American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an appropriate treatment for a stone measuring between 10-15 mm?

1. Hydration and pain control only

2. Ureteroscopy or shockwave lithotripsy

3. Endoscopic stone fragmentation

4. Immediate surgical intervention

The correct answer is: Ureteroscopy or shockwave lithotripsy

For a stone measuring between 10-15 mm, ureteroscopy or shockwave lithotripsy is considered an appropriate treatment. This size range typically presents a challenge for spontaneous passage, as stones greater than 10 mm are less likely to pass without intervention. Ureteroscopy involves the direct removal or fragmentation of the stone using a ureteroscope, providing a minimally invasive option for treatment. This technique allows the physician to visualize the stone and precisely target it for removal or fragmentation. Shockwave lithotripsy is another non-invasive method where shock waves are used to break the stone into smaller fragments that can pass more easily through the urinary tract. For stones in the 10-15 mm range, these approaches are effective in managing the patient’s symptoms and reducing the risk of complications. Simple hydration and pain management alone may not adequately address the issue, especially in a stone of this size, as there is a significant risk of obstruction or infection. Endoscopic stone fragmentation can be considered in specific contexts but is less conventional than ureteroscopy for stones of this size. Immediate surgical intervention might be excessively aggressive for the size of the stone, as less invasive techniques are usually effective.