kidney stones

Practice targeted AMC-style multiple-choice questions on kidney stones.

Ultrasonographic picture taken from a patient with left ureteral stone with hydronephrosis, created in Taiwan

Image by morning2k — CC BY 2.5 · Source

A 48-year-old woman presents with acute onset severe left flank pain radiating to the groin, associated with nausea. She denies fever or dysuria. Vitals are stable. Urinalysis shows haematuria. Serum creatinine is 75 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most appropriate next diagnostic step?

A. Prescribe tamsulosin and arrange outpatient follow-up.

B. Repeat the renal ultrasound in 24 hours.

C. Perform a retrograde pyelogram.

D. Arrange a non-contrast CT scan of the kidneys, ureters, and bladder.

E. Obtain a plain abdominal X-ray (KUB).

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Image by morning2k — CC BY 2.5 · Source

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, which of the following developments would most strongly necessitate urgent urological intervention?

A. Discovery of bilateral hydronephrosis on repeat imaging.

B. Passage of a small stone fragment.

C. Persistence of severe pain despite adequate analgesia.

D. Development of fever and rigors.

E. Increase in serum creatinine to 150 µmol/L.

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Image by morning2k — CC BY 2.5 · Source

A 38-year-old man presents with sudden onset severe left flank pain radiating to the groin, associated with nausea. He is afebrile, blood pressure 140/90 mmHg, heart rate 95 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following best explains the mechanism of the patient's pain?

A. Spasm of the renal artery

B. Increased pressure within the renal pelvis and collecting system

C. Ischaemia of the renal medulla

D. Distension of the renal capsule due to oedema

E. Inflammation of the renal parenchyma

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CT, ultrasonography, SPECT and scintigraphy of intra-thyroid parathyroid adenoma

Image by Mnahi Bin Saeedan, Ibtisam Musallam Aljohani, Ayman Omar Khushaim, Salwa Qasim Bukhari, Salahudin Tayeb Elnaas — CC BY 4.0 · Source

A 62-year-old woman with osteoporosis and a history of kidney stones presents with a serum calcium of 2.9 mmol/L (2.1-2.6 mmol/L) and PTH of 120 pg/mL (10-65 pg/mL). She denies neck pain or swelling. The provided imaging was obtained. What is the MOST appropriate next step?

A. Cinacalcet to lower PTH levels

B. Vitamin D and calcium supplementation

C. Surgical excision of the identified lesion

D. Bisphosphonate therapy and observation

E. Thyroidectomy

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Image by Mnahi Bin Saeedan, Ibtisam Musallam Aljohani, Ayman Omar Khushaim, Salwa Qasim Bukhari, Salahudin Tayeb Elnaas — CC BY 4.0 · Source

A 62-year-old woman with osteoporosis and a history of kidney stones presents for evaluation. Her calcium is 2.9 mmol/L (2.1-2.6 mmol/L), PTH 110 pg/mL (10-65 pg/mL), and creatinine is normal. She denies neck pain or swelling. Given the imaging, what is the MOST appropriate next step?

A. Cinacalcet administration

B. Vitamin D supplementation

C. Surgical exploration and parathyroidectomy

D. Observation with serial calcium monitoring

E. Bisphosphonate therapy

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Image by morning2k — CC BY 2.5 · Source

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Based on the clinical presentation and the finding shown in the image, what is the most appropriate immediate next step in management?

A. Admit for observation, serial renal function tests, and pain management.

B. Arrange urgent non-contrast CT scan of the kidneys, ureters, and bladder.

C. Arrange urgent flexible cystoscopy and retrograde pyelography.

D. Administer intravenous fluids, opioid analgesia, and prescribe tamsulosin for medical expulsive therapy.

E. Urgent urology consultation for consideration of upper tract decompression.

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Image by morning2k — CC BY 2.5 · Source

A 38-year-old woman presents with sudden onset, severe left flank pain radiating to her groin. She reports associated nausea but denies fever or dysuria. On examination, she is afebrile, blood pressure 125/75 mmHg, heart rate 80 bpm. Urinalysis shows microscopic haematuria. Serum creatinine is 80 µmol/L. An ultrasound is performed. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following is the most likely underlying mechanism causing the patient's pain?

