mksap

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

MKSAP: 38-year-old man is evaluated during a periodic health maintenance visit

mksap

Conditions

March 17, 2018

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

A 38-year-old man is evaluated during a periodic health maintenance visit. His friend was recently diagnosed with type 2 diabetes mellitus, and the patient expresses interest in being screened. He is asymptomatic and reports no symptoms of polyuria or polydipsia. He exercises regularly. Medical and family histories are unremarkable. He takes no medications.

On …

MKSAP: 50-year-old man with a firm, darkly pigmented papule

mksap

Conditions

March 10, 2018

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

A 50-year-old man is evaluated for a firm, darkly pigmented papule on his back that has been growing steadily over a period of several months. His medical history is unremarkable, and he takes no medications.

On physical examination, vital signs are normal. The skin lesion is a 0.5-cm darkly pigmented, raised plaque with irregular …

MKSAP: 67-year-old woman with degenerative joint disease

mksap

Conditions

March 3, 2018

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

A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any gastrointestinal …

MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis

mksap

Conditions

February 24, 2018

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

A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d).

On …

MKSAP: 82-year-old woman with left-sided headaches

mksap

Conditions

February 17, 2018

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

An 82-year-old woman is evaluated for a 2-week history of left-sided headaches with pain on chewing, accompanied by achiness in the shoulders and hips. She has no other pertinent personal or family history. She takes no medications.

On physical examination, temperature is 38.1 °C (100.6 °F), blood pressure is 132/86 mm Hg, pulse …

MKSAP 27-year-old woman with type 1 diabetes mellitus

mksap

Conditions

February 10, 2018

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

A 27-year-old woman is evaluated for management of her type 1 diabetes mellitus. She was diagnosed 10 years ago. She has no known complications from her diabetes. She eats a healthy diet and exercises an average of 60 minutes per day in the evening. She takes insulin glargine and insulin aspart. She is …

MKSAP: 75-year-old man with very severe COPD

mksap

Conditions

February 3, 2018

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

A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He …

MKSAP: 22-year-old woman with abnormal involuntary movements

mksap

Conditions

January 27, 2018

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

A 22-year-old woman is evaluated for a 2-year-history of abnormal involuntary movements. She describes these movements as a quick elevation of the left shoulder followed by a rolling movement of the neck from side to side. The patient is able to suppress the movements completely for brief periods but then feels pressure building at the …

MKSAP: 55-year-old woman after bariatric surgery

mksap

Conditions

January 20, 2018

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

A 55-year-old woman is evaluated during a routine examination. She underwent biliopancreatic diversion with duodenal switch 8 years ago for treatment of obesity-related complications and lost 68.0 kg (150.0 lb) in the first year following surgery. Her weight has been relatively stable for the last year. She has had chronic nonbloody diarrhea since her bariatric …

MKSAP: 65-year-old man with chronic kidney disease

mksap

Conditions

January 13, 2018

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

A 65-year-old man is evaluated during a follow-up visit for stage G3b/A3 chronic kidney disease due to diabetic nephropathy. He reports doing well with good baseline exercise tolerance and no shortness of breath. Medical history is also significant for type 2 diabetes mellitus and hypertension. Medications are basal bolus insulin and lisinopril, 20 mg/d.

On physical …

MKSAP: 25-year-old man is evaluated in follow-up after HIV testing

mksap

Conditions

January 6, 2018

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

A 25-year-old man is evaluated in follow-up after HIV testing. He states he has sex with other men and usually uses condoms. He had a negative HIV test result 1 year ago. He feels well today but reports having a flulike illness last week with mild fever, headache, myalgias, and fatigue; these symptoms have resolved. …

MKSAP: 64-year-old man with diabetes

mksap

Conditions

December 30, 2017

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

A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type …

Read more…

MKSAP: 64-year-old man with diabetes

MKSAP: 63-year-old man with mid-upper back pain

mksap

Conditions

December 23, 2017

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

A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.

On physical examination, temperature is 37.3 …

MKSAP: 48-year-old man with knee pain and swelling

mksap

Conditions

December 16, 2017

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 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or chills. He has no history …

MKSAP: 22-year-old woman is evaluated for a flare of Crohn disease

mksap

Conditions

December 9, 2017

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

A 22-year-old woman is evaluated for a flare of Crohn disease. A colonoscopy performed 6 months ago showed moderate, patchy, left-sided colitis extending from the descending colon to the splenic flexure. She responded to therapy with prednisone but declined maintenance therapy in advance of conceiving. She is now 12 weeks pregnant and …

MKSAP: 25-year-old man positive for hepatitis B surface antigen

mksap

Conditions

December 2, 2017

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

A 25-year-old man is evaluated in follow-up after recently testing positive for hepatitis B surface antigen. He underwent testing as part of the immigration process from Somalia. Two other siblings also have hepatitis B virus (HBV) infection.

On physical examination, he is a young, healthy-appearing man. Vital signs are normal. No jaundice is …

MKSAP: 40-year-old woman with amenorrhea

mksap

Conditions

November 25, 2017

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

A 40-year-old woman is evaluated for amenorrhea of 4 months’ duration. She has had weight gain, facial hair, alopecia, and debilitating fatigue. Her medical history is significant for psoriasis. She seems to be gaining weight in her face, abdomen, and neck. She also bruises easily. Her only medication is clobetasol for psoriasis.

On …

MKSAP: 45-year-old man with type 2 diabetes mellitus

mksap

Conditions

November 18, 2017

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

A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports no symptoms and takes no …

MKSAP: 32-year-old man with a rash on his face and midchest

mksap

Conditions

November 11, 2017

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

A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical history is significant for a …

MKSAP: 35-year-old man with upper abdominal discomfort

mksap

Conditions

November 4, 2017

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

A 35-year-old man is evaluated for a 2-month history of upper abdominal discomfort after eating. He has recently returned from working in a rural area of a developing country. He takes no medications. There is no family history of esophageal or gastric cancer.

On physical examination, vital signs are normal. BMI is 40. …