MKSAP Questions of the Week

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

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

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