mksap

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

MKSAP: 72-year-old man with a holosystolic murmur

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Conditions

October 28, 2017

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A 72-year-old man is evaluated during a routine examination. He has no symptoms or significant medical history. He is active and exercises regularly. He does not take any medications.

On physical examination, blood pressure is 135/70 mm Hg, pulse rate is 82/min, and respiration rate is 17/min. Cardiac examination reveals a grade 3/6 …

MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools

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Conditions

October 21, 2017

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

A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse …

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus

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Conditions

October 14, 2017

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

A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning.

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

MKSAP: 58-year-old man with hepatitis C-related cirrhosis

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Conditions

October 7, 2017

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 hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide.

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

MKSAP: 57-year-old woman with hematemesis

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Conditions

September 30, 2017

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

A 57-year-old woman is evaluated in the emergency department for an episode of hematemesis that occurred 1 hour ago. She had previously felt well except for a recent knee injury, for which she has been taking ibuprofen. She currently is experiencing lightheadedness and weakness. Medical history is otherwise unremarkable. She does not …

MKSAP: 68-year-old man with Parkinson disease

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Conditions

September 23, 2017

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

A 68-year-old man is seen for follow-up evaluation of Parkinson disease, which was diagnosed 10 years ago. Although his symptoms initially were well controlled with medications, he has experienced increasing fluctuations in motor symptoms, specifically tremor at rest and slowness, within the past 3 years. Medications are carbidopa-levodopa, entacapone, and amantadine. He …

MKSAP: 54-year-old man with elevated blood pressure

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Conditions

September 16, 2017

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

A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications.

On this visit and on two subsequent nurse visits, the patient’s blood pressure measurements are less than 140/90 mm Hg. BMI is 34. Cardiac examination reveals an …

MKSAP: 46-year-old man with fever, dysuria, and urinary frequency

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Conditions

September 9, 2017

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

A 46-year-old man is evaluated for fever, dysuria, and urinary frequency of 1 day’s duration. He also notes a sensation of deep pelvic pain near the rectum. He has no urethral discharge or testicular pain. He states that he felt well before the current illness and has no other symptoms. Medical history …

MKSAP: 38-year-old woman with a HbA1c value of 9.1%

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Conditions

September 2, 2017

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

A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, obstructive sleep apnea, hypertension, and …

MKSAP: 58-year-old man with cancer of the ascending colon

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Conditions

August 26, 2017

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

A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report showed a 4-cm primary adenocarcinoma …

MKSAP: 36-year-old man with history of fatigue

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Conditions

August 19, 2017

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

A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation has included a complete blood …

MKSAP: 54-year-old man with dysphagia

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Conditions

August 12, 2017

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

A 54-year-old man is evaluated for a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. There is no family history …

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MKSAP: 54-year-old man with dysphagia

MKSAP: 67-year-old woman who takes diclofenac

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Conditions

August 5, 2017

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 …

MKSAP: 34-year-old man with episodic palpitations

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Conditions

July 29, 2017

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

A 34-year-old man is evaluated for episodic palpitations of 8 months’ duration. The palpitations last 5 to 10 minutes and then resolve spontaneously. They are usually associated with sweating and anxiety. Medical history is significant for thyroidectomy for medullary thyroid carcinoma diagnosed at 12 years of age. His father has also undergone thyroidectomy …

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

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Conditions

July 22, 2017

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 presents to clinic requesting more information about use of a closed-loop insulin-delivery system (artificial beta cell).

Although her HbA1c is at goal, she notes frequent hypoglycemia as an issue. In addition, she would like to further improve her glycemic control in anticipation of pregnancy in the next …

MKSAP: 20-year-old male college student with a superficial skin infection

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Conditions

July 15, 2017

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

A 20-year-old male college student on the wrestling team is evaluated for a superficial skin infection. He has a history of several episodes of folliculitis and furunculosis over the past year that has required systemic treatment. His recurrent infections were treated with various oral antibiotics, including cephalexin, clindamycin, and trimethoprim-sulfamethoxazole. He currently …

MKSAP: 60-year-old woman with substernal chest pain

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Conditions

July 8, 2017

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

A 60-year-old woman is evaluated for a 3-week history of substernal chest pain. The pain is dull, nonradiating, and unrelated to activities. Sometimes the pain is worse after eating spicy foods and can be occasionally triggered by emotional stress. She has not had shortness of breath or weakness. She is moderately active, …

MKSAP: 21-year-old woman with mosquito bites

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Conditions

July 1, 2017

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

A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has no significant medical history, and …

MKSAP: 28-year-old pregnant woman with a cardiac murmur

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Conditions

June 24, 2017

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

A 28-year-old pregnant woman is evaluated for a cardiac murmur identified on examination by her obstetrician. She is asymptomatic. She is in her 24th week of pregnancy. Medical history is unremarkable, and there is no family history of heart disease. She takes prenatal vitamins and no other medications.

On physical examination, she is …

MKSAP: 56-year-old woman with type 2 diabetes mellitus

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Conditions

June 17, 2017

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

A 56-year-old woman presents to the office to discuss management of her type 2 diabetes mellitus. She is unhappy with her recent HbA1c value. She adheres to the maximum dose metformin monotherapy, which she has been taking for 1 year. Additionally, she has been working toward weight reduction without success; however, weight …

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