This page is dedicated to organizing various examples of standardized exam questions whose answer is nephrolithiasis. While this may seem a odd practice, it is useful to see multiple examples of how nephrolithiasis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
55-year-old man comes to the clinic because of a two day history of constipation to pass gas. For the last four days he’s been having intermittent the worsening pain. He explains that he has vomited several times today and feels nauseous. The physical exam shows tenderness in the right lower quadrant but is otherwise unremarkable. A rectal exam was performed it is only remarkable for an enlarged prostate. An abodminal X-ray is performed and shows gas distributed through small and large bowels and the presence of some fluid levels. After an NG tube is placed to patient is his temperature is 97.8°F, blood pressure is 142/85 mmHg, pulse is 60 bpm, and his respirations are 12/men. A CBC and BMP are collected and both are unremarkable. A urine sediment is performed showing:
- WBC: 2/hpf
- RBC: 20/hpf
- Other: presence of needle shaped crystals
What is the likely diagnosis in this patient?
Explanation: abdominal pain + hematuria + needle shaped crystals in urine = nephrolithiasis (uric acid stones)
Question # 2
A 32 year old male comes to the ER with symptoms of nausea, vomiting, and severe right flank pain. The pain is colicky in nature, and radiates to his right thigh. His vitals are within normal limits. His physical exam is remarkable for right CVA tenderness, however is otherwise unremarkable. A UA is performed and is notable for numerous RBCs but is otherwise unremarkable. What is a possible diagnosis in this patient?
Explanation: abdominal pain + hematuria + CVA tenderness = nephrolithiasis (uric acid stones)
Question # 3
For 4 hours, a 60-year-old male has had acute intermittent pain that begins in his left flank and radiates to his left testicle. His pulse is 89/min. and blood pressure is 140/90 mm Hg. His urinalysis is remarkable only for RBC30/hpf. What is the likely diagnosis in this patient?
Explanation: flank pain (radiating to the testicle) + hematuria = nephrolithiasis
Page Updated: 02.19.2017