Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 35-year-old woman is evaluated for a 6-month history of right upper quadrant abdominal pain that has slowly increased in intensity and is worse on deep inspiration. The patient is otherwise well, and her only medication is an oral contraceptive pill that she has taken ...
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MKSAP: 78-year-old woman is seen for management of her diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient's blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more ...
MKSAP: 60-year-old woman with pruritic hives
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 60-year-old woman is evaluated for pruritic hives that have persisted for 12 weeks. The lesions appear, resolve within hours, and leave no residual mark but reappear at a later time. She does not associate the hives with any particular foods or exposures. Her medical ...
MKSAP: 58-year-old woman with acute left-sided flank pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is ...
MKSAP: 25-year-old with diffuse muscle and joint pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 25-year-old woman is evaluated during a follow-up visit for a 6-month history of diffuse muscle and joint pain above and below the waist, fatigue, and difficulty sleeping. She has a 2-year history of hypothyroidism treated with levothyroxine. Her only other medication is hydrocodone-acetaminophen, which ...
MKSAP: 67-year-old man with confusion, agitation, and malignant hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 67-year-old man is evaluated in the emergency department for confusion and agitation secondary to malignant hypertension. Initial blood pressure is 230/130 mm Hg, and funduscopic examination reveals papilledema.He is admitted to the intensive care unit, and therapy with nitroprusside by continuous infusion is begun; ...
MKSAP: 38-year-old woman with increasingly frequent headache
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 38-year-old woman is evaluated in the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning on awakening. She has recently started keeping a headache diary, which reveals episodes on approximately 25 days of each month. The ...
MKSAP: 42-year-old woman with lymphadenopathy, fatigue, and edema
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 42-year-old woman is evaluated for a 3-month history of progressive cervical lymphadenopathy, fatigue, night sweats, bilateral lower-extremity and abdominal wall edema, and a 4.5-kg (10.0-lb) weight gain. History is significant for three episodes of weight gain and facial and lower-extremity edema lasting 4 weeks ...
MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin ...
MKSAP: 52-year-old man with perineal and suprapubic pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 52-year-old man is evaluated for a 3-month history of perineal and suprapubic pain. He has experienced urinary frequency and dysuria for 4 to 6 weeks. The patient reports fatigue, insomnia, and low mood for the past 6 months. He has hypertension. Current medications are ...
MKSAP: 32-year-old man with abdominal pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, he had one or two bowel movements of well-formed stool ...
MKSAP: 25-year-old man is evaluated for infertility
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 25-year-old man is evaluated for a 2-year history of infertility. He and his wife have been unable to conceive since marrying 2 years ago. Analysis of a semen sample provided 3 weeks ago during an infertility evaluation showed azoospermia. The patient has a strong ...
MKSAP: 68-year-old man with a sensation of dryness in his eyes
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 68-year-old man is evaluated for a 6-month history of a sensation of dryness in his eyes. He notes that it feels as though there is sand in his eyes.On physical examination, the eyes are red, and trichiasis (ingrown eyelashes) and symblepharon (adhesions of the ...
MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time ...
MKSAP: 72-year-old woman with fatigue and decreased exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 72-year-old woman is evaluated for fatigue and decreased exercise capacity. The patient has severe chronic obstructive pulmonary disease, which was first diagnosed 10 years ago, and was hospitalized for her second exacerbation 1 month ago. She is a former smoker, having stopped smoking 5 ...
MKSAP: 75-year-old woman with a sudden loss of vision
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 75-year-old woman is evaluated for a sudden loss of vision in the left eye that began 30 minutes ago. She has a 2-week history of fatigue; malaise; and pain in the shoulders, neck, hips, and lower back. She also has a 5-day history of ...
MKSAP: 81-year-old man is evaluated for the gradual onset and progression of memory loss
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.An 81-year-old man is evaluated for the gradual onset and progression of memory loss over the past year. He says he has difficulty recalling the names of familiar people, has misplaced his wallet on numerous occasions, and is slower to find his car in large, ...
MKSAP: 25-year-old man with swelling of the feet and legs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 25-year-old man is evaluated in the emergency department for swelling of the feet and legs. He has a 5-year history of HIV infection for which he has refused treatment.On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 88/min, ...
MKSAP: 20-year-old with fever, myalgia, headache, and a rash
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication is an oral contraceptive agent.On physical examination, the patient appears ill. Temperature is 38.8 °C (101.8 °F), blood pressure is 90/45 ...
MKSAP: 58-year-old man is evaluated for increasing fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 58-year-old man is evaluated for increasing fatigue of 2 months' duration. The patient has hypertension and hyperlipidemia treated with lisinopril and atorvastatin. A sister has hypothyroidism.On physical examination, temperature is normal, blood pressure is 135/80 mm Hg, pulse rate is 72/min, and respiration ...
