MKSAP Questions of the Week

Gastroenterology Q33

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 medication. On physical examination, vital signs and other findings are normal; BMI is 19.

Publish date: 04/15/2021

Endocrinology Q45

A 37-year-old woman is unable to achieve pregnancy despite 7 months of unprotected intercourse. Her menstrual cycles are normal, occurring every 28 days with associated breast tenderness and bloating. There have been no prior pregnancies or attempts to achieve pregnancy by either the patient or her male partner. There is no history of previous sexually transmitted infections. She is otherwise healthy. Medical history is significant for appendicitis at age 26 for which she had an uncomplicated appendectomy. Her only medication is a prenatal vitamin. On physical examination, vital signs are normal. She has a well-healed abdominal scar. Thyroid, skin, and pelvic examinations are all unremarkable. There is no elicitable breast discharge, no signs of hyperandrogenism, and no visual field cuts.

Publish date: 04/08/2021

Dermatology Q55

A 16-year-old woman is evaluated for an acne breakout on her face for 6 months' duration. She has been using over-the-counter benzoyl peroxide products, but the acne is not improving. She is not sexually active. Medical history is unremarkable, and she takes no medications. On physical examination, vital signs are normal. Skin findings show scattered open and closed comedones on the forehead, nose, and cheeks. There are no inflammatory pustules or nodules. The remainder of the examination is normal.

Publish date: 04/01/2021

Cardiology Q27

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. Medical history is significant for hypertension and hyperlipidemia. Medications are hydrochlorothiazide, lisinopril, and atorvastatin. On physical examination, vital signs and the remainder of the examination are normal. An electrocardiogram is normal.

Publish date: 03/24/2021

Rheumatology Q31

A 75-year-old woman is evaluated for a 2-week history of gradually increasing pain in both shoulders and hips; the pain radiates down both arms to the elbows and down both hamstrings to the knees. She reports no headache, jaw claudication, or vision changes. She was diagnosed with polymyalgia rheumatica 3 months ago. She started prednisone, 15 mg/d, with immediate and complete relief of symptoms; prednisone was weaned from 15 to 10 mg/d 2 months ago, then to 8 mg/d (current dose) 1 month ago. She remained asymptomatic until 2 weeks ago. She says that her current symptoms are just as bad as when she was first diagnosed. On physical examination, vital signs are normal; blood pressure is identical in both arms. There is no temporal tenderness or induration. Painful range of motion of both shoulders and hips is noted.

Publish date: 03/17/2021

Pulmonary and Critical Care Medicine Q35

A 72-year-old woman is evaluated during a routine visit. She has a 30-pack-year smoking history and quit 5 years ago. She has a history of mild COPD and breast cancer diagnosed 15 years ago, currently in remission. A chest radiograph from 5 years ago showed no signs of disease recurrence. Medications are albuterol and tiotropium inhalers. On physical examination, vital signs are normal. Lung examination reveals prolonged expiration and diminished breath sounds throughout. The breast examination is unremarkable. A screening low-dose chest CT scan shows a peripheral 9-mm solid pulmonary nodule in the left upper lobe and emphysema but no mediastinal or hilar lymphadenopathy and no pleural effusion. A PET/CT scan using fluorodeoxyglucose (FDG) is performed and the nodule is intensely hypermetabolic. There is no evidence of distant uptake.

Publish date: 03/10/2021

Neurology Q59

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, pulse rate is 78/min and regular, and respiration rate is 16/min. A left carotid bruit is heard on cardiac examination. All other physical examination findings, including those from a neurologic examination, are unremarkable. Results of laboratory studies show an LDL cholesterol level of 82 mg/dL (2.12 mmol/L). The carotid ultrasound report describes a mixed-density plaque at the origin of the left internal carotid artery with stenosis estimated to be 60% to 80%.

Publish date: 03/03/2021

Nephrology Q45

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 normal. On physical examination, vital signs are normal. There is pitting lower extremity edema to the mid shins bilaterally.

Publish date: 02/24/2021

Infectious Disease Q42

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 are normal. On abdominal examination, bowel sounds are present with diffuse tenderness to palpation. The abdomen is not distended; no guarding or rebound is noted. Stool polymerase chain reaction assay is positive for Cyclospora.

Publish date: 02/17/2021

Hematology -Oncology Q14

A 67-year-old woman undergoes follow-up evaluation for an elevated globulin fraction of total serum protein level. She has no symptoms. Medical history is notable for hypertension treated with hydrochlorothiazide and atorvastatin. On physical examination, vital signs are normal. No lymphadenopathy or hepatosplenomegaly is noted. Serum protein electrophoresis and immunofixation show an IgG monoclonal spike of 0.7 g/dL. Serum free light chain assay and 24-hour urine protein electrophoresis are normal. Skeletal survey shows no lytic lesions.

Publish date: 02/10/2021

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