Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks’ gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS). She has had multiple uncomplicated painful crises treated at home with hydration, nonopioid analgesia, and incentive spirometry. She requires hospital management for these episodes approximately twice per year. She has declined …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 26-year-old man is evaluated for a 3-month history of depressed mood, poor concentration, decreased energy, increased sleep, and weight gain. He reports missing many days at work and that his work performance has lagged. He has no suicidal ideation. He states that his current symptoms differ markedly from his usual state of being “highly …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 29-year-old man is evaluated during a routine examination. His medical history is significant for ulcerative colitis involving the entire colon, which was diagnosed 4 years ago. His symptoms responded to therapy with mesalamine and have remained in remission on this medication. His family history is significant for a maternal uncle who died …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 40-year-old man with type 1 diabetes mellitus presents to the office. He seeks advice on his diabetes management as he intensifies his exercise routine in preparation for participation in a 10-K race. He reports prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. His insulin regimen is insulin …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 34-year-old man is evaluated for a 2-year history of fatigue, low libido, and infertility. His family history is notable for a brother with infertility. His medical history is unremarkable, and he takes no medications.
On physical examination, vital signs are normal. His height is 195.6 cm (77 in), and his weight is 86.2 …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated at a well-patient visit. Both her parents have a history of nonmelanoma skin cancer within the past year, and she is seeking counseling regarding skin cancer prevention. She has a history of remote sunburns and had previously tanned as a teenager. She requests advice on how to approach …
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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 routine examination. He has no symptoms. Medical history is significant for a bicuspid aortic valve. He is not taking any medications.
On physical examination, he is afebrile, blood pressure is 130/70 mm Hg, pulse rate is 56/min, and respiration rate is 15/min. Cardiac examination reveals a grade …
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A 21-year-old woman is evaluated for management of type 1 diabetes. She was diagnosed 3 months ago after presenting to the emergency department with diabetic ketoacidosis. Her HbA1c level at the time of diagnosis was 15.2%. She was discharged from the hospital on a basal and prandial insulin regimen with minor adjustments required as an outpatient. Her blood glucose log demonstrates a recent change manifesting as frequent symptomatic episodes of …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking. His occupation does not require repetitive bending. He played football in college and experienced left knee trauma during sports participation; he underwent left meniscectomy and stopped playing sports. His …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is evaluated in follow-up for a right-sided pleural effusion. He initially presented with increasing dyspnea and a constant dull ache on his right side. He also has lost 9.1 kg (20.0 lb) over the last 6 months. Medical history is otherwise unremarkable, and he takes no medications. He has never …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for difficult-to-treat migraine. She has had severe headaches, usually on the first day of menses, since menarche. The pain is hemicranial, pulsatile, and associated with severe nausea and vomiting but no aura. She frequently awakens with the attack already in progress. Ibuprofen was helpful in controlling migraine pain …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is evaluated for a diagnosis of acute kidney injury. He was diagnosed with gastroesophageal reflux disease 3 weeks ago and was prescribed omeprazole. Several days ago he noticed lower extremity swelling and decreased frequency of urination. Laboratory evaluation showed a serum creatinine level of 2.2 mg/dL (194.5 µmol/L). Medical history …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman e-mails her internist from Mexico with a report of diarrhea for 2 days. She is traveling and reports three to four loose bowel movements per day. She has been dining in the hotel restaurants but has also consumed foods and bottled soft drinks served with ice from local food vendors.
She …
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A 54-year-old man is evaluated during follow-up consultation regarding laboratory studies completed for a life insurance policy. He reports no symptoms.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 131/76 mm Hg, pulse rate is 88/min, and respiration rate is 15/min. No splenomegaly is noted.
Laboratory studies:
Hemoglobin 8.9 g/dL (89 g/L)
Leukocyte count 3000/µL (3.0 × 109/L) with 30% neutrophils, 10% monocytes, and 60% lymphocytes
Mean corpuscular volume 105 fL
Platelet count 75,000/µL …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 26-year-old woman is evaluated during a routine examination. Her last Pap smear was performed 1 year ago and was normal. She has received a complete human papillomavirus (HPV) quadrivalent vaccine series. Medical history is unremarkable. Family history is noncontributory. She takes no medications.
On physical examination, temperature is normal, blood pressure is 110/72 …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of lifestyle modification for his diabetes but has not yet started antihypertensive therapy. He is currently taking no medications.
On physical examination, blood pressure is 148/92 mm Hg, and pulse rate …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old woman is seen for follow-up evaluation. Two weeks ago, she was in a car accident, and an incidental pituitary adenoma was found on a cervical spine CT scan. She has no residual injuries from the car accident.
She is otherwise healthy and takes no medications. She went through menopause at age 51. …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 34-year-old woman is evaluated for very dry, painful hands. She works in a daycare center and washes her hands 15 to 20 times daily, often for 2 to 3 minutes at a time. She has been applying lotion multiple times daily with no relief of the pain. She has a history of …
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