MKSAP Questions of the Week

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

Nephrology Q 13

A 57-year-old man is evaluated during a routine visit. History is significant for hypertension. Medications are hydrochlorothiazide, 25 mg/d, and amlodipine, 5 mg/d. On physical examination, blood pressure is 135/86 mm Hg, and pulse rate is 70/min; other vital signs are normal. There is 1+ bilateral ankle edema. The remainder of the examination is normal. Laboratory studies show a serum creatinine level of 1.0 mg/dL (88.4 µmol/L), a serum potassium level of 3.6 mEq/L (3.6 mmol/L), and an estimated glomerular filtration rate >60 mL/min/1.73 m2.

Publish date: 06/25/2020

Infectious Disease Q 5

A 43-year-old man is seen in follow-up for fever up to 38.3 °C (101 °F) occurring periodically over the past 3 months. He has no associated symptoms other than fatigue. He reports no recent travel, animal exposures, or tick or insect bites. He does not eat raw meats, raw seafood, or unpasteurized dairy products. He returns for further evaluation after initial testing. Family history is negative for undiagnosed fevers. He takes no medications. On physical examination, temperature is 37.8 °C (100.1 °F), blood pressure is 114/72 mm Hg, pulse rate is 88/min, and respiration rate is 14/min. A complete physical examination is unremarkable.

Publish date: 06/17/2020

Hematology and Oncology Q 10

A 52-year-old woman undergoes perioperative evaluation. She has osteoarthritis of the right hip since sustaining injuries in a motor vehicle accident 15 years ago and is scheduled for elective hip arthroplasty in the next few months. Medical history is otherwise notable for type 2 diabetes mellitus. She is up to date on routine health care. Her last menstrual period was 5 weeks ago. Medications are ibuprofen and metformin.

Publish date: 06/10/2020

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