American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended follow-up if a stone passage is not achieved within 4-6 weeks?

1. Continue pain management only

2. Consult urology

3. Start a new medication

4. Schedule a follow-up ultrasound

The correct answer is: Consult urology

When a patient has not passed a kidney stone within the 4-6 week timeframe, it becomes essential to consider further intervention due to potential complications such as obstruction, infection, or renal impairment. Consulting urology is the appropriate next step because urologists specialize in conditions affecting the urinary tract and can provide a more comprehensive evaluation. They may suggest imaging studies, perform procedures to facilitate stone passage, or recommend surgical options if necessary. This proactive approach helps ensure that the patient receives proper management and minimizes the risk of complications associated with untreated kidney stones. In contrast, simply continuing with pain management may overlook the underlying issues, while starting a new medication without guidance might not be effective. Scheduling a follow-up ultrasound may provide additional information but does not address the need for intervention in a timely manner. Therefore, referring to a urology specialist is the most prudent course of action in this scenario.