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 ...

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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 ...

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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 ...

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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 ...

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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). ...

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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 ...

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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 ...

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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 ...

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