IM MKSAP UPDATED ACTUAL Exam
Questions and CORRECT Answers
35 yo F evaluated after lab shows an elevated LDL during routine screening. Family hx
remarkable for MI in father at 45. Most appropriate primary prevention for ASCVD in this
patient? - CORRECT ANSWER - High intensity rosuvastatin
40 yo F who seeks advice on whether she should undergo breast cancer screening with
mammography. PT engaged in discussion of the potential benefits and harms of initiating
mammography now. Most appropriate screening test? - CORRECT ANSWER - No testing
49 yo M scheduled for total right knee arthroplasty. Low molecular weight heparin and
intermittent pneumatic compression will be initiated and continued. What is the recommended
duration of low molecular weight heparin prophylaxis? - CORRECT ANSWER - Total of
35 days
67 yo M evaluated for 2 year history of worsening pain in his feet. Describes the pain as long-
standing, burning, and aching. Most appropriate treatment? - CORRECT ANSWER - Oral
duloxetine
23 yo F evaluated for depression as she prepares for discharge from the hospital from hospice
care. She as diagnosed with metastatic ovarian cancer 2 years ago. Most appropriate treatment? -
CORRECT ANSWER - Methylphenidate
52 yo M evaluated for 2 day history of painless red eye, which began on the right side and
quickly spread to the left. Reports that his eyes have a thin mucopurulent discharge and that
eyelids are matted shut in the morning upon waking. Most appropriate treatment? - CORRECT
ANSWER - Trimethoprim-polymyxin B ophthalmic drops
Two new treatments for patients with heart failure with preserved EF were compared in a
randomized controlled trial. Primary outcome was reduction in heart failure related
hospitalizations. Which of the following is needed to conclude that tx A is superior to tx B? -
CORRECT ANSWER - Harms and cost of treatment
,68 yo M is evaluated for fever, perineal pain, dysuria, frequency, and intermittent straining that
began yesterday. Sx began 48 hours after a prostate biopsy due to an elevated PSA. Most
appropriate tx? - CORRECT ANSWER - Trimethoprim-sulfamethoxazole
22 yo M evaluated during a pre-employment examination. Pt is starting a new job as a registered
nurse. Which of the following is the most appropriate vaccination strategy for this health care
worker? - CORRECT ANSWER - Administer a second dose of MMR vaccine
A 32 yo F is evaluated during a domestic airline flight for an episode of weakness and
lightheadedness. She is pregnant at 35 weeks gestation. Most appropriate next step in
management? - CORRECT ANSWER - Connect with the ground-based physician
82 yo M is evaluated during a routine exam. Pt lives alone and son expresses reservations about
his father continuing to drive. Which of the following is the most appropriate mgt regarding this
pt's driving? - CORRECT ANSWER - Advise the pt to retire from driving
36 yo F is evaluated for a 3 year history of fatigue that worsens after activity and does not
improve with rest. She also notes intermittent diffuse myalgia and arthralgia, constipation,
dizziness, headaches, urinary urgency, memory problems, and paresthesias. - CORRECT
ANSWER - No further testing is recommended
62 yo M is evaluated for severe low back pain that began 2 days ago and is progressively
worsening. Pain began when he was lifting concrete blocks at his job. - CORRECT
ANSWER - MRI of the lumbosacral spine
24 yo F is evaluated for a breast lump. She has had no breast trauma or discharge from the
nipples. Nulliparous and has regular menstrual cycles. Most appropriate test to perform in this
patient? - CORRECT ANSWER - Ultrasonography
24 yo M is evaluated for a 6 week hx of severely depressed mood and loss of interest in work,
family, and friends. During this time he has been sleeping more than usual , but still feels like he
has no energy. Most likely diagnosis - CORRECT ANSWER - Bipolar disorder
, 27 yo M is evaluated during a routine follow up for obesity. On his previous two visits, he had a
BMI of 38. - CORRECT ANSWER - Bariatric surgery
39 yo M is evaluated for a 3 month hx of dry, intermittent cough. Reports no other associated sx
and has had no unusual environmental exposures. Most appropriate management? - CORRECT
ANSWER - Discontinue lisinopril
46 yo M seeks advice on whether he should undergo prostate cancer screening. He recently
underwent direct-to-direct consumer genetic testing, which revealed that his risk for prostate
cancer is 33% higher. Most appropriate management? - CORRECT ANSWER - Pt
education and no further testing.
55 yo F is evaluated for left-sided tinnitus that has gradually emerged over the last 6 months.
Most appropriate management? - CORRECT ANSWER - MRI of the internal auditory
canal
82 yo F is evaluated for severe and progressive SOB on ambulation. (Bottom): Spirometry
performed 2 months ago showed an FEV1 of 42% of predicted. - CORRECT ANSWER -
Pulmonary rehab
A 50 yo M is seen for preoperative medical evaluation before left shoulder arthroplasty.
(Bottom): MELD score is 22. - CORRECT ANSWER - Cancel surgery and refer for liver
transplant evaluation
24 yo M is evaluated as an add-on pt for a 1 week hx of nasal congestion, watery eyes, and
cough productive of yellow sputum. Pt is new to the practice and indicated on the intake form
that his gender is transmale. Most appropriate next step? - CORRECT ANSWER - Obtain
a social and sexual history
A 75 yo M is being discharged following treatment for acute decompensated heart failure. Pt and
wife are alerted to sx that indicate worsening of his heart failure and are informed of when he
should seek immediate medical assistance. - CORRECT ANSWER - Timely discharge
summary for the primary care physician.
