American Board of Internal Medicine (ABIM) Certification Practice Exam

What is one of the first steps in managing urolithiasis if no complications are present?

1. Consult urology immediately

2. Start hydration and control pain

3. Perform imaging studies

4. Schedule surgery

The correct answer is: Start hydration and control pain

In managing urolithiasis, one of the first steps, especially when no complications are present, is to start hydration and control pain. This approach is important because dehydration can exacerbate the condition by concentrating urine and increasing the risk of stone formation. Adequate hydration helps in promoting the passage of stones through the urinary tract, which can alleviate symptoms. Pain management is equally vital, as urolithiasis often presents with significant discomfort due to the stones obstructing the flow of urine. Administering analgesics can help in alleviating this pain and improving the patient's overall comfort, allowing for better tolerance of the condition while awaiting further evaluation or resolution. Considering other options, consulting urology may be indicated in cases of complications or if initial management fails, but it is not the immediate step when complications are absent. Performing imaging studies could be necessary for diagnosis or to evaluate if complications arise, but it is not the initial measure taken when managing uncomplicated cases. Scheduling surgery is typically reserved for cases where stones are large, unable to pass, or causing significant complications, making it an inappropriate first step when complications are not present.