mksap

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

MKSAP: 82-year-old woman with a 1-week history of urinary incontinence

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Conditions

November 24, 2018

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An 82-year-old woman is evaluated for a 1-week history of urinary incontinence with lower abdominal discomfort. She reports no dysuria, fever, or back pain. Medical history is significant for hypertension and allergic reaction to sulfa drugs, which cause a generalized rash. Her only medication is amlodipine.

On physical examination, temperature is 36.8 °C (98.2 …

MKSAP: 42-year-old man with thrombophilia

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Conditions

November 17, 2018

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

A 42-year-old man arrives for follow-up consultation. Three months ago he developed a proximal right leg deep venous thrombosis following a skiing-related fracture of the right tibia. Although not recommended by guidelines, a thrombophilia evaluation was performed, which revealed an elevated plasma homocysteine level, and subsequent genetic testing revealed that he is homozygous …

MKSAP: 64-year-old man seen after an intraoperative liver biopsy

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Conditions

November 10, 2018

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

A 64-year-old man is evaluated in follow-up after recent abnormal findings on intraoperative liver biopsy. Two days ago he underwent right colon resection for a large villous adenoma with high-grade dysplasia. At the time of surgery, an abnormal-appearing liver was noted and biopsy was performed. His medical history is notable for type 2 …

MKSAP: 79-year-old man with a sacral ulcer

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Conditions

November 3, 2018

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A 79-year-old man is evaluated for pain in the buttocks region. He was diagnosed with non-Hodgkin large B-cell lymphoma 6 months ago. Although his lymphoma has responded well to therapy and he is without evidence of active disease, he required hospitalization three times for chemotherapy-associated complications during his treatment course. He has been …

MKSAP: 30-year-old woman is evaluated for a 2-month history of diarrhea

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Conditions

October 27, 2018

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

A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. She works …

MKSAP: 34-year-old man with slow-growing lesions

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Conditions

October 20, 2018

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

A 34-year-old man is evaluated for several slow-growing lesions on his penis. He first noticed the wart-like growths 3 years ago, and they have progressively enlarged. He was treated with topical cryotherapy six times and topical imiquimod over the past year without improvement; the lesions have continued to enlarge. Medical history is significant …

MKSAP: 36-year-old woman with refractory constipation

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Conditions

October 13, 2018

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

A 36-year-old woman is evaluated for a 12-year history of refractory constipation. Her symptoms began after a difficult childbirth. She has constipation marked by straining, bloating, and a constant sensation of incomplete emptying. She sometimes has 4 or more days between bowel movements. When she does have a bowel movement, the stool is …

MKSAP: 56-year-old man with a family history of hypertrophic cardiomyopathy (HCM)

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Conditions

October 6, 2018

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

A 56-year-old man is being evaluated after his 18-year-old son had a syncopal episode during a high school basketball game and was diagnosed with hypertrophic cardiomyopathy (HCM). The patient has had no symptoms, including with physical activity such as golfing or playing tennis. Medical history is unremarkable, and a review of family history …

MKSAP: 56-year-old man with painless intermittent bloody urine

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Conditions

September 29, 2018

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

A 56-year-old man is evaluated for painless intermittent bloody urine of 6 weeks’ duration. History is significant for granulomatosis with polyangiitis (formerly known as Wegener granulomatosis) diagnosed 10 years ago, which is now in remission; he was treated with prednisone for 3 years and oral cyclophosphamide for 1 year. He also has hypertension …

MKSAP: 25-year-old woman with type 1 diabetes mellitus

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Conditions

September 22, 2018

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

A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years ago. Her HbA1c levels since diagnosis have ranged from 6.4% to 7.3%, with the most recent value at 7.3%. She reports eating a carbohydrate-consistent diet at each meal, with …

MKSAP: 52-year-old man with severe obstructive sleep apnea

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Conditions

September 15, 2018

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

A 52-year-old man is evaluated in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. He does not have …

MKSAP: 48-year-old man with a 4-week history of heartburn

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Conditions

September 11, 2018

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

A 48-year-old man is evaluated for a 4-week history of heartburn that awakens him at night. The symptoms occur about three times per week. He has been taking over-the-counter antacids with incomplete relief. Food triggers include coffee and spicy foods. He has not had unintentional weight loss or difficulty swallowing.

Physical examination and laboratory …

MKSAP: 56-year-old woman with a 1-year history of tremor

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Conditions

September 8, 2018

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

A 56-year-old woman is evaluated for a 1-year history of tremor. The tremor is more prominent on the right side. She also reports increasing problems with balance and numerous falls, especially when arising from a chair or turning. The patient does not have any significant cognitive symptoms. She has occasional urinary incontinence, intermittent …

MKSAP: 49-year-old woman with obesity, hypertension, and type 2 diabetes mellitus

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Conditions

September 1, 2018

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

A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with a behavioral therapist, and …

MKSAP: 25-year-old man with dark-colored urine

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Conditions

August 25, 2018

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

A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, …

MKSAP: 30-year-old woman with HIV infection

mksap

Conditions

August 20, 2018

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

A 30-year-old woman is evaluated in follow-up after being recently diagnosed with HIV infection. She is asymptomatic. Medical history is unremarkable, and she takes no medications; she has not yet started antiretroviral therapy. She received all scheduled childhood immunizations.

On physical examination, vital signs are normal. She has shotty cervical lymphadenopathy, but the examination …

MKSAP: 77-year-old woman with frequently fluctuating INRs

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Conditions

August 18, 2018

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

A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.

On physical …

MKSAP: 57-year-old man with type 2 diabetes mellitus

mksap

Conditions

August 11, 2018

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

A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before …

MKSAP: 38-year-old woman with endometrial cancer

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Conditions

August 4, 2018

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

A 38-year-old woman is evaluated in follow-up after recent surgery for endometrial cancer. Her family history is significant for colon cancer in her sister (diagnosed at age 45 years) and her mother (diagnosed at age 65 years). Her maternal grandfather was diagnosed with rectal cancer at age 47 years. The patient has never …

MKSAP: 24-year-old woman with severe cramps associated with her menstrual periods

mksap

Conditions

July 28, 2018

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

A 24-year-old woman is evaluated for severe cramps associated with her menstrual periods. The cramps have worsened over the past year, and the discomfort is severe enough that she has periodically missed work. She reports no abnormal vaginal discharge. Menses are unchanged from her baseline pattern. She has tried ibuprofen and naproxen for …

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