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Self-Assessment Questions

Family Medicine

Nephrolithiasis: Review Questions

Paul F. Roberts, MD

Dr. Roberts is an assistant professor of family medicine, Mayo Clinic, Jacksonville, FL.


Choose the single best answer for each question.

Questions 1 and 2 refer to the following case.

A 30-year-old man presents to his family physician for evaluation of flank pain that radiates towards his groin with associated nausea and vomiting. The pain came on suddenly and is described as intermittent and crampy. Physical examination reveals some diffuse left-sided abdominal pain to palpation but no other significant abnormalities. Laboratory evaluation is performed, including a complete blood count, serum chemistry, and urinalysis. The laboratory evaluation is normal, with the exception of the urinalysis, which reveals microscopic hematuria. Based on this patient’s presentation and laboratory results, a diagnosis of nephrolithiasis is suspected.

1. Which of the following has become the imaging modality of choice to aid in the diagnosis of nephrolithiasis?
  1. Abdominal radiography
  2. Computed tomography (CT)
  3. Intravenous pyelography
  4. Magnetic resonance imaging
  5. Ultrasonography
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2. Urinary calculi are classified based on their composition. What type of urinary calculi does this patient most likely have, given that this is a single episode and no prior evaluation has been performed?

  1. Calcium oxalate
  2. Calcium phosphate
  3. Cystine
  4. Struvite
  5. Uric acid
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  3. A 38-year-old man with a past medical history of hypertension and obesity presents with severe, crampy abdominal pain, nausea, an inability to get comfortable, and blood in his urine. His vital signs are stable. His physical examination is significant for left flank pain and left lower quadrant abdominal pain, but no other abnormalities are noted. A complete blood count and serum chemistry are unremarkable. Urinalysis is positive for blood but is otherwise negative. A CT scan with stone protocol is performed and reveals a 4-mm calculus. How should this patient be managed?
  1. Extracorporeal shock wave lithotripsy
  2. Open pyelolithotomy
  3. Pain control and hydration
  4. Percutaneous nephrolithotomy
  5. Ureteroscopic stone extraction
Click here to compare your answer.


4. A 42-year-old man presents for further treatment and management of renal stones. He has been trying to increase his fluid intake per the physician’s recommendations. Past medical history includes 3 episodes of passing stones over the past 5 years, all requiring visits to the emergency department for pain control. The patient had not presented for follow-up until the third episode occurred, at which time he was given a strainer and instructed to bring any stones to the office for analysis. Stone analysis was performed and revealed that the patient has uric acid stones. Which of the following medications would help treat this patient?

  1. Acetohydroxamic acid
  2. Captopril
  3. Penicillamine
  4. Potassium citrate
  5. Thiazide diuretics
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