Test your medical knowledge each month with questions from the Medical Knowledge Self-Assessment Program® (MKSAP).
MKSAP has been trusted by internal medicine physicians since 1967 as the best resource for updating knowledge. MKSAP 19, available in Complete, Digital, and Print packages, consists of 11 comprehensive text chapters with related multiple-choice questions. You'll find 1,200 completely new questions to help you identify learning gaps, stay current, and gain the knowledge you need to provide the best possible patient care. MKSAP 19's original and high-quality questions evolve out of case studies and patient scenarios based on the latest evidence.
For more information on MKSAP 19, or to order your copy, visit
MKSAP 19 Q & A
An 18-year-old woman is evaluated for a 5-year history of recurrent headaches. Headaches occur approximately 12 days per month; three of these episodes are severe, occurring without a trigger or premonitory symptoms, and last for a full day, followed by profound fatigue the next day. She describes the pain as bilateral, frontotemporal, steady and throbbing, associated with sensitivities to light and noise, worsening with movement, and causing her to miss 2 or 3 days of school per month. The severe headaches have not responded to ibuprofen or naproxen. The patient also has seasonal allergies. Other medications are fexofenadine and a combination estrogen-progestin oral contraceptive.
All physical examination findings, including vital signs, are normal.
Which of the following is the most appropriate next step in management?
A: Begin oral zolmitriptan
B: Discontinue the oral contraceptive
C: Obtain a brain MRI
D: Substitute loratadine for fexofenadine
Back to the August 2023 issue of ACP IMpact