Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication. All physical examination findings, including vital signs, are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old woman is evaluated for constipation. She reports passage of hard stool every 3 to 4 days and associated bloating. Her symptoms have been present for more than 10 years and have progressed gradually. Trials of over-the-counter fiber supplementation and polyethylene glycol worsened the bloating, prompting discontinuation. Senna ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated at a follow-up appointment for elevated liver chemistry tests over the preceding 6 months. She reports no symptoms. She has type 2 diabetes mellitus and hypertension. Her family history is unremarkable. She drinks two glasses of wine one or two times per month. Her ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated for persistent constipation symptoms of 2 years' duration. She has reflex sympathetic dystrophy syndrome involving the right arm and neck that began 3 years earlier and requires chronic opioid analgesic therapy. She reports passing two hard bowel movements per week. Trials of several fiber ...

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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 in the office during a routine visit. Medical history is significant for HIV diagnosed at age 25 years, hypertension, and hyperlipidemia. He is a current smoker. Medications are chlorthalidone, tenofovir-emtricitabine, and raltegravir. On physical examination, the patient is afebrile, and blood pressure is 126/74 mm ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman is evaluated for decreased exercise tolerance and ice cravings for the past several weeks. Medical history is notable for Crohn colitis diagnosed 6 years ago. Her symptoms flared 3 months ago with increased abdominal pain and diarrhea, and she began therapy with azathioprine and infliximab. Her ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old woman is evaluated during a routine examination. She feels well and has no exercise limitations. Medical history is significant for hypertension treated with enalapril. She does not smoke. At her last examination 4 years ago, her blood pressure was 122/76 mm Hg. Laboratory studies at that time ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream. On physical examination, vital signs are ...

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