Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old woman is evaluated for a 2-month history of a painless right neck mass. Medical history is unremarkable, and she takes no medications. She is a lifelong nonsmoker. On physical examination, vital signs are normal. A 5-cm right anterior neck mass is palpated. The remainder of the examination is unremarkable. An initial ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a ...

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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 for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife's requests for sexual intercourse, although he still has sexual desires. He has been ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated in follow-up for elevated liver chemistry test results, which were performed to assess a 3-month history of fatigue. He has no history of liver disease and has not had abdominal pain or fever. His medical history is significant for a 3-year history of diarrhea. Following a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated for a recent diagnosis of primary hyperparathyroidism after an elevated serum calcium level was incidentally detected on laboratory testing. Medical history is significant only for hypertension, and his only medication is ramipril. On physical examination, temperature is 35.8 °C (96.4 °F), blood pressure is 120/68 mm Hg, ...

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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 a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. ...

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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 during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including ...

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