MKSAP Questions of the Week

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

Dermatology Q32

A 60-year-old man is evaluated for dry skin and a pruritic rash of 6 months' duration. He is a farmer and has extensive exposure to the sun. The rash is transient, occurring most frequently during the winter and spring when his skin is dry, and is worsened by heat and sweating during the summer. The patient is otherwise well, has no other medical problems, and takes no medications.

Publish date: 04/29/2020

Dermatology Q52

A 40-year-old man is evaluated during a follow-up visit for an extremely pruritic skin eruption for several months that was recently diagnosed as dermatitis herpetiformis. He denies gastrointestinal symptoms and is otherwise healthy and takes no medications.

Publish date: 04/22/2020

Rheumatology Q19

A 65-year-old man is evaluated for a 1-month history of progressive malaise, myalgia, a 3.6-kg (8.0-lb) weight loss, and numbness and weakness of the right foot; left testicular pain for 1 week; and a painful rash on his legs for 2 days. He was diagnosed 2 months ago with hypertension, for which he takes hydrochlorothiazide.

Publish date: 04/14/2020

Nephrology Q25

A 27-year-old woman is evaluated for a 6-month history of fatigue, arthralgia, and myalgia. She has a history of urinary tract infections. Medications are an oral contraceptive pill and as-needed naproxen for pain.

Publish date: 04/07/2020

Pulmonology Q3

A 69-year-old man is evaluated for a 3-year history of dyspnea and chronic productive cough. He was diagnosed with COPD 2 years ago after spirometry confirmed severe airflow obstruction. He discontinued smoking at that time but in the past year he was treated for three COPD exacerbations, one requiring hospitalization. Medications are tiotropium, fluticasone/salmeterol, and albuterol inhalers.

Publish date: 04/01/2020

Neurology Q12

A 41-year-old woman is evaluated for a 2-year history of tremor in the dominant right hand. She says that the tremor has begun interfering with her work as a hairdresser, especially when she uses scissors. She also reports tightness in the forearm. The patient is able to eat, write, and type without difficulty and has had no trauma, imbalance, slowness of movement, or change in gait speed. Alcohol has no effect on the tremor. There is no family history of tremor.

Publish date: 03/18/2020

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