American Board of Internal Medicine (ABIM) Certification Practice Exam

In treating urolithiasis, when should a urology consultation be considered?

1. If the stone is less than 5 mm

2. If stone size is 10 mm or more

3. If there is no pain

4. If there is no tissue obstruction

The correct answer is: If stone size is 10 mm or more

In the management of urolithiasis, a urology consultation is particularly warranted when the stone size is 10 mm or more. This is because larger stones are less likely to pass spontaneously through the urinary tract and are associated with a higher risk of complications such as obstruction, infection, and renal damage. In such cases, urologists can offer advanced treatment options, including lithotripsy, ureteroscopy, or percutaneous nephrolithotomy, which are more effective for larger stones. While smaller stones, particularly those less than 5 mm, generally have a good chance of passing without intervention, and consultation is not typically necessary in such cases. Similarly, the absence of pain or tissue obstruction also does not strongly indicate the need for a urology consult, as these factors usually suggest a less acute situation that can often be managed in primary care or through watchful waiting. Thus, the need for specialized urological care is significantly heightened when facing larger stones due to their potential to cause serious complications.