MKSAP Questions of the Week

Rheumatology Q66

A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The patient is of Thai descent.

Publish date: 01/15/2020

 
Gastroenterology and Hepatology Q14

A 24-year-old man is evaluated in the emergency department for a 2-week history of worsening bloody diarrhea with up to 10 bloody bowel movements per day. He also reports increasing lower abdominal pain and distension and that stool frequency has decreased over the past day. He has extensive ulcerative colitis of 5 years' duration. His medications are infliximab and azathioprine.

Publish date: 01/08/2020

 
Neurology Q27

A 52-year-old man is evaluated for a 1-year history of progressive weakness that began as right foot drop and bilateral tingling in the feet. Within the past 2 months, the patient has developed progressive weakness, which makes walking difficult; he also notes weakness in the hands and burning below the knees but no autonomic symptoms. He has hypothyroidism treated with levothyroxine.

Publish date: 01/02/2020

 
Hematology and Oncology Q24

A 28-year-old woman is evaluated for decreased exercise tolerance and ice cravings for the past several weeks. Medical history is notable for Crohn colitis diagnosed 6 years ago. Her symptoms flared 3 months ago with increased abdominal pain and diarrhea, and she began therapy with azathioprine and infliximab. Her only other medication is ferrous sulfate tablets, 325 mg once daily, which she has been taking for 6 weeks after being diagnosed with iron deficiency anemia; her hemoglobin level at that time was 8.2 g/dL (82 g/L).

Publish date: 12/26/2019

 
Gastroenterology and Hepatology Q22

A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or family history of colon cancer or other cancers. She takes no medication.

Publish date: 12/18/2019

 
Dermatology Q13

A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream.

Publish date: 12/11/2019

 
Cardiovascular Medicine Q32

A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her hospital course was uncomplicated. Since discharge, she has had shortness of breath. Medical history is significant for hyperlipidemia. Medications are aspirin, ticagrelor, lisinopril, metoprolol, and atorvastatin.

Publish date: 12/05/2019

 
Rheumatology Q37

A 49-year-old woman is evaluated for recently worsening joint symptoms. She has a 13-year history of Crohn disease characterized by four to six stools daily and mild crampy abdominal pain. She also has a 1-year history of arthritis. She currently has pain in the left knee, right ankle, and two joints of the right foot; diffuse swelling involving the left third toe; and 30 minutes of morning stiffness. She has been treated with various NSAIDs, which seem to worsen her bowel disease. She has tried, in succession, azathioprine, mesalamine, and methotrexate, without notable improvement in her symptoms. She currently is taking methotrexate.

Publish date: 11/27/2019

 
Neurology Q45

A 79-year-old man is evaluated for a 2-month history of progressively worsening headaches, nausea, visual disturbance, and difficulty speaking. He also has hypertension and gastroesophageal reflux disease. Medications are lisinopril and omeprazole.

Publish date: 11/21/2019

 
Dermatology Q22

A 44-year-old man is evaluated for a new lesion on the side of his face. It has been present for several months and is asymptomatic. When he shaves he cuts it, and it starts bleeding. He is otherwise healthy and takes no medications.

Publish date: 11/13/2019

 
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