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USMLE (United States Medical Licensing Examination) Practice Exam 15

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 comes to the clinic for evaluation of recurrent kidney stones. She reports intermittent flank pain for 2 years and has passed two stones. She eats a high-protein diet and takes no medications. Temperature is 36.8°C (98.2°F), blood pressure is 112/70 mm Hg, and pulse is 72/min. Urinalysis shows pH 5.2 and numerous envelope-shaped crystals. Which of the following changes is most likely to decrease her risk of future stones?

Most recurrent stones are calcium oxalate; high urinary calcium is promoted by high sodium intake due to coupled Na+/Ca2+ handling in the proximal tubule, so reducing dietary sodium lowers calciuria and stone risk. Low fluid intake and higher animal protein increase stone risk; vitamin C increases oxalate; acetazolamide alkalinizes urine and can promote calcium phosphate stones.

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