A. Stretching of the renal capsule due to rapid kidney enlargement from a mass.

B. Direct irritation of nerve endings in the bladder wall.

C. Ischaemia of the renal cortex due to vascular compromise.

D. Inflammation of the renal parenchyma due to infection.

E. Increased pressure within the renal pelvis and ureter proximal to an obstruction.

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Image by Mnahi Bin Saeedan, Ibtisam Musallam Aljohani, Ayman Omar Khushaim, Salwa Qasim Bukhari, Salahudin Tayeb Elnaas — CC BY 4.0 · Source

A 62-year-old woman with osteoporosis and a history of kidney stones presents for evaluation. Her calcium is 2.9 mmol/L (2.1-2.6 mmol/L), and PTH is 110 pg/mL (10-65 pg/mL). Imaging is shown. What is the MOST appropriate next step?

A. Bisphosphonate therapy

B. Cinacalcet administration

C. Vitamin D and calcium supplementation

D. Serial calcium and PTH monitoring

E. Referral for parathyroidectomy

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Image by Mnahi Bin Saeedan, Ibtisam Musallam Aljohani, Ayman Omar Khushaim, Salwa Qasim Bukhari, Salahudin Tayeb Elnaas — CC BY 4.0 · Source

A. Vitamin D supplementation and repeat calcium level in 3 months

B. Bisphosphonate therapy

C. Kidney stone removal

D. Surgical exploration and parathyroidectomy

E. Cinacalcet administration

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A 25-year-old man presents with a history of recurrent urinary tract calculi. Which of the following is most likely to help him reduce the recurrent rate of calculi?

A. Calcium chloride

B. Potassium citrate

C. Allopurinol

D. Cranberry juice

E. Increased dietary calcium intake

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Image by morning2k — CC BY 2.5 · Source

A 55-year-old man presents to the emergency department with sudden onset, severe left flank pain radiating to his groin, associated with nausea. He is afebrile, blood pressure 130/80 mmHg, heart rate 85 bpm. Urinalysis shows 20-30 red blood cells per high-power field. Serum creatinine is within normal limits. An ultrasound is performed. Considering the clinical context and the findings demonstrated in the provided image, which of the following is the most appropriate immediate management step?

A. Initiate empirical broad-spectrum intravenous antibiotics.

B. Prescribe oral tamsulosin and diclofenac and discharge home.

C. Urgent urology consultation for potential decompression.

D. Administer intravenous fluids and opioid analgesia and observe for spontaneous stone passage.

E. Arrange a non-contrast CT KUB as the definitive imaging modality.

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Image by morning2k — CC BY 2.5 · Source

A 45-year-old male presents to the emergency department with sudden onset severe left flank pain radiating to the groin. He reports some nausea but no vomiting. His temperature is 37.5°C, pulse 88 bpm, BP 130/80 mmHg, respiratory rate 16/min, oxygen saturation 98% on room air. On examination, he has significant left costovertebral angle tenderness. Urinalysis shows microscopic haematuria and trace leukocytes. His creatinine is 90 µmol/L (baseline unknown). An ultrasound of the kidneys is performed, shown in the image. Considering the patient's presentation and the findings demonstrated in the provided image, the most likely primary mechanism responsible for the severe pain experienced by this patient is:

A. Ischaemic injury to the renal tubules resulting from compromised blood flow.

B. Increased hydrostatic pressure leading to distension of the renal pelvis and collecting system.

C. Reflex spasm of the psoas muscle due to ureteral irritation.

D. Direct irritation of sensory nerve endings in the ureteral wall by the obstructing object.

E. Inflammatory response within the renal parenchyma secondary to bacterial invasion.

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kidney stones

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