For over 50 years, the Medical Knowledge Self-Assessment Program (MKSAP) has been the most trusted resource in continuous learning for internal medicine physicians and residents. The tradition continues with MKSAP 19.
MKSAP 19 is available in several flexible formats, allowing you to choose the format that best fits your lifestyle. Each format includes 12 syllabus sections and 1,200 associated deep-learning self-assessment questions.
Learn about the new features in MKSAP 19, as well as pricing and release dates.
MKSAP 19 Q & A
A 78-year-old woman is evaluated for 6 weeks of exertional dyspnea. She has hypertension and paroxysmal atrial fibrillation. Medications are apixaban, enalapril, and chlorthalidone.
On physical examination, blood pressure is 148/90 mm Hg; other vital signs are normal. BMI is 38. Central venous pressure is normal, and lungs are clear. An S4, but no murmur, is noted.
B-type natriuretic peptide level is 211 pg/mL (211 ng/L).
An ECG demonstrates sinus rhythm and left ventricular hypertrophy. An echocardiogram shows an ejection fraction of 55% and increased left ventricular wall thickness. The calculated cardiac index is 2.9 L/min/m2. There is no rest or dynamic outflow tract obstruction. The estimated right ventricular systolic pressure is 40 mm Hg. The left atrium is enlarged.
Which of the following is the most likely diagnosis?
A: Heart failure with preserved ejection fraction
B: High-output heart failure
C: Hypertrophic obstructive cardiomyopathy
D: Noncardiac dyspnea