Step 2 CK NBME 8 EXAM

Impaired fertility in a man and high riding bilateral mass. What is the underlying cause? - answer- Varicocele. 82 year old with decreased vision. Dilated veins, widespread retinal hemorrhages intermixed with white plaques on fundoscopic exam. Diagnosis? - answer- 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? - answer- Osteoporotic compression fracture. Patient with flank pain with radiation to the groin. He has normal vital signs. Pain relieved with morphine. Next best step? - answer- 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? - 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? - answer- Child abuse What is the treatment for an acute gout attack? - 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? - 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? - answer- Bone marrow biopsy. This kid has ALL.