Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide. On physical examination, he is not ill appearing. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old man is evaluated in the office for a 6-month history of progressive weakness of the lower extremities. He says he has difficulty rising from a seated position and walking up stairs and also has episodes of dry eyes, dry mouth, and erectile dysfunction. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old woman with advanced multiple myeloma diagnosed 6 months ago undergoes a follow-up visit. Treatment includes daily oral thalidomide and pulse dexamethasone. The patient now feels well. Laboratory studies indicate a serum monoclonal protein concentration of 3.0 g/dL (30 g/L). Hemoglobin concentration, serum calcium level, ...

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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 during a routine examination. He has a 5 pack-year cigarette smoking history but stopped 12 years ago. He has no history of hypertension, diabetes mellitus, stroke, or transient ischemic attack. He has no claudication. He is being treated for hyperlipidemia. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated in the emergency department for a 5-day history of worsening crampy abdominal pain and eight to ten loose bowel movements a day. The patient has a 5-year history of ulcerative colitis treated with azathioprine and topical mesalamine; before this episode, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman is evaluated for a 4-month history of amenorrhea. Menses began at age 13 years. At age 18 years, the patient was placed on an oral contraceptive pill to control heavy bleeding. She discontinued the oral contraceptive pill 4 months ago because she ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old businessman is evaluated during a routine health examination. He has a 30 pack-year history of smoking, but quit 5 years ago. He consumes two or more alcoholic beverages on most days. He is asymptomatic, but performs no regular physical exercise. He takes no ...

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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 irregular menses and infertility. She reports having had normal puberty but having irregular menses until she started taking an oral contraceptive pill. She has been unable to become pregnant since marrying 1 year ago despite regular intercourse and discontinuing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old woman is evaluated during a follow-up visit for a 4-week history of fatigue; pain in the proximal interphalangeal joints, knees, and hips; and low-grade fever. She has not had joint swelling, chest pain, or shortness of breath. Over the past 4 years, she ...

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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 has a 3-month history of easy bruising and bleeding gums. She feels otherwise well. Medical and family histories are unremarkable, and she takes no medications. On physical examination, temperature is normal, blood pressure is 110/70 mm Hg, pulse rate is 64/min, and respiration ...

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