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USMLE (United States Medical Licensing Examination) Practice Exam 19

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 27-year-old woman is evaluated for recurrent calcium oxalate kidney stones. She reports intermittent flank pain for 2 years and drinks "a lot of soda" but little water. Medications include a daily multivitamin. Vitals are normal. Urinalysis shows pH 5.5 and numerous calcium oxalate crystals. A 24-hour urine collection shows elevated urinary calcium with normal serum calcium. Which of the following is the most likely change in renal tubular handling contributing to her hypercalciuria?

Idiopathic hypercalciuria is commonly associated with increased urinary calcium due to reduced paracellular Ca2+ reabsorption in the thick ascending limb when the lumen-positive potential is diminished; decreased NaCl reabsorption in the TAL reduces this driving force. Proximal tubule Ca2+ reabsorption is largely passive and parallels Na+ and water; isolated proximal changes are less typical here.

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