MKSAP Questions of the Week

Nephrology Q 35

A 26-year-old man is evaluated during a follow-up visit after presenting to an urgent care clinic for back pain 1 week ago. Laboratory studies at that time were significant for a serum creatinine level of 1.4 mg/dL (123.8 µmol/L); other laboratory studies, including urinalysis, were normal. A urine albumin-creatinine ratio obtained in preparation for this visit is 10 mg/g. He is a personal trainer, and his daily exercise regimen includes weightlifting. He states that his back pain has resolved. He occasionally takes ibuprofen; the last use was 1 week ago. He takes no over-the-counter supplements. On physical examination today, vital signs are normal. BMI is 29. The patient is muscular, without signs of obesity. There is no muscle tenderness.

Publish date: 12/03/2020

 
Infectious Disease Q 29

A 19-year-old man is hospitalized with a 6-day history of lightheadedness and nightly fevers. He also reports sore throat, headache, joint and muscle aches, and a dry cough. He recalls a blotchy rash on his trunk and arms, which has resolved. He returned home 12 days ago from a trip to Vietnam, for which he did not receive specific immunizations or other prophylaxis. During the second week of his trip, he experienced 2 days of diarrhea; he has had none since, but abdominal discomfort and anorexia persist.

Publish date: 11/24/2020

 
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

 
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