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  #1  
Old 09-28-2012
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Arrow Billy Step 1 Questions #3

A 24-year-old man is awakened at night because of severe lower abdominal pain that radiates to the groin. The pain is
very intense and comes in waves. The next morning, he notices blood in his urine. He has no underlying illnesses and has
been healthy all his life. On physical examination, he is afebrile and has a blood pressure of 110/70 mm Hg. Laboratory
studies show serum Na+, 142 mmol/L; K+, 4 mmol/L; Cl−, 96 mmol/L; CO2, 25 mmol/L; glucose, 74 mg/dL; creatinine,
1.1 mg/dL; calcium, 9.1 mg/dL; and phosphorus, 2.9 mg/dL. Urinalysis shows a pH of 7; specific gravity of 1.020; and no
protein, glucose, ketones, or nitrite. The patient is advised to drink more water. He likes iced tea and consumes large
quantities over the course of a hot summer. He continues to have similar episodes. Which of the following substances is
most likely to be increased in his urine?

□ (A) Calcium oxalate
□ (B) Cystine
□ (C) Magnesium ammonium phosphate
□ (D) Mucoprotein
□ (E) Uric acid
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Old 09-28-2012
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I will go with Staghorn stones
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Old 09-28-2012
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Originally Posted by blade View Post
I will go with Staghorn stones
acidic urine points more to cysteine??
hope i guessed right
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Old 09-28-2012
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hmmmm im guessing calcium oxalate
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Old 09-28-2012
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Calcium oxalate
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Old 09-28-2012
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A) Calcium oxalate

This urine is considered alkaline. In alkaline urine Calcuim oxalate or Calcium phosphate calculi would be performed ( most common 80% ), or Struvite "which is Magnesium ammonium phosphate"calculi "a result of infection".

The tea is rich in oxalate + the alkaline urine support choice A.
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Quote:
Originally Posted by greatarablion View Post
A) Calcium oxalate

This urine is considered alkaline. In alkaline urine Calcuim oxalate or Calcium phosphate calculi would be performed ( most common 80% ), or Struvite "which is Magnesium ammonium phosphate"calculi "a result of infection".

The tea is rich in oxalate + the alkaline urine support choice A.
how can you say the urine is considered ALKALINE??urine of 7ph is not alkaline in my dictionary.
if it where alkaline,i would have considered type 1 RTA with calcium stones but lets wait for his xplanation
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Quote:
how can you say the urine is considered ALKALINE??urine of 7ph is not alkaline in my dictionary.
My friend.... urine pH normally between 4.5 to 6.5 ... when it is 7 it is relatively Alkaline !

This is from the urine dictionary...
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Quote:
Originally Posted by greatarablion View Post
My friend.... urine pH normally between 4.5 to 6.5 ... when it is 7 it is relatively Alkaline !

This is from the urine dictionary...
lol..well,this is what i got from wiki

The pH of urine can vary between 4.6 and 8, with neutral (7) being norm. In persons with hyperuricosuria, acidic urine can contribute to the formation of stones of uric acid in the kidneys, ureters, or bladder.[11] Urine pH can be monitored by a physician[12] or at home.
A diet high in citrus, vegetables, or dairy can increase urine pH (more basic)[dubious discuss]. Some drugs also can increase urine pH, including acetazolamide, potassium citrate, and sodium bicarbonate.[citation needed]
A diet high in meat can decrease urine pH (more acidic).[citation needed] Cranberries, popularly thought to decrease the pH of urine, have actually been shown not to acidify urine.[13] Drugs that can decrease urine pH include ammonium chloride, chlorothiazide diuretics, and methenamine mandelate.[14][15]
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Old 09-28-2012
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I will go with A.

Don't care if I get it wrong.
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i think i saw similar q in uw. Ca oxalate was the answer.
maybe this is the case of idiopathic hypercalciuria ..)
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Old 09-29-2012
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Default my answer :)

(A) Calcium oxalate
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A

why? because it's the most common stone

common things are common...rare things are rare
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I am thinking calcium oxalate
provide answer please
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Old 10-01-2012
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Correct Answer A Is correct

This patient has ureteral colic from the passage of a stone down the ureter. About 70% of all renal stones are
composed of calcium oxalate crystals. Patients with these stones tend to have hypercalciuria without hypercalcemia. Uric
acid stones and cystine stones are radiolucent and tend to form in acidic urine. Cystine stones are rare. Triple phosphate
(magnesium ammonium phosphate) stones tend to occur in association with urinary tract infections, particularly infections
caused by urease-positive bacteria, such as Proteus. Mucoproteins may coalesce into hyaline casts, which are too small
to produce signs and symptoms.
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