American Board of Internal Medicine (ABIM) Certification Practice Exam

When is mechanical stone removal appropriate for smaller kidney stones?

1. After failed medical management

2. When the patient is asymptomatic

3. Only during pregnancy

4. For stones causing mild pain

The correct answer is: After failed medical management

Mechanical stone removal is appropriate for smaller kidney stones primarily when there has been a failure of medical management. This situation arises when conservative treatments, such as medication to facilitate stone passage or increased fluid intake, do not lead to successful removal or resolution of symptoms. In cases where a patient continues to experience significant pain, recurrent urinary obstruction, or any complications related to the stone, a more invasive approach becomes warranted. In the context of managing kidney stones, certain conditions dictate the necessity for intervention. While there may be various other scenarios involving kidney stones, they do not support the rationale for immediate mechanical removal like unsuccessful treatment does. If the patient is asymptomatic, conservative management is typically preferred, and mechanical removal would not be justified. Similarly, stones occurring during pregnancy may require special considerations, but the overall treatment approach would depend on the specific circumstances - this would not inherently necessitate mechanical removal. Lastly, mild pain suggests that the stone may still be managed with conservative measures rather than needing immediate mechanical intervention. Hence, the failed medical management route stands out as the correct and most justifiable context for proceeding with mechanical stone removal in smaller kidney stones.