MKSAP Questions of the Week

Infectious Disease Q42

A 36-year-old man is evaluated for a 10-day history of abdominal cramping, diarrhea, malaise, and nausea. Diarrhea is watery without mucus or blood. He returned 2 weeks ago from a 7-day trip to Lima, Peru. On physical examination, temperature is 37.7 °C (99.9 °F); the remaining vital signs are normal. On abdominal examination, bowel sounds are present with diffuse tenderness to palpation. The abdomen is not distended; no guarding or rebound is noted. Stool polymerase chain reaction assay is positive for Cyclospora.

Publish date: 02/17/2021

Hematology -Oncology Q14

A 67-year-old woman undergoes follow-up evaluation for an elevated globulin fraction of total serum protein level. She has no symptoms. Medical history is notable for hypertension treated with hydrochlorothiazide and atorvastatin. On physical examination, vital signs are normal. No lymphadenopathy or hepatosplenomegaly is noted. Serum protein electrophoresis and immunofixation show an IgG monoclonal spike of 0.7 g/dL. Serum free light chain assay and 24-hour urine protein electrophoresis are normal. Skeletal survey shows no lytic lesions.

Publish date: 02/10/2021

General IM Q37

A 37-year-old woman is evaluated for contraceptive advice. She is married and has a 1-year-old child. The patient describes the conception of this child as an “accident” because she often missed taking her previous oral contraceptive. Her menstrual periods have resumed and are regular but heavy and, in that regard, bothersome to her. Medical history is unremarkable. She drinks a glass of wine every night and smokes a pack of cigarettes daily. She has no other health issues and takes no medications. The result of a pregnancy test performed today is negative. The patient is provided with a brief smoking cessation intervention. She is not ready to stop smoking but will consider it again at a later time.

Publish date: 02/03/2021

Gastroenterology Q18

A 65-year-old man is evaluated after a screening ultrasound for abdominal aortic aneurysm showed incidental gallbladder findings. He reports no symptoms. He continues to smoke cigarettes, 1 pack per day. He has no other medical problems and takes no medications. On physical examination, vital signs are normal, as is the remainder of the examination. The results of all laboratory studies, including a complete blood count and alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin levels, are within normal limits. The abdominal ultrasound shows numerous layering gallstones and an immobile 8-mm gallbladder polyp.

Publish date: 01/27/2021

Endocrinology Q19

A 54-year-old woman is evaluated for flushing of the face of 1 year's duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, diaphoresis, and tachycardia. Medical history is significant for increasingly frequent migraine headaches, difficult to control hypertension, and gastroesophageal reflux disease. Medications are amitriptyline, chlorthalidone, metoprolol, conjugated estrogens, progesterone, and omeprazole. On physical examination, blood pressure is 156/92 mm Hg; the remainder of the vital signs is normal. BMI is 32. The remainder of the examination is unremarkable

Publish date: 01/21/2021

Dermatology Q28

A 40-year-old man is evaluated for a firm, flesh-colored lesion that has been growing on the back for several months. Foul-smelling material can be expressed from the lesion. The patient is bothered by the periodic drainage. He is otherwise healthy and takes no medications. On physical examination, vital signs are normal. There is a 3-cm subepidermal nodule with a central punctum on the upper back. There is no erythema or warmth of surrounding skin.

Publish date: 01/13/2021

Cardiology Q45

A 59-year-old man is evaluated during a routine examination. He feels well and has no symptoms. Medical history is significant for hypertension. He does not smoke, and he does not have diabetes mellitus. He is active, performing aerobic exercise for 20 to 30 minutes four times per week. Medications are lisinopril and chlorthalidone. On physical examination, the patient is afebrile, blood pressure is 122/74 mm Hg, and pulse rate is 76/min. Cardiac examination is unremarkable.

Publish date: 01/06/2021

Rheumatology Q 21

A 79-year-old man is evaluated for a 2-month history of progressive malaise and weakness, aching bilateral shoulders and hips, and stiffness for 2 hours in the morning and after immobility. He recently noted aching in his jaw when chewing. He also reports new left-sided headaches. Last week he had an episode of diplopia lasting 1 minute. He has hypertension, for which he takes hydrochlorothiazide. On physical examination, vital signs are normal. Tenderness and slight swelling over the left temple are present. Painful and limited range of motion of both hips and shoulders is noted. The remainder of the examination is unremarkable. Laboratory studies show an erythrocyte sedimentation rate of 85 mm/h.

Publish date: 12/23/2020

Pulmonary and Critical Care Medicine Q 23

A 35-year-old woman is evaluated for a 4-month history of exertional dyspnea and a 1-week history of chest pressure. She has no sputum production, cough, or wheezes. She has never smoked. On physical examination, vital signs are normal. Oxygen saturation is 91% breathing ambient air. Cardiopulmonary examination reveals a widened split S2 with a prominent pulmonic component and neck vein distention. Lungs are clear to auscultation. Laboratory studies, including complete blood count and comprehensive metabolic profile, are normal. Electrocardiogram is normal. Chest radiograph shows clear lung fields and prominent hilae.

Publish date: 12/16/2020

Neurology Q 23

A 71-year-old woman is evaluated for difficulty holding her head upright. She notes that her head feels heavy and reports intermittent difficulty with swallowing and speech that is worse in the evening. She has had no pain, sensory changes, weakness in the extremities, or cognitive or visual symptoms. She has no other medical problems and takes no medication. On physical examination, vital signs are normal. Speech is mildly dysarthric. Cervical extension is weak. No ptosis, ophthalmoplegia, sensory deficit, or weakness in the extremities is noted. Results of laboratory studies show a normal serum creatine kinase level; no acetylcholine receptor antibodies are detected. Findings from routine nerve conduction and needle electromyography studies of the limbs are unremarkable, but a repetitive stimulation protocol reveals a decremental response. An MRI of the brain is normal.

Publish date: 12/09/2020

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