Step 2 CK NBME Form 7 Questions and Answers Rated A

Step 2 CK NBME Form 7 Questions and Answers Rated A Impaired fertility in a man w/high-riding bilateral scrotal mass. Underlying cause? Correct Answer-Varicocele. 82 year old with decreased vision. Dilated veins, widespread retinal hemorrhages intermixed with white plaques on fundoscopic exam. Diagnosis? Correct Answer-Central retinal vein artery occlusion. 15 year old girl on chronic steroid therapy presents with acute back pain. Most likely cause? Correct Answer-Osteoporotic compression fracture. Patient with flank pain with radiation to the groin and normal vital signs. Pain relieved with morphine. Next best step? Correct Answer-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? Correct Answer-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? Correct Answer-Child abuse What is the treatment for an acute gout attack? Correct Answer-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? Correct Answer-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? Correct Answer-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? Correct Answer-This patient has latent TB. This means that he needs to be treated with INH for 9 months. Furthermore, if he had a negative PPD. B/c this is his first time, he would come back in two weeks. Patient that is mute. Has bilateral nystagmus, hypertonia, decreased sensation to skin prick. What is the most likely overdose? Correct Answer-Intoxication with PCP. Remember he does not always have to be aggressive. Patient has a family history of ovarian cancer. What is the best thing to do if she is worried that she may get an ovarian malignancy? Correct Answer-Put her on OCP. They prevent risk of ovarian and endometrial cancer. Elderly patient with increased ESR. Decreased hip motion, and a 20 degree hip flexion contracture. What is the most likely cause? Correct Answer-Osteoarthritis. Decrease in flexion of 115 degrees is diagnostic criteria. X-ray may show joint space narrowing. COPD patient that is post operative day 4 complains of serosang discharge. PE shows abdominal distension, mild tenderness to the incision, and no erythema. What is the most likely diagnosis? Correct Answer-Wound dehiscence. Pestana says a salmon colored discharge that SOAKS the dressing on post-op day four. A patient comes in with upper motor neuron signs along with atrophy fasiculations and LMN signs. What will the EMG show? Correct Answer-Fibrillation potentials in multiple sites of the muscle. UpToDate: Fibrillation potentials occur when an individual muscle fiber is denervated (eg, it is no longer innervated by its nerve terminal). The denervated muscle fiber spontaneously produces a muscle action potential, or fibrillation potential. Patient feels as if something is crawling on his skin. He has visual hallucinations, and multiple excoriations on his face. What is the urinary tox screen going to show? Correct Answer-Amphetamines or cocaine. Remember this might be an opiate withdrawal, however the question asks the urinary toxicology screen. A patient has a nine-pound baby, and continues to bleed. Furthermore, the placenta comes out. It is torn, but intact. What is the likely cause of increased bleeding? Correct Answer-Uterine atony. Just had a huge baby. Patient with urinary dripping. Found to have a midline cystic mass