skip to main content

Ureteral stone — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardSurgery (post-operative, follow-up)Ureteral stoneUSMLE Step 3

A 43-year-old woman has fever 39.3 C, hypotension, right flank pain, pyuria, and creatinine 2.0 mg/dL. CT shows an 8-mm proximal ureteral stone with hydronephrosis. Broad-spectrum intravenous antibiotics and fluids have begun. Which procedure is most appropriate next?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Urgently drain with a ureteral stent or nephrostomy and defer stone removal

The best answer is “Urgently drain with a ureteral stent or nephrostomy and defer stone removal”. An infected obstructed urinary system is a urologic emergency. Antibiotics cannot reliably sterilize a pressurized obstructed collecting system, so urgent drainage is required. Definitive ureteroscopy or lithotripsy is postponed until sepsis resolves.

Reference: AUA Surgical Management of Stones Guideline: https://www.auanet.org/guidelines-and-quality/guidelines/kidney-stones-surgical-management-guideline