Medical Management
In addition to appropriate fluid intake and possible citrate supplimentation, what specifically should clinicians advice uric acid stone formers in regards to diet?
Limit animal protein intake
Clinicians (pick: should or may) obtain a non-contrast CT prior to performing a PCNL.
Should
Name 4/6 risk factors for calcium stone formation
Low volume
Low or high pH
High urinary excretion of calcium
Oxalate
Uric acid
Low urinary excretion of citrate
First line therapy options for symptomatic patient with total non-lower pole stone burden of <20mm?
URS
ESWL
NSAIDs were associated with a greater reduction in pain than opioids
What are the 3 specific components of a screening evaluation the clinician should perform/order for a patient with newly diagnosed kidney or ureteral stone?
1. Medical/Dietary history
2. Urinalysis
3. Serum chemistry
Clinicians may offer what two things to reduce stent discomfort?
Alpha blockers
Antimuscarinic therapy
UPJ obstruction
Horseshoe kidney
Calyceal diverticulum
T or F: Clinicians should not offer ESWL to patients with symptomatic <10mm lower pole renal stones?
False: Should offer ESWL or URS
First treatment stone free rate of URS vs ESWL? (Must be within a combined 6% of sum of both to get answer correct)
90% vs 72%
What three patient groups should get a metabolic stone work-up?
Recurrent stone formers
First time stone formers who are high risk
First time stone formers who are interested
When discussing treatment options for proximal ureteral stones and kidney stones what are the key points that should be discussed with the patient in regards to ESWL and ureteroscopy?
ESWL: Least morbidity and lowest complication rate
URS: Greater stone free rate in a single procedure
Name 4 promoters of stone formation and 2 inhibitors.
Promoters: calcium, sodium, oxalate, urate, cystine, tamm-horsfall protein
Inhibitors: Citrate, magnesium, pyrophosphate, phosphate, glycosaminoglycans, osteopontin, glycoproteins, tamm-horsfall protein, urinary prothombin fragment 1
T or F: Clinicians must use normal saline irrigation for PCNL and URS
True
Ultrasound has limited sensitivity for ureteral stones less than what size?
2-3mm
A 24 hour urine should be analyzed for at least what 9 components? You must get at least 7 to get the question correct
Total volume, creatinine, pH, uric acid, Na, K, citrate, oxalate, calcium
Recommended treatment option(s) for a pediatric patient with total renal stone burden >20mm?
PCNL
ESWL
mSv is the radiation dose one experiences with an imaging modality. A KUB is 0.2-0.4, a CT A/P is 8.5, a CT IVP is 14.8. For a low dose CT stone protocol what is the mSv the patient experiences? (Correct answer must be +/-0.2)
0.98
First line therapy for a pediatric patient with total renal stone burden <20mm?
URS
In patients undergoing ESWL, using tamsulosin and what other drug post-operatively is associated with improved stone free rates compared to placebo or no treatment.
Nifedipine
What is the name of the drug that should be offered to cystine stone patients who are unresponsive to dietary modifications and urinary alkalinization or have large stone burdens?
Alpha-mercaptopropionylglycine (tiopronin)
Following ureteroscopy a physician may omit stent placement when all 5 of these criteria are met. Must get all 5 correct.
No ureteral stricture or other anatomical impediment to stone clearance
Normal contralateral kidney
No renal functional impairment
Second URS is not planned
The fragmentation of stones with ESWL technology occurs due to what 6 mechanisms? Must get 4 to get question correct
Shear stress
Spall fracture
Superfocusing
Squeezing
Cavitation
Fatigue
Prior to PCNL, AUA best practice policy recommends what antibiotics within 24 hours of the procedure? There are two options and both must be correctly stated to get the question correct
First or second generation cephalosporin
or
Gentamycin + metronidazole or clindamycin
There are 5 specific theoretical complications that are thought to be associated with ESWL. What are they? You must name all 5 specifically as listed in the guidelines/core curriculum.
1. Renal injury (will accept contusion/hematoma)
2. Steinstrasse (10% rate)
3. Hypertension
4. Diabetes
5. Renal impairment (AKI/CKD)