Questions and CORRECT Answers
35 yo F evaluated after lab shows an elevated LDL during routine screening. Family hx
remarkable for MI in father at 45. Most appropriate primary prevention for ASCVD in this
patient? - CORRECT ANSWER - High intensity rosuvastatin
40 yo F who seeks advice on whether she should undergo breast cancer screening with
mammography. PT engaged in discussion of the potential benefits and harms of initiating
mammography now. Most appropriate screening test? - CORRECT ANSWER - No testing
49 yo M scheduled for total right knee arthroplasty. Low molecular weight heparin and
intermittent pneumatic compression will be initiated and continued. What is the recommended
duration of low molecular weight heparin prophylaxis? - CORRECT ANSWER - Total of
35 days
67 yo M evaluated for 2 year history of worsening pain in his feet. Describes the pain as long-
standing, burning, and aching. Most appropriate treatment? - CORRECT ANSWER - Oral
duloxetine
23 yo F evaluated for depression as she prepares for discharge from the hospital from hospice
care. She as diagnosed with metastatic ovarian cancer 2 years ago. Most appropriate treatment? -
CORRECT ANSWER - Methylphenidate
52 yo M evaluated for 2 day history of painless red eye, which began on the right side and
quickly spread to the left. Reports that his eyes have a thin mucopurulent discharge and that
eyelids are matted shut in the morning upon waking. Most appropriate treatment? - CORRECT
ANSWER - Trimethoprim-polymyxin B ophthalmic drops
Two new treatments for patients with heart failure with preserved EF were compared in a
randomized controlled trial. Primary outcome was reduction in heart failure related
hospitalizations. Which of the following is needed to conclude that tx A is superior to tx B? -
CORRECT ANSWER - Harms and cost of treatment
,68 yo M is evaluated for fever, perineal pain, dysuria, frequency, and intermittent straining that
began yesterday. Sx began 48 hours after a prostate biopsy due to an elevated PSA. Most
appropriate tx? - CORRECT ANSWER - Trimethoprim-sulfamethoxazole
22 yo M evaluated during a pre-employment examination. Pt is starting a new job as a registered
nurse. Which of the following is the most appropriate vaccination strategy for this health care
worker? - CORRECT ANSWER - Administer a second dose of MMR vaccine
A 32 yo F is evaluated during a domestic airline flight for an episode of weakness and
lightheadedness. She is pregnant at 35 weeks gestation. Most appropriate next step in
management? - CORRECT ANSWER - Connect with the ground-based physician
82 yo M is evaluated during a routine exam. Pt lives alone and son expresses reservations about
his father continuing to drive. Which of the following is the most appropriate mgt regarding this
pt's driving? - CORRECT ANSWER - Advise the pt to retire from driving
36 yo F is evaluated for a 3 year history of fatigue that worsens after activity and does not
improve with rest. She also notes intermittent diffuse myalgia and arthralgia, constipation,
dizziness, headaches, urinary urgency, memory problems, and paresthesias. - CORRECT
ANSWER - No further testing is recommended
62 yo M is evaluated for severe low back pain that began 2 days ago and is progressively
worsening. Pain began when he was lifting concrete blocks at his job. - CORRECT
ANSWER - MRI of the lumbosacral spine
24 yo F is evaluated for a breast lump. She has had no breast trauma or discharge from the
nipples. Nulliparous and has regular menstrual cycles. Most appropriate test to perform in this
patient? - CORRECT ANSWER - Ultrasonography
24 yo M is evaluated for a 6 week hx of severely depressed mood and loss of interest in work,
family, and friends. During this time he has been sleeping more than usual , but still feels like he
has no energy. Most likely diagnosis - CORRECT ANSWER - Bipolar disorder
, 27 yo M is evaluated during a routine follow up for obesity. On his previous two visits, he had a
BMI of 38. - CORRECT ANSWER - Bariatric surgery
39 yo M is evaluated for a 3 month hx of dry, intermittent cough. Reports no other associated sx
and has had no unusual environmental exposures. Most appropriate management? - CORRECT
ANSWER - Discontinue lisinopril
46 yo M seeks advice on whether he should undergo prostate cancer screening. He recently
underwent direct-to-direct consumer genetic testing, which revealed that his risk for prostate
cancer is 33% higher. Most appropriate management? - CORRECT ANSWER - Pt
education and no further testing.
55 yo F is evaluated for left-sided tinnitus that has gradually emerged over the last 6 months.
Most appropriate management? - CORRECT ANSWER - MRI of the internal auditory
canal
82 yo F is evaluated for severe and progressive SOB on ambulation. (Bottom): Spirometry
performed 2 months ago showed an FEV1 of 42% of predicted. - CORRECT ANSWER -
Pulmonary rehab
A 50 yo M is seen for preoperative medical evaluation before left shoulder arthroplasty.
(Bottom): MELD score is 22. - CORRECT ANSWER - Cancel surgery and refer for liver
transplant evaluation
24 yo M is evaluated as an add-on pt for a 1 week hx of nasal congestion, watery eyes, and
cough productive of yellow sputum. Pt is new to the practice and indicated on the intake form
that his gender is transmale. Most appropriate next step? - CORRECT ANSWER - Obtain
a social and sexual history
A 75 yo M is being discharged following treatment for acute decompensated heart failure. Pt and
wife are alerted to sx that indicate worsening of his heart failure and are informed of when he
should seek immediate medical assistance. - CORRECT ANSWER - Timely discharge
summary for the primary care physician.
