Quizzes and Case ChallengesSeptember 23, 2022 | Testing Your Knowledge Cardiology MKSAP Quiz: 4-Month History of Progressive Exertional Dyspnea A 57-year-old woman is evaluated for a 4-month history of progressive exertionaldyspnea and occasional chest pain and palpitations. She has limited cutaneoussystemic sclerosis with Raynaud phenomenon and gastroesophageal refluxdisease. Click to see the physical and lab results and see if you can choose the bestnext step. Read full article Emergency Medicine MKSAP Quiz: Abdominal Pain for Several Months A 56-year-old man has had right-upper-quadrant abdominal pain for several months but is otherwise healthy. He does not drink alcohol, has not been exposed to other hepatotoxins, and takes no medications. On physical examination, vital signs are normal. Abdominal examination reveals hepatosplenomegaly. The remainder of the physical exam is normal. What would you do? Read full article Hematology/Oncology MKSAP Quiz: Early-Stage Nodular Sclerosing Hodgkin Lymphoma After receiving a recently confirmed diagnosis of early-stage nodular sclerosing Hodgkin lymphoma, a 27-year-old woman is evaluated. She has not experienced weight loss, night sweats, or fever. She has an unremarkable medical history and doesn’t use any drugs. What is the best course of action after a physical examination, lab tests, and scans? Read full article Family Medicine/General Practice MKSAP Quiz: Follow-Up for Gonococcal Arthritis This quiz tests your knowledge on the appropriate screening follow-up from a 23-year-old woman who was treated for gonococcal arthritis. After a physical exam that showed a complete resolution of symptoms, which screening test is the next course of action? A CD4 lymphocyte subset? Serum IgA level? Total hemolytic complement (CH50) level? Is any additional testing even needed? Read full article Hematology MKSAP Quiz: Multiple Segmental Pulmonary Emboli Can you determine what the appropriate treatment is for a 65-year-old man is diagnosed with multiple segmental pulmonary emboli? Read full article Cardiology MKSAP Quiz: Syncopal and Near-Fainting Events Can you determine the appropriate case management for a 68-year-old man who is evaluated for an episode of syncope and repeated episodes of near-fainting when standing and working on his tractor? On physical examination, vital signs are normal. Supine blood pressure is 124/78 mm Hg, and pulse rate is 76/min. After the patient stands for three minutes, standing blood pressure is 88/68 mm Hg, and pulse rate is 94/min. The remainder of the examination is normal. How would you proceed? Read full article Dermatology DermDx: Bump Under Nose The lesion had been present for approximately 4 years in this healthy adolescent male.Physical examination reveals a 0.3-cm firm papule with a brownish hue and no similarlesions elsewhere. What is the diagnosis? Read full article Dermatology Clinical Challenge Slide Show: Swollen Lips This 16-year-old patient with an 8-year history of psoriasis, currently being treated with topical steroids and UV light therapy, presents with a swollen lip with white crusting. View the image and check your diagnosis. Read full article Allergy & Immunology Clinical Challenge: Circles of Scaly Papules Similarly, can you determine how to treat a 22-year-old man with Marfan syndrome who complains of an asymptomatic rash on his arms and neck that began over a year ago? Take the quiz to test your diagnostic prowess. Read full article Dermatology Clinical Challenge: Flesh-Colored Papule Above Lip A 76-year-old Black woman arrives at the clinic for an evaluation of a slowly increasing bump on her face that she discovered about a year ago, which hasn’t itched, burnt, or caused any other pain. Is it a trichofolliculoma, a hypertrophic scar, basal cell carcinoma, or a cutis osteoma? Read full article Allergy & Immunology Clinical Challenge: Red Papules on Foot After Skiing Can you solve the case? A 40-year-old man presents with intermittent burning on his feet over the past three years, typically in colder months, often after outdoor activities. He has no history of disease, denies drug use, and does not smoke. What’s your diagnosis? Read full article Endocrinology, Diabetes, Metabolism Clinical Challenges: Pediatric ALL in Children With Obesity Pediatric B-cell acute lymphoblastic leukemia (B-ALL) is the most common malignancy seen in children and adolescents and young adults (AYAs). This article highlights two recent studies that provide novel evidence of the association between obesity and increased risk of high-risk B-ALL and the effectiveness of a non-pharmacologic intervention for reducing minimal residual disease (MRD) risk. Read full article Family Medicine/General Practice ACP Internist Quiz: Nonproductive Cough A 59-year-old man is hospitalized with a five-day history of nonproductive cough and fever. The patient reports that he recreationally breeds carrier pigeons and reports no travel outside of the United States. After a physical exam and chest radiograph, what is the most likely cause of this patient’s symptoms? Read full article Family Medicine/General Practice MKSAP Quiz: Evaluation for Recurrent Diarrhea, Abdominal Pain 57-year-old man, otherwise healthy 2 month history of recurrent abdominal pain with diarrhea A history of celiac disease that had been well controlled with a gluten-free diet 5-pound unintentional weight loss since the onset of symptoms Tissue IgA > 30x over nl What conditions would you consider in your evaluation? Read full article Family Medicine/General Practice MKSAP Quiz: Genetic Consult for Breast Cancer Risk A 29-year-old woman bought a genetic test that includes BRCA analysis. She comes to you with the results and asks for guidance. The results are negative for BRCA1 and BRCA2, but she has a positive family history for breast cancer. What do you advise? Read full article Neurology Challenge Case Report: Tic Disorder in an Adult Test your clinical knowledge on JB, a right-handed, 35-year-old patient with a history of generalized anxiety disorder, who came into the clinic to be evaluated and managed for atypical movements that started in adolescence. JB frequently exhibits quick shoulder shrugs, abrupt head movements to the right, and throat clearing during the neurologic examination. Examination results for the cerebellum, motor, sensory, and reflexes are unremarkable. Read full article Dermatology Clinical Challenge: Firm Papules and Hair Loss A young Black man has been troubled by recurring papules and crusting pustules in the hairline at the back of his neck. What is the disorder and how would you treat it? Read full article Hematology MKSAP Quiz: Elevated INR Found on Routine Monitoring A 75-y-o man is found to have an INR of 8.5 on routine monitoring. There is no evidence of bleeding, and he is otherwise well. He is instructed to stop warfarin. His hemoglobin comes back normal. What is the best next step in managing him: intervention or observation? Read full article Cardiology MKSAP Quiz: Preparticipation Physical Examination for Sports An 18-year-old man comes to you for a sports physical. He is asymptomatic, with no limitation in his exercise capacity. He has a history of exercise-induced bronchospasm for which he takes a budesonide-formoterol inhaler. He does not smoke, drink alcohol, or use any drugs. There is no family history of cardiac disease or sudden death. What’s the next appropriate test? Read full article Family Medicine/General Practice MKSAP Quiz: Follow-up of Osteoporosis After 5 years of denosumab therapy, this patient has had no fractures and bone density scores have improved. You plan to discontinue denosumab. What else should be done? Read full article
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