Step 2 CK NBME Form 7 with complete
solutions
Impaired fertility in a man and high riding bilateral mass. What is the 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 she is on chronic steroid therapy. Now presents with acute back
pain. What is the most likely cause? - Osteoporotic compression fracture.
Patient with flank pain with radiation to the groin. He has normal vital signs. Pain
relieved with morphine. Next best step? - Increase fluid discharge and send him
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.
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? - 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? - 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? - 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? - 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? - 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.
solutions
Impaired fertility in a man and high riding bilateral mass. What is the 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 she is on chronic steroid therapy. Now presents with acute back
pain. What is the most likely cause? - Osteoporotic compression fracture.
Patient with flank pain with radiation to the groin. He has normal vital signs. Pain
relieved with morphine. Next best step? - Increase fluid discharge and send him
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.
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? - 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? - 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? - 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? - 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? - 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.
