Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes ...

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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 with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between ...

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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 in follow-up after recent surgery for endometrial cancer. Her family history is significant for colon cancer in her sister (diagnosed at age 45 years) and her mother (diagnosed at age 65 years). Her maternal grandfather was diagnosed with rectal cancer at age 47 years. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for severe cramps associated with her menstrual periods. The cramps have worsened over the past year, and the discomfort is severe enough that she has periodically missed work. She reports no abnormal vaginal discharge. Menses are unchanged from her baseline pattern. She has tried ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old man is evaluated for intermittent rectal bleeding of 3 months' duration. He is otherwise well and takes no medications. His father had a few polyps removed from the colon when he was 71 years old, but no other details are known about his father's medical history. The ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old man is evaluated in follow-up for heartburn of 7 years' duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. ...

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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 at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications ...

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