USMLE Forum Archives - USMLE Step 3 - stones
stones
bingousmle - 07-13-10 01:30
A 34-year-old woman comes to the office for a follow-up examination after passing a kidney stone in the hospital last week. Passing the stone was "more painful than the vaginal delivery of all 3 children combined" and so she wants to make sure that she never has one again. She has no chronic medical conditions, never had surgery, and takes no medications. Her father and brother both suffer from nephrolithiasis. You go over to the computer to check if the laboratory report on the composition of her kidney stone is complete. You see that the stone was composed of calcium and that she had a 24-hour urine collection done in the hospital that showed 295 mg of calcium and 15 mg of oxalate. Her serum calcium level is 8.5 mg/dL. The most appropriate course of action is to
A. prescribe allopurinol, orally
B. prescribe cholestyramine, orally, and a low-fat diet
C. prescribe hydrochlorothiazide, orally
D. recommend a high fluid intake, but no medications or supplements
E. recommend megadoses of vitamin C
bingousmle - 07-13-10 01:30
A 34-year-old woman comes to the office for a follow-up examination after passing a kidney stone in the hospital last week. Passing the stone was "more painful than the vaginal delivery of all 3 children combined" and so she wants to make sure that she never has one again. She has no chronic medical conditions, never had surgery, and takes no medications. Her father and brother both suffer from nephrolithiasis. You go over to the computer to check if the laboratory report on the composition of her kidney stone is complete. You see that the stone was composed of calcium and that she had a 24-hour urine collection done in the hospital that showed 295 mg of calcium and 15 mg of oxalate. Her serum calcium level is 8.5 mg/dL. The most appropriate course of action is to
A. prescribe allopurinol, orally
B. prescribe cholestyramine, orally, and a low-fat diet
C. prescribe hydrochlorothiazide, orally
D. recommend a high fluid intake, but no medications or supplements
E. recommend megadoses of vitamin C
The correct answer and explanation will be available after you answer.
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#1
Re: stones babbu5508 - 07-13-10 09:48 My answer is: c.
familial hypercalciuria...indication for starting medication is evidence of bone demineralization or history of previous renal stone formation despite a low calcium diet. Hydrochlorothiazide (HCTZ) and other thiazide-type diuretics are the agents most frequently used to treat hypercalciuria.
#2
Re: stones
bingousmle - 07-14-10 03:40 My answer is: c.
the labs are suggestive of benign hypercalciuria and her family history further supports this diagnosis.. so start her on thiazide
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