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MKSAP Questions of the Week

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

 
Hematology-Oncology Q50

An 81-year-old woman is evaluated for a 1-year history of headaches, redness of the face, and itching. She indicates being otherwise capable of performing her daily activities on her farm. She reports no shortness of breath, chest pain, or difficulty sleeping. Medical history is significant for hypertension; she has never smoked and does not drink alcohol. Her only medication is hydrochlorothiazide.

Publish date: 11/07/2019

 
Gastroenterology Q5

A 75-year-old man is evaluated for progressive dysphagia of 8 months' duration for both solid food and water, and the necessity to induce vomiting several times each month to relieve his symptoms. He also has experienced chest pain and heartburn symptoms. He has lost approximately 6 kg (13 lb) of weight over the preceding 3 months and a total of 9 kg (20 lb) since his symptoms began. He has a long history of cigarette and alcohol use. His medical history and review of systems is otherwise negative. He has no travel history outside the northeastern United States. He takes no medication.

Publish date: 11/01/2019

 
Dermatology Q3

A 32-year-old man is evaluated for an intermittent pruritic rash of 8 years' duration. Medical history is significant for mild persistent asthma. His only medications are an albuterol inhaler and an inhaled glucocorticoid. What of the following is the most appropriate treatment?

Publish date: 10/25/2019

 
Cardiovascular Medicine Q12

A 78-year-old man is evaluated for palpitations, worsening fatigue, and exercise intolerance. Two months ago, he was diagnosed with atrial flutter and subsequently underwent cardioversion to normal sinus rhythm. Ambulatory electrocardiographic monitoring following cardioversion demonstrated recurrent atrial flutter with an average ventricular rate of 69/min. What is the most appropriate treatment?

Publish date: 10/18/2019

 
Hematology Oncology Question 78

A 28-year-old woman is evaluated in the emergency department for a 1-week history of progressive headache associated with nausea and vomiting. Medical history is significant for HIV infection. She is nonadherent to her antiretroviral therapy regimen and takes no other medications. What is the most appropriate next step in management?

Publish date: 10/02/2019

 
Endocrinology Question 65

A 64-year-old woman is seen for follow-up evaluation. Two weeks ago, she was in a car accident, and an incidental pituitary adenoma was found on a cervical spine CT scan. She has no residual injuries from the car accident. What is the most appropriate management?

Publish date: 09/27/2019

 
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