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Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 1/Question#15 (reveal difficulty score)
A 42-year-old man comes to the emergency ...
Discharge and encourage fluid intake ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: renal

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submitted by โˆ—step_prep5(246)
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  • Young, otherwise healthy man presents with severe flank pain, CVA tenderness and hematuria with pain that is responsive to morphine, most consistent with kidney stone
  • Key idea: Patients with a kidney stone that is <10 mm and/or not causing urosepsis or renal failure can often be medically managed with hydration, pain control, alpha blockers and straining urine (to look for passage of stone)

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bluebul  Also, he probably passed the stone already given that the half life of morphine is 2hrs and his pain subsided 2hrs in. He'd be coming down off the morphine so if he hadn't passed it his pain would be worse. +1
usmile1  Thats a good point bluebul! i didnt notice that. +
link981  @bluebul you can't know for certain if he passed the stone because sometimes stones can cause intermittent pain. Movement can cause the stone to move and cause less obstruction which will temporary relieve the pain, or stone might have moved further down the urinary system to a place causing less obstruction. +



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submitted by โˆ—thajoker(21)
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Kidney stone, not pyelo. Antibiotics not indicated and hydration among first line tx

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