mksap

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

MKSAP: 46-year-old man with intermittent rectal bleeding

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Conditions

July 24, 2018

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

A 46-year-old man is evaluated for intermittent rectal bleeding of 3 months’ duration. He is otherwise well and takes no medications. His father had a few polyps removed from the colon when he was 71 years old, but no other details are known about his father’s medical history. The patient and his wife …

MKSAP: 55-year-old woman with an eating disorder

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Conditions

July 23, 2018

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

A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …

MKSAP: 70-year-old man with heartburn

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Conditions

July 21, 2018

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

A 70-year-old man is evaluated in follow-up for heartburn of 7 years’ duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette smoking and continues to …

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MKSAP: 70-year-old man with heartburn

MKSAP: 24-year-old woman with atopic dermatitis

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Conditions

July 14, 2018

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

A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. She is otherwise well …

MKSAP: 68-year-old man with heart failure

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Conditions

July 7, 2018

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

A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to …

MKSAP: 70-year-old man with a transient ischemic attack

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Conditions

June 30, 2018

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

A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications are metformin and lisinopril.

On …

MKSAP: 30-year-old woman with systemic lupus erythematosus

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Conditions

June 23, 2018

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

A 30-year-old woman is evaluated during a follow-up visit for systemic lupus erythematosus. She was diagnosed 3 months ago after presenting with pericarditis and arthritis. She was initially treated with prednisone, 40 mg/d, with improvement of her presenting symptoms. The prednisone has been tapered over 3 months to her current dose of 10 mg/d with …

MKSAP: 58-year-old man with idiopathic pulmonary fibrosis (IPF)

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Conditions

June 16, 2018

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

A 58-year-old man is evaluated in follow-up for idiopathic pulmonary fibrosis (IPF), which was diagnosed 2 years ago. He has cough and shortness of breath and now requires supplemental oxygen at rest. Previous evaluations have not identified any cause for his symptoms other than progressive IPF. He has participated in pulmonary rehabilitation and continues in …

MKSAP: 78-year-old man with symptoms of dysphagia

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Conditions

June 9, 2018

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

A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.

On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, …

MKSAP: 29-year-old woman is evaluated during a routine follow-up examination of multiple sclerosis

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Conditions

June 2, 2018

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

A 29-year-old woman is evaluated during a routine follow-up examination of multiple sclerosis, which was diagnosed 3 years ago. The patient says she wishes to discontinue her oral contraceptive and attempt to become pregnant. She has no other personal or family medical history of note. Medications are fingolimod, vitamin D, and an oral …

MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea

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Conditions

May 26, 2018

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

A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has …

MKSAP: 28-year-old man with lower-extremity edema

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Conditions

May 19, 2018

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

A 28-year-old man is evaluated for a 2-month history of progressive lower-extremity edema, weight loss, and fatigue. Medical history is significant for recreational use of inhaled cocaine; he denies injection drug use. He has no other known medical issues and takes no medications.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure …

MKSAP: 35-year-old woman is evaluated for intermittent fever

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Conditions

May 12, 2018

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

A 35-year-old woman is evaluated for intermittent fever, sweats, fatigue, and dull midchest pain of 2 weeks’ duration. Medical history is significant for liver transplantation 6 months ago for primary biliary cirrhosis; she was seronegative for cytomegalovirus and Epstein-Barr virus, and her donor was positive for both. Results of pretransplant testing for tuberculosis …

MKSAP: 38-year-old man with ulcerative colitis

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Conditions

May 5, 2018

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

A 38-year-old man is evaluated in follow-up after a diagnosis of ulcerative colitis. Ten days ago he was started on prednisone, 60 mg/d, but his symptoms have not improved. He has six to nine bloody bowel movements per day and moderate abdominal pain. He has decreased his oral intake because eating exacerbates his …

MKSAP: 19-year-old woman is seen for counseling regarding contraceptives

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Conditions

April 28, 2018

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

A 19-year-old woman is seen for counseling regarding contraceptives. Medical history is unremarkable; she is nulliparous and has never taken prescription contraceptives. Her father had a pulmonary embolism at age 47 years, which was associated with arthroscopic knee surgery, and her 23-year-old sister experienced a deep venous thrombosis 3 weeks after delivering her …

MKSAP: 62-year-old man is evaluated during a routine visit

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Conditions

April 21, 2018

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

A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.

On physical examination, the patient is afebrile, blood pressure is 130/66 …

MKSAP: 28-year-old man with right knee pain

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Conditions

April 14, 2018

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

A 28-year-old man is evaluated for right knee pain that began 2 days ago. He was playing football when he stopped suddenly and pivoted to make a catch. He heard a popping sound and immediately developed severe pain in his right knee. Within 30 minutes, the knee became swollen. Since the injury, he …

MKSAP: 41-year-old woman with burning epigastric and chest pain

mksap

Conditions

April 7, 2018

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

A 41-year-old woman is evaluated in follow-up after presenting to the emergency department 1 week ago for burning epigastric and chest pain. In the emergency department, a complete blood count and liver chemistry studies were normal, but a radiograph of the chest and upper abdomen demonstrated calcified gallstones. The pain resolved with administration …

MKSAP: 57-year-old man with chronic hepatitis C infection

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Conditions

March 31, 2018

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

A 57-year-old man is evaluated during a routine examination. His medical history is notable for chronic hepatitis C infection with cirrhosis, which was diagnosed 3 years ago. He undergoes surveillance ultrasound for hepatocellular carcinoma every 6 months.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/82 mm Hg, pulse rate …

MKSAP: 62-year-old woman with a left adrenal mass

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Conditions

March 24, 2018

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

A 62-year-old woman is evaluated for an incidentally discovered left adrenal mass. Two weeks ago, the patient was evaluated in the emergency department for diffuse abdominal pain and vomiting. A CT scan was obtained that was normal except for the adrenal mass. Three hours after presentation to the emergency department, the pain resolved …

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