MKSAP Questions of the Week

Gastroenterology Q 30

A 62-year-old man with compensated cirrhosis is evaluated at a follow-up visit. Six months ago, he was diagnosed with hepatitis C virus infection and treated with direct-acting antiviral agents. He experienced sustained viral response. Current liver ultrasound shows a small nodular liver compatible with cirrhosis and no masses. On physical examination, vital signs and other findings are normal.

Publish date: 01/19/2022

 
Gastroenterology Q 60

A 55-year-old man is evaluated at follow-up for iron deficiency anemia and positive result on stool guaiac testing. Despite excellent preparation and visualization, upper endoscopy and colonoscopy performed last week did not find the source of bleeding. He has no melena, hematochezia, or localizing symptoms. He has no other medical conditions and takes no medications. Vital signs and other findings on physical examination are normal. Which of the following is the most appropriate diagnostic test to perform next?

Publish date: 01/13/2022

 
GIM Q110

An 81-year-old woman is evaluated for bruising. For the past few years, she has noticed dark red patches appearing intermittently on the forearms without trauma or other triggers. They are not painful and resolve without treatment. History includes hypertension, for which she takes hydrochlorothiazide. On physical examination, vital signs, including blood pressure, are normal. Skin is dry, and skin findings on the forearm are shown.

Publish date: 01/05/2022

 
Gastroenterology Q 71

A 35-year-old woman is evaluated for follow-up of abdominal pain, which has prompted multiple emergency department visits. CT scans have revealed intussusception. Her mother was diagnosed with breast cancer at age 40 years. The rest of her family history is unknown. On physical examination, vital signs are normal. Findings on lips are shown

Publish date: 12/22/2021

 
GIM Q2

A 44-year-old woman is evaluated during routine follow-up of type 2 diabetes mellitus. She also has hypertension. Current medications are metformin, canagliflozin, lisinopril, and hydrochlorothiazide. On physical examination, vital signs are normal. BMI is 26. Triglyceride level is 165 mg/dL (1.86 mmol/L). Her 10-year risk for atherosclerotic cardiovascular disease is 3.8%. Using shared decision making, the patient opts to follow the recommendation of the American Heart Association/American College of Cardiology for cholesterol management. Which of the following is the most appropriate treatment?

Publish date: 12/15/2021

 
Nephrology Q 18

A 57-year-old man is evaluated during a follow-up visit for stable chronic kidney disease diagnosed 1 year ago. Renal duplex Doppler ultrasound at that time showed a 7-cm right kidney and 11-cm left kidney with a >75% midstenotic lesion of the left renal artery. He also has type 2 diabetes mellitus, hyperlipidemia, and peripheral artery disease. Medications are low-dose aspirin, furosemide, lisinopril, amlodipine, carvedilol, metformin, empagliflozin, and atorvastatin. On physical examination, blood pressure is 128/74 mm Hg, pulse rate is 65/min, and respiration rate is 18/min. Bilateral carotid and lower abdominal quadrant bruits are heard. Peripheral extremity pulses are diminished. The remainder of the examination is normal.

Publish date: 12/10/2021

 
Oncology Q 18

A 56-year-old man is evaluated for an enlarging, painful inguinal lymph node he first noticed 1 month ago. He has a history of follicular lymphoma of 8 years' duration. The patient was treated in the past with two courses of rituximab 8 and 3 years ago with durable partial responses. For the past 3 years, he had stable diffuse adenopathy managed with observation. He has no other symptoms. On physical examination, vital signs are normal. The patient has diffuse adenopathy in the neck, axillae, and right inguinal area and a new left inguinal conglomerate nodal mass measuring 5 × 7 cm. Complete blood count and metabolic profile are normal. PET/CT scan shows diffuse uptake in axillary, mediastinal, hilar, and mesenteric nodes with elevated standardized uptake values in the 4 to 12 range, but 28 in the left inguinal area.

Publish date: 12/01/2021

 
Infectious Diseases Q 12

A 26-year-old woman is seen for follow-up discussion of test results. Three days ago, she was evaluated for a 1-week history of a nonpruritic rash that appears to be resolving since the initial evaluation. The patient reports no recent history of oral or genital ulcers. She is transgender. She has multiple sexual partners (men and women) and reports consistent use of condoms except for oral sex. Medical history is notable for two instances of gonorrhea and treatment for early latent syphilis 1 year ago. Medications are combination tenofovir-emtricitabine. On physical examination, temperature is 37.9 °C (100.2 °F); other vital signs are normal. Enlarged cervical, axillary, and epitrochlear lymph nodes are present. Faint, erythematous macules and papules are spread over the trunk and extremities; a few lesions are noted on the left palm. Rapid plasma reagin (RPR) is 1:128; RPR 3 months ago was 1:2. Testing of urine and throat and anal swabs for gonorrhea and chlamydia is negative. HIV testing is negative.

Publish date: 11/17/2021

 
Gastroenterology Q 3

A 50-year-old man is evaluated for newly developed ascites. He has cirrhosis due to nonalcoholic steatohepatitis. Paracentesis confirms cirrhosis as a cause of the ascites and excludes infection, and a low-sodium diet is implemented. Medical history includes type 2 diabetes mellitus, hypertension, and dyslipidemia. Current medications are metformin, lisinopril, and atorvastatin. On physical examination, vital signs are normal. The abdomen is nontender and mildly distended, with normal bowel sounds. Serum creatinine level is 1.1 mg/dL (97.2 μmol/L). Random urine protein-creatinine ratio is 16 mg/g. Which of the following is the most appropriate additional treatment?

Publish date: 11/10/2021

 
GIM Q16

A 70-year-old woman is evaluated for pain in the left great toe that has been present for 5 years and has steadily worsened. The pain is exacerbated by standing for long periods and wearing shoes with higher heels. At times the toe becomes inflamed, and throbbing pain may persist throughout the day and night. Oral and topical NSAIDs do not help. She is otherwise well and takes no medications. Findings on physical examination are shown. No palpable masses or interdigital clicks are observed when the foot is compressed.

Publish date: 11/04/2021

 
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