NBME Step 2 CK Form 7 Discharge and encourage fluid intake (NBME Answers)

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submitted by ∗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. +