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USMLE (United States Medical Licensing Examination) Practice Exam 12

Practice exam for USMLE (United States Medical Licensing Examination).

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Question 1 of 1000%
Time remaining120:00
Attempts allowedUnlimited
Difficulty mixE • M • H
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Question 1

MEDIUM

A 24-year-old woman is evaluated for recurrent kidney stones. She reports episodic flank pain and has passed two calcium-containing stones in the past year. She takes no medications. Vital signs are normal. Laboratory studies show: serum calcium 9.3 mg/dL, serum phosphate 3.4 mg/dL, PTH 38 pg/mL (normal), urine pH 5.2, and a 24-hour urine collection shows elevated urinary calcium excretion. Which of the following is the most likely mechanism contributing to her hypercalciuria?

Idiopathic hypercalciuria often reflects decreased renal tubular calcium reabsorption, commonly in the proximal tubule where calcium follows sodium and water via paracellular pathways; reduced reabsorption increases urinary calcium and calcium stone risk. Elevated 1,25(OH)2D would typically raise serum calcium and suppress PTH; CaSR defects cause hypercalcemia and high/normal PTH rather than isolated hypercalciuria.

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