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USMLE (United States Medical Licensing Examination) Practice Exam 13

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 comes to the clinic for evaluation of recurrent kidney stones. She reports intermittent flank pain for 2 years and has passed several small stones. She drinks 1–2 L of water daily. She has no history of gout. Medications include a combined oral contraceptive pill. Vital signs are normal. Serum studies show: calcium 9.4 mg/dL, phosphate 3.6 mg/dL, uric acid 4.8 mg/dL. Urinalysis shows pH 6.0 and no protein. A 24-hour urine collection reveals markedly elevated urinary calcium excretion with normal serum calcium. Which of the following is the most likely underlying mechanism of her hypercalciuria?

Idiopathic hypercalciuria commonly reflects increased intestinal calcium absorption (often with increased 1,25-(OH)2 vitamin D activity) leading to increased filtered load and urinary calcium despite normal serum calcium. Primary hyperparathyroidism typically causes hypercalcemia. Low citrate from metabolic acidosis predisposes to calcium stones but does not explain isolated marked hypercalciuria with normal serum calcium.

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