American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial treatment approach for uncomplicated kidney stones less than 10 mm in size?

1. Hydration and analgesia alone

2. Medical expulsive therapy only

3. Observation and surgical intervention

4. Hydration, analgesia, observation, and medical expulsive therapy

The correct answer is: Hydration, analgesia, observation, and medical expulsive therapy

The initial treatment approach for uncomplicated kidney stones less than 10 mm in size typically involves a combination of hydration, analgesia, observation, and medical expulsive therapy. Hydration is crucial as it helps to facilitate the passage of the stone through the urinary tract. Increased fluid intake can assist in diluting urine and may reduce the likelihood of stone formation in the future. Analgesia is important for managing the pain that accompanies the passage of kidney stones, which can be quite significant. Observation is a key component since many small kidney stones (particularly those under 10 mm) can spontaneously pass without the need for invasive procedures. Therefore, monitoring the patient's condition is essential to assess whether the stone is passing effectively. Medical expulsive therapy involves the use of medications, such as alpha-blockers, which can help relax the ureter and facilitate the passage of stones. This approach has been shown to increase the odds of spontaneous passage, particularly for stones that are less than 10 mm in size. This multifactorial approach is supported by clinical guidelines and has been demonstrated to be effective in managing uncomplicated kidney stones while minimizing unnecessary interventions.