Step 2 CK NBME Form 7 with complete solution

Step 2 CK NBME Form 7 with complete solution Impaired fertility in a man w/high-riding bilateral scrotal mass. Underlying cause? Varicocele. 82 year old with decreased vision. Dilated veins, widespread retinal hemorrhages intermixed with white plaques on fundoscopic exam. Diagnosis? Central retinal vein artery occlusion. 15 year old girl on chronic steroid therapy presents with acute back pain. Most likely cause? Osteoporotic compression fracture. Patient with flank pain with radiation to the groin and normal vital signs. Pain relieved with morphine. Next best step? Increase fluid intake and send home. Terminal cancer patient that comes in with acute onset lower back pain. She is taking morphine Q4 which works for a bit but then subsides. What should you do to her regimen? Make the morphine Q3 so she has adequate pain control. A young infant that has bilateral retinal hemorrhages and tense fontanelle. What is the most likely cause? Child abuse What is the treatment for an acute gout attack? 1. NSAIDs: Indomethacin 2. Steroids 3. Colchicine Patient who is sick in the ICU, and has (comatose level) hypernatremia. She has a low urine specific gravity. Normal kidney function. What is the underlying cause of hypernatremia? Diabetes Insipidus. She cannot concentrate her urine. 4 year old boy. Suddenly develops a pancytopenia, has hepatosplenomegaly and adenopathy. Some mild gingival bleeding. Next best step? Bone marrow biopsy. This kid has ALL. Patient has a first time positive PPD and a negative chest X-ray. What is the next best step? This patient has latent TB. This means that he needs to be treated with INH for 9 months.