MKSAP Questions of the Week

Hematology and Oncology Q 32

A 76-year-old woman is evaluated for worsening fatigue. She reports no additional symptoms. Medical history is significant for myelodysplastic syndrome diagnosed 3 years ago, which has required the transfusion of 1 to 2 units of blood every 5 to 6 weeks to maintain a hemoglobin level of approximately 8 g/dL (80 g/L); she has exertional dyspnea when the hemoglobin level drops below 7 g/dL (70 g/L).

Publish date: 11/18/2020

General Internal Medicine Q32

A 65-year-old man is evaluated during a visit to establish care. He is interested in colorectal cancer screening; however, he adamantly refuses to undergo colon preparation, and he does not want to modify his diet for screening. He has never undergone colorectal cancer screening. Medical and family histories are unremarkable. He takes no medications. Physical examination, including vital signs, is normal. After discussing the colon preparation process and dietary restrictions with the patient and exploring his concerns, he is steadfast in his refusal.

Publish date: 11/11/2020

Gastroenterology and Hepatology Q 25

A 43-year-old man is evaluated for 4 days of fever and arthralgia, as well as a raised purple rash over his lower extremities of 1 week's duration. He is a current intravenous drug user. He has no other medical problems and takes no medications. On physical examination, temperature is 37.8 °C (100 °F) and blood pressure is 132/85 mm Hg; other vital signs are normal. The large and small joints are tender to palpation without evidence of synovitis. The abdomen is not tender to palpation. The liver edge is palpable below the right costal margin.

Publish date: 11/04/2020

Endocrinology Q 28

A 45-year-old man is evaluated for anorexia, dizziness, and weakness. He was discharged from the hospital 5 days ago after transsphenoidal pituitary surgery for a pituitary macroadenoma abutting the optic chiasm. His postoperative course was uneventful, and his postoperative hormone evaluation was normal; he did not require any hormone replacement. He denies any polyuria or increase in thirst. He takes no medications

Publish date: 10/28/2020

Dermatology Q 44

A 19-year-old man is evaluated for 4 to 5 months of persistent itching, thickening of the skin, and odor of the feet. He also has hyperhidrosis of the palms and soles. Medical history is otherwise unremarkable, and he takes no medications. On physical examination, vital signs are normal. Skin findings are shown.

Publish date: 10/21/2020

Cardiovascular Medicine Q 3

A 65-year-old woman is evaluated during a routine examination. She was diagnosed with a cardiac murmur in early adulthood. She is active, healthy, and without symptoms. She takes no medications. On physical examination, vital signs are normal. A grade 3/6 holosystolic murmur preceded by multiple clicks is present at the apex. Physical findings are otherwise unremarkable.

Publish date: 10/14/2020

Rheumatology Q 15

A 50-year-old man is evaluated for a left lower extremity ulcer. He has a 15-year history of worsening arthritis for which he has never been evaluated. He takes ibuprofen as needed. On physical examination, vital signs are normal. The spleen tip is palpable. There is swelling of multiple small joints at the hands, knees, and metatarsophalangeal (MTP) joints. There is ulnar deviation and subluxation of the metacarpophalangeal joints. Subcutaneous nodules are present at the elbows bilaterally. There is a 2- × 2-cm shallow ulcer at the medial left lower extremity just above the ankle.

Publish date: 10/07/2020

Pulmonary and Critical Care Medicine Q 18

A 42-year-old man is evaluated in the office for follow-up of progressive dyspnea of 2 years' duration. He first noted dyspnea with exercise but now has symptoms when walking up a flight of stairs. He has intermittent wheezing but no coughing or nocturnal respiratory symptoms. At the time of his initial evaluation 2 years ago, pulmonary function tests demonstrated moderate airflow obstruction. He has a 1-pack-year smoking history but has not smoked in 20 years. He has no environmental exposures. His father and uncle both have emphysema without a history of smoking. He takes no medications. On physical examination, vital signs are normal. Oxygen saturation is 94% breathing ambient air. Examination reveals no clubbing or jugular venous distention, extra cardiac sounds, edema, pulmonary crackles, or wheezing. A chest radiograph shows hyperinflation and diaphragmatic flattening.

Publish date: 09/30/2020

Neurology Q 20

A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, metformin, and atorvastatin. On physical examination, blood pressure is 126/68 mm Hg, pulse rate is 86/min and regular, and respiration rate is 12/min. No carotid bruits or cardiac murmurs are heard on cardiac auscultation. All other physical examination findings are normal. An electrocardiogram shows normal sinus rhythm with no ST-segment or T-wave changes.

Publish date: 09/23/2020

Nephrology Q 32

A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks' gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin. On physical examination, the patient is afebrile, blood pressure is 102/62 mm Hg, and pulse rate is 80/min. Pain and bruising over the left chest wall are noted. Abdominal examination findings are consistent with changes of pregnancy. Laboratory studies are significant for a serum sodium level of 132 mEq/L (132 mmol/L).

Publish date: 09/17/2020

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