First Stone Metabolic Workup — ESENeph MCQ
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Correct answer: A — Measure serum calcium and consider analysis of the recovered stone
The best answer is “Measure serum calcium and consider analysis of the recovered stone”. NICE distinguishes what it can recommend for every adult stone presentation: serum calcium is measured, while stone analysis is considered. A broader metabolic evaluation is selected from recurrence and high-risk features. “Arrange a kidney biopsy before giving prevention advice” is less appropriate because biopsy has no role in routine metabolic assessment of a passed ureteric stone “Order genetic testing for cystinuria for every first presentation” is less appropriate because genetic testing is selected by phenotype and risk rather than used as the routine adult first-line assessment “Perform a mandatory 24-hour urine profile in every first-time adult” is less appropriate because NICE did not make a universal adult recommendation for full 24-hour urine testing “Omit laboratory assessment because this is the first stone” is less appropriate because NICE specifically recommends serum calcium measurement and consideration of stone analysis
Reference: NICE NG118: renal and ureteric stones: https://www.nice.org.uk/guidance/ng118/chapter/recommendations