A 40-year-old male presents to the emergency department ...



A 40-year-old male presents to the emergency department with the complaint of acute-onset severe abdominal pain. Past medical history is noncontributory. Family history reveals two living parents in fairly good health, except that his father had one episode of urolithiasis at age 50. Vital signs reveal a temperature of 36.7°C (98.0°F), a blood pressure of 136/88 mmHg, and a heart rate of 92/min. Physical examination reveals:

• Normal cardiac and pulmonary findings

• Marked tenderness to palpation of the right lower quadrant of the abdomen

• No rebound tenderness

• No costovertebral tenderness to percussion

• Tissue texture abnormalities at T10-L1

Laboratory studies reveal:

|Test |Patient's Value |Reference Range |

|Hemoglobin |14.2 g/dL |14.0-18.0 g/dL |

|Creatinine |0.8 mg/dL |0.7-1.3 mg/dL |

|Calcium |10.0 mg/dL |8.6-10.0 mg/dL |

Urinalysis reveals 2+ blood. Flat plate radiograph of the abdomen reveals no evidence of free air or intestinal obstruction. The most likely cause of this patient’s condition is

A) chronic urinary tract infections

B) cystinuria

C) gout

D) idiopathic hypercalciuria

E) vitamin D intoxication

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