Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old man is evaluated during a follow-up visit after presenting to an urgent care clinic for back pain 1 week ago. Laboratory studies at that time were significant for a serum creatinine level of 1.4 mg/dL (123.8 µmol/L); other laboratory studies, including urinalysis, were normal. A ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 10-day history of abdominal cramping, diarrhea, malaise, and nausea. Diarrhea is watery without mucus or blood. He returned 2 weeks ago from a 7-day trip to Lima, Peru. On physical examination, temperature is 37.7 °C (99.9 °F); the remaining vital signs ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman undergoes perioperative evaluation. She has osteoarthritis of the right hip since sustaining injuries in a motor vehicle accident 15 years ago and is scheduled for elective hip arthroplasty in the next few months. Medical history is otherwise notable for type 2 diabetes mellitus. She ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated for anorexia, dizziness, and weakness. He was discharged from the hospital 5 days ago after transsphenoidal pituitary surgery for a pituitary macroadenoma abutting the optic chiasm. His postoperative course was uneventful, and his postoperative hormone evaluation was normal; he did not require ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated during a routine examination. He feels well and has no symptoms. Medical history is significant for hypertension. He does not smoke, and he does not have diabetes mellitus. He is active, performing aerobic exercise for 20 to 30 minutes four times per ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated for a 5-month history of exertional chest discomfort that improves with rest. His symptoms have progressively worsened such that he has reduced his activity to a minimum. Medical history is significant for hypertension and hyperlipidemia. Medications are low-dose aspirin, losartan, hydrochlorothiazide, and atorvastatin. On physical ...

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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 2-month history of progressive malaise and weakness, aching bilateral shoulders and hips, and stiffness for 2 hours in the morning and after immobility. He recently noted aching in his jaw when chewing. He also reports new left-sided headaches. Last week he had ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a 6-month history of dyspnea on exertion. He has gastroesophageal reflux disease and Raynaud phenomenon. He does not smoke and has no cough or wheezing. Current medications are lansoprazole and amlodipine. On physical examination, vital signs are normal. Oxygen saturation is 91% breathing ambient ...

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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 carotid bruit detected on routine medical examination. He reports no history of previous focal neurologic symptoms or visual loss. He has type 2 diabetes mellitus and hyperlipidemia treated with metformin, moderate-intensity pravastatin, and aspirin. On physical examination, blood pressure is 128/64 mm Hg, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit for primary membranous glomerulopathy. Diagnosis was made by kidney biopsy 4 months ago, and she was found to be positive for anti–phospholipase A2 receptor (PLA2R) antibodies. Medications are furosemide, losartan, and simvastatin. Recent age- and sex-appropriate cancer screening tests were ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 19-year-old man is hospitalized with a 6-day history of lightheadedness and nightly fevers. He also reports sore throat, headache, joint and muscle aches, and a dry cough. He recalls a blotchy rash on his trunk and arms, which has resolved. He returned home 12 days ago from a ...

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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 undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black. On physical examination, vital signs and other examination findings are normal. A peripheral blood smear shows ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated during a visit to establish care. He is interested in colorectal cancer screening; however, he adamantly refuses to undergo colon preparation, and he does not want to modify his diet for screening. He has never undergone colorectal cancer screening. Medical and family histories are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old man is evaluated for ongoing symptoms of dysphagia. He was previously diagnosed with eosinophilic esophagitis on upper endoscopy and has completed an 8-week course of swallowed aerosolized fluticasone, which did not alleviate his symptoms. He takes no other medications. On physical examination, vital signs are normal; BMI is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated for flushing of the face of 1 year's duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a firm, flesh-colored lesion that has been growing on the back for several months. Foul-smelling material can be expressed from the lesion. The patient is bothered by the periodic drainage. He is otherwise healthy and takes no medications. On physical examination, vital signs are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old woman is evaluated for a 6-week history of chest pressure. The symptom occurs when she walks up an incline on her daily 2-mile walk and is relieved with rest. She also had chest pressure during a stressful meeting at work last week. She reports no associated symptoms. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated for a left lower extremity ulcer. He has a 15-year history of worsening arthritis for which he has never been evaluated. He takes ibuprofen as needed. On physical examination, vital signs are normal. The spleen tip is palpable. There is swelling of multiple small joints ...

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