MKSAP Questions of the Week

Infectious Disease Q 9

A 44-year-old woman is evaluated for persistent fatigue, headache, myalgia, and arthralgia. Early localized Lyme disease was diagnosed 2 months ago after the patient returned from a camping trip in western New Jersey with the symptoms described and a skin eruption of erythema migrans. She was treated with a 14-day course of doxycycline with resolution of the cutaneous lesions but continuation of the other symptoms, which now are adversely affecting her work and personal life. Her only medication is ibuprofen.

Publish date: 09/09/2020

 
Hematology and Oncology Q 12

A 50-year-old woman undergoes follow-up evaluation for a right iliofemoral deep venous thrombosis diagnosed 6 weeks ago by Doppler ultrasonography. She reports no new symptoms and notes her right leg edema is improving. She has no history of travel, surgery, or immobility. She indicates feeling well before her diagnosis, with no shortness of breath. She had a normal screening colonoscopy 3 months ago and a normal mammogram and Pap smear 6 months ago. Medical history is otherwise unremarkable. Her only medication is rivaroxaban.

Publish date: 09/02/2020

 
General Internal Medicine Q 24

A 54-year-old man is evaluated for a 6-month history of right shoulder pain. He describes the pain as moderately severe aching that is diffusely localized over the shoulder without radiation to the arm. The pain is constant, although it is worse at night and with any shoulder movement. The pain was insidious in onset and has been progressively worsening. He has had no neurologic or constitutional symptoms. Ibuprofen provides some pain relief.

Publish date: 08/26/2020

 
Gastroenterology and Hepatology Q 13

A 30-year-old man is evaluated for ongoing symptoms of dysphagia. He was previously diagnosed with eosinophilic esophagitis on upper endoscopy and has completed an 8-week course of swallowed aerosolized fluticasone, which did not alleviate his symptoms. He takes no other medications. On physical examination, vital signs are normal; BMI is 25. Other findings, including those of an abdominal examination, are unremarkable. Upper endoscopy shows an area of high-grade stenosis in the distal esophagus.

Publish date: 08/19/2020

 
Endocrinology Q 22

A 19-year-old woman is evaluated for irregular menstrual cycles since menarche at 12 years of age, increasing amount of coarse facial hair, and acne. Symptoms have worsened since she stopped playing high school sports and subsequently gained weight. She is most concerned about the hair growth and acne. Medical history is otherwise unremarkable, and she takes no medications.

Publish date: 08/12/2020

 
Dermatology Q2

A 25-year-old man is evaluated for recurrent skin eruption with oval lesions on the chest and upper back, which are occasionally itchy. The lesions began in late spring and worsened over the summer. Medical history is unremarkable, and he takes no medications. On physical examination, vital signs are normal.

Publish date: 08/06/2020

 
Cardiovascular Medicine Q 2

A 69-year-old man is evaluated in the hospital for four episodes of chest pain at rest in the past 24 hours. Medical history is significant for hyperlipidemia, hypertension, tobacco use, and previous transient ischemic attack. Medications are aspirin, hydrochlorothiazide, atorvastatin, and ramipril.

Publish date: 07/29/2020

 
Rheumatology Q 8

A 55-year-old woman is evaluated for an 18-month history of increasingly severe knee pain with the inability to arise when seated on the floor. She does not have pain at rest or nocturnal pain. Medications are celecoxib and omeprazole. On physical examination, vital signs are normal. Bony hypertrophy of both knees is present. There is no warmth, erythema, or swelling of the joints. Plain anteroposterior knee radiographs show medial joint space narrowing, peaking of the tibial spines, and osteophytes; there are no erosions or osteopenia.

Publish date: 07/22/2020

 
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

 
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