions, and biopsies revealed H. pylori gastritis. Currently, she reports alleviated symptoms. She is otherwise healthy and …

MKSAP: 32-year-old man with an intermittent pruritic rash

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Conditions

February 9, 2019

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

A 32-year-old man is evaluated for an intermittent pruritic rash of 8 years’ duration. Medical history is significant for mild persistent asthma. His only medications are an albuterol inhaler and an inhaled glucocorticoid.

On physical examination, vital signs are normal. There is mild xerosis with erythematous plaques on the bilateral …

MKSAP: 66-year-old man with ST-elevation myocardial infarction

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Conditions

February 2, 2019

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

A 66-year-old man is evaluated in the hospital following ST-elevation myocardial infarction treated with primary percutaneous coronary intervention of the left anterior descending artery 4 days ago. His initial presentation was complicated by the presence of heart failure and pulmonary edema. He is asymptomatic and ambulating, and he is …

MKSAP: 65-year-old woman with a cardiac murmur

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Conditions

January 26, 2019

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

A 65-year-old woman is evaluated during a routine examination. She was diagnosed with a cardiac murmur in early adulthood. She is active, healthy, and without symptoms. She takes no medications.

On physical examination, vital signs are normal. A grade 3/6 holosystolic murmur preceded by multiple clicks is present at the …

MKSAP: 56-year-old woman pulmonary hypertension

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Conditions

January 19, 2019

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

A 56-year-old woman is evaluated during an appointment to establish care. She has a developmental delay, and she is known to have pulmonary hypertension due to a congenital cardiac condition. There is no history of cardiac surgery. She is on low-dose aspirin and thyroid replacement therapy.

On physical examination, blood …

MKSAP: 55-year-old man with mild nausea and dyspepsia

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Conditions

January 12, 2019

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

A 55-year-old man is evaluated in the emergency department for a 2-day history of mild nausea and dyspepsia that is worse with fasting and improved with eating. He has also had a 24-hour history of frequent black stools and fatigue. He has no history of gastrointestinal bleeding, alcoholism, chronic liver disease, bleeding disorders, …

MKSAP: 25-year-old woman with ankylosing spondylitis

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Conditions

January 5, 2019

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 an 18-month history of ankylosing spondylitis. She has minimal lower back pain with morning stiffness lasting 20 minutes. She is able to pursue her activities of daily living without any restrictions. She has been taking etanercept for 1 year with good results.

On physical …

MKSAP: 55-year-old man with severe COPD

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Conditions

December 29, 2018

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

A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago without much improvement in exercise capacity. He quit smoking 1 year ago. …

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MKSAP: 55-year-old man with severe COPD

MKSAP: 60-year-old man with a variable 2-hour postprandial blood glucose

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Conditions

December 22, 2018

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

A 60-year-old man variable 2-hour postprandial blood glucose is evaluated during a routine follow-up examination. He has type 2 diabetes mellitus. Review of his blood glucose log demonstrates fasting blood glucose values ranging from 120 to 160 mg/dL (6.7-8.9 mmol/L) and variable 2-hour postprandial blood glucose values ranging from 50 to 190 mg/dL …

MKSAP: 82-year-old woman with Alzheimer’s disease

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Conditions

December 15, 2018

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

An 82-year-old woman is seen for follow-up evaluation of Alzheimer disease. Since her last visit 12 weeks ago, she has been taking rivastigmine, with a progressively titrated dosage. The patient’s only new symptoms are increasing insomnia, loss of appetite, and occasional diarrhea; she has had no feelings of hopelessness, helplessness, sadness, or guilt. …

MKSAP: 53-year-old woman with hypertension and chronic active hepatitis B infection

mksap

Conditions

December 8, 2018

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

A 53-year-old woman is evaluated during a routine follow-up visit. Medical history is significant for hypertension and chronic active hepatitis B infection. Her hepatitis B infection has been treated with tenofovir for the past 5 years with suppression of her serum hepatitis B DNA levels. She currently notes mild generalized weakness but otherwise …

MKSAP: 58-year-old woman with left lower abdominal discomfort

mksap

Conditions

December 1, 2018

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

A 58-year-old woman is evaluated in the emergency department for a 2-day history of left lower abdominal discomfort. The pain began insidiously and has gradually progressed. She has felt warm but has not had shaking chills, urinary symptoms such as dysuria or urgency, change in bowel habits, or apparent blood in her stool. …

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