MKSAP Questions of the Week

Pulmonary and Critical Care Medicine Q14

A 67-year-old man is evaluated in the emergency department with a 3-day history of weakness and nausea and a 2-week history of difficulty swallowing. He has lost 22.7 kg (50 lb) during the past year. He has no other symptoms. History is significant for a 30-pack-year history of smoking. He quit smoking 4 years ago. He takes no medications. On physical examination, vital signs are normal. Lung examination reveals decreased tactile fremitus above the lower portion of the right lung as well as dullness to percussion and decreased breath sounds. His neurologic examination is normal. Laboratory studies reveal a serum sodium concentration of 127 mEq/L (127 mmol/L). A chest CT scan is shown.

Publish date: 07/15/2020

Neurology Q 6

A 51-year-old woman is evaluated for a 1-year history of daily afternoon fatigue that necessitates frequent naps and impairs her concentration at the office, where she works as a lawyer. Lifestyle adjustments, such as improving sleep hygiene, getting regular exercise, yoga, and vitamin supplementation have not resolved this symptom. She has a 5-year history of multiple sclerosis. Medications are glatiramer acetate and a vitamin D supplement. On physical examination, vital signs are normal. Depression screening is negative. The remainder of the physical examination is noncontributory. Results of laboratory studies, including hemoglobin and serum thyroid-stimulating hormone levels, are unremarkable.

Publish date: 06/30/2020

Nephrology Q 13

A 57-year-old man is evaluated during a routine visit. History is significant for hypertension. Medications are hydrochlorothiazide, 25 mg/d, and amlodipine, 5 mg/d. On physical examination, blood pressure is 135/86 mm Hg, and pulse rate is 70/min; other vital signs are normal. There is 1+ bilateral ankle edema. The remainder of the examination is normal. Laboratory studies show a serum creatinine level of 1.0 mg/dL (88.4 µmol/L), a serum potassium level of 3.6 mEq/L (3.6 mmol/L), and an estimated glomerular filtration rate >60 mL/min/1.73 m2.

Publish date: 06/25/2020

Infectious Disease Q 5

A 43-year-old man is seen in follow-up for fever up to 38.3 °C (101 °F) occurring periodically over the past 3 months. He has no associated symptoms other than fatigue. He reports no recent travel, animal exposures, or tick or insect bites. He does not eat raw meats, raw seafood, or unpasteurized dairy products. He returns for further evaluation after initial testing. Family history is negative for undiagnosed fevers. He takes no medications. On physical examination, temperature is 37.8 °C (100.1 °F), blood pressure is 114/72 mm Hg, pulse rate is 88/min, and respiration rate is 14/min. A complete physical examination is unremarkable.

Publish date: 06/17/2020

Hematology and Oncology Q 10

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 is up to date on routine health care. Her last menstrual period was 5 weeks ago. Medications are ibuprofen and metformin.

Publish date: 06/10/2020

General Internal Medicine Q 12

A 36-year-old woman is evaluated for a 3-year history of fatigue that worsens after activity and does not improve with rest. She also notes intermittent diffuse myalgia and arthralgia, constipation, dizziness, headaches, urinary urgency, memory problems, and paresthesias. Her musculoskeletal symptoms, dizziness, and headache worsen in the upright position and improve when she lies back down. She has almost entirely eliminated social activities. Medical history is significant for episodic migraine and irritable bowel syndrome. Medications are sumatriptan, polyethylene glycol, and hyoscyamine.

Publish date: 06/05/2020

Gastroenterology and Hepatology Q 7

A 52-year-old man is evaluated for dysphagia of 3 months' duration. He reports regurgitating undigested food soon after eating solid food, occasional coughing and choking after swallowing, and chronic halitosis. He reports no weight loss or chest pain. He drinks two beers weekly and does not smoke. On physical examination, vital signs are normal; BMI is 25. The remainder of the examination, including abdominal examination, is unremarkable.

Publish date: 05/27/2020

Endocrinology Q 7

A 25-year-old woman is evaluated for anterior neck pain, fatigue, exercise intolerance, excessive sweating, and tremors that began 6 weeks ago. Other than an upper respiratory infection 2 months ago, she has been healthy. Medical history is otherwise unremarkable, and she takes no medications. On physical examination, pulse rate is 105/min. Other vital signs are normal. The patient's thyroid gland is tender to palpation and is without discrete nodules. No thyroid bruit is auscultated. Bilateral lid lag is noted, but there is no proptosis, conjunctival injection, or chemosis. There is a fine tremor of her outstretched hands. Deep tendon reflexes are brisk.

Publish date: 05/20/2020

Dermatology Q 1

A 63-year-old man is evaluated for a skin eruption that is itchy and worsening for the past several weeks. Medical history is unremarkable, and he takes no medications. On physical examination, vital signs are normal. There are tense bullae on an erythematous base and scattered erosions on the trunk and extremities.

Publish date: 05/13/2020

Cardiovascular Medicine Q 1

A 19-year-old man is evaluated in the emergency department for a 2-week history of abdominal pain and exertional dyspnea. He underwent cardiac transplantation 10 months ago for viral myocarditis. Medications are tacrolimus, prednisone, mycophenolate mofetil, valganciclovir, trimethoprim-sulfamethoxazole, valsartan, calcium–vitamin D supplement, and low-dose aspirin.

Publish date: 05/06/2020

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