Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old woman is evaluated for a 12-year history of refractory constipation. Her symptoms began after a difficult childbirth. She has constipation marked by straining, bloating, and a constant sensation of incomplete emptying. She sometimes has 4 or more days between bowel movements. When she does have a bowel ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old man is being evaluated after his 18-year-old son had a syncopal episode during a high school basketball game and was diagnosed with hypertrophic cardiomyopathy (HCM). The patient has had no symptoms, including with physical activity such as golfing or playing tennis. Medical history is unremarkable, and a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old man is evaluated for painless intermittent bloody urine of 6 weeks' duration. History is significant for granulomatosis with polyangiitis (formerly known as Wegener granulomatosis) diagnosed 10 years ago, which is now in remission; he was treated with prednisone for 3 years and oral cyclophosphamide for 1 year. ...

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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 with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years ago. Her HbA1c levels since diagnosis have ranged from 6.4% to 7.3%, with the most recent value at 7.3%. She reports eating a carbohydrate-consistent diet ...

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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 in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated for a 4-week history of heartburn that awakens him at night. The symptoms occur about three times per week. He has been taking over-the-counter antacids with incomplete relief. Food triggers include coffee and spicy foods. He has not had unintentional weight loss or difficulty ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old woman is evaluated for a 1-year history of tremor. The tremor is more prominent on the right side. She also reports increasing problems with balance and numerous falls, especially when arising from a chair or turning. The patient does not have any significant cognitive symptoms. She has ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical ...

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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 in follow-up after being recently diagnosed with HIV infection. She is asymptomatic. Medical history is unremarkable, and she takes no medications; she has not yet started antiretroviral therapy. She received all scheduled childhood immunizations. On physical examination, vital signs are normal. She has shotty cervical ...

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