Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg ...

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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 undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12. On physical examination, vital signs are normal, as is the remainder of the physical examination. Upper endoscopy discloses a 6-mm polyp in the ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated because of fatigue. He also notes constipation and cold intolerance. Medical history is significant for tonsillar squamous cell carcinoma treated with radiation 3 years ago. There is no family history of thyroid disorders. On physical examination, the skin is dry. Mild periorbital edema is present. The thyroid ...

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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 ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated for management of type 2 diabetes mellitus. He was diagnosed with diabetes 6 months ago after being admitted to the hospital with diabetic ketoacidosis. He was discharged from the hospital on a basal and preprandial insulin regimen. Medications are regular insulin before meals and neutral protamine ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated during a routine appointment and asks for advice on cardiac risk assessment. He does not have any current cardiac symptoms, exercises 4 days per week, and has never smoked. He has no chronic health issues and takes no medications. He has no known drug allergies. Results of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old woman is evaluated for a 4-month history of progressive dyspnea and fatigue without chest pain. Eighteen months ago, she was diagnosed with liver cirrhosis due to nonalcoholic steatohepatitis (NASH). Medical history is also significant for obesity. Medications are propranolol, spironolactone, and lactulose. On physical examination, temperature is 36.4 °C (97.5 ...

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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 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of urinary hesitancy or incomplete emptying. The patient has primary progressive multiple sclerosis. Medications are dalfampridine and vitamin D. On physical evaluation, temperature is 36.8 °C (98.2 °F), blood pressure ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated following a screening for type 2 diabetes mellitus. He is asymptomatic. He has a history of hypertension and hyperlipidemia. There is no history of anemia, liver disease, or kidney disease. Medications are lisinopril and rosuvastatin. On physical examination, blood pressure is 123/76 mm Hg and pulse rate ...

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