During pyelolithotomy for removing a staghorn urate stone; how to ensure a complete removal of calyceal branches?
by performing intra-operative ultrasonography
by performing radial nephrotomies
by performing adjunct PCLN
by taking a scout KUB film
Correct Answer :
A. by performing intra-operative ultrasonography
intra-op. u/s is a non-invasive way to detect remaining stones. Urate stones are typically radiolucent and dont appear on scout KUB. Nephrotomies carry the risk of bleeding.
Related Questions
Which of the following dietary advice is recommended for Ca.oxalate stone formers?
limit beef, chicken, pork, eggs, fish, shellfish, and other animal proteins
limit beans, nuts, chocolate, coffee, dark green vegetables, and soda
limit canned, packaged, and fast foods
limit milk, cheese, and other dairy products
What is false concerning preputial stones?
form due to inspissated smegma
form due to stasis of urinary salts
cause inguinal lymphadenopathy
often associated with phimosis in uncircumcised males
When urine reaches a high tendency to form stones, the situation is called:
lithogenic anion to cation ratio
Randall cut off
saturation index
solubility product
What is (are) the indication(s) of hospitalization of ureteral stone patients?
steinstrasse
a stone in ureterocele
fever, leucocytosis, pain
brushite stones
What is the treatment of choice for a 15 mm stone in the lower calyx with a narrow infundibulum?
ESWL
PCNL
radial nephrolithotomy
pyelolithotomy with ureteral stenting
What is true regarding a stone in a urethral diverticulum?
is symptomless
should undergo a trial of milking out
diverticulectomy and stone extraction is the treatment of choice
ESWL is the preferred treatment option
What is false concerning struvite stones?
the commonest to form staghorn giant calculi
formed by urease producing bacteria
antibiotics have a role in the treatment
form at the two extremes of urinary pH range
How can the effectiveness of ESWL treatment session be enhanced?
by ensuring optimal coupling of the patient to the lithotripter
by running the treatment at a slower rate (60 shocks/min)
by running the treatment with general anesthesia
by all of the above
What stones are radiopaque on plain X-ray film?
2,8 dihydroxyadenine stones
sulfa medications-induced stones
calcium oxalate stones
matrix stones
What is the most common composition of ureteral stones?
Ca.phosphate
Ca.oxalate
Na.urate
struvite
What is (are) true concerning ESWL?
a stone is fragmented when the force of the shockwaves overcomes the tensile strength of the stone
fragmentation occurs as a result of compressive and tensile forces, erosion, shearing, spalling, and cavitation
the generation of compressive and tensile forces and cavitation are thought to be the most important
all of the above
What is the most favorable stone characteristic for PCNL treatment?
≥ 2 cm diameter
upper calyx location
Na.urate composition
600 - 800 HU density
What statement is false concerning the use of desmopressin (DDAVP) in renal colic patients?
it causes reduction in the mean intra-ureteral pressure
it reduces the pain of acute renal colic
it has a direct relaxing effect on the renal pelvis and ureteral musculature
it is indicated when stones are ≤ 4 mm in diameter
Which of the following bacteria split urea?
Klebsiella pneumonia
Morganella morganii
Proteus mirabilis
all of the above
The process where nucleation and further precipitations occur by different components to form urinary stones, is called:
classical nucleation theory
heterogeneous nucleation
suspension solution
concentric lamination
Which patient is at lowest risk for the development of perinephric hematoma after ESWL?
hypertensive patient
patient on aspirin withheld 5 days prior to ESWL
a stone in a scared poorly functioning kidney
ESWL every other day
What is the principal defect in renal hypercalciuria?
impaired renal tubular calcium reabsorption
excessive glomerular leak of calcium
deficiency of the enzyme xanthine oxidase
hypercalcemia
What is the Hounsfield density range of uric acid stones?
400 600 HU
600 800 HU
800 1000 HU
1000 1200 HU
What is false concerning obesity and urinary stone formation?
obese patients have a higher tendency for uric acid stone formation
high-protein, low-carbohydrate diet might increase the risk of stone formation and bone loss
metabolic syndrome is associated with high urinary pH
Roux-en-Y-gastric bypass surgery may increase the risk for stone formation
During pyelolithotomy for removing a staghorn urate stone; how to ensure a complete removal of calyceal branches?
by performing intra-operative ultrasonography
by performing radial nephrotomies
by performing adjunct PCLN
by taking a scout KUB film
What bowel surgery could result in enteric hyperoxaluria?
right hemicolectomy
small bowel resection
Roux-en-Y gastric bypass
b & c
What kind of stones is more likely to recur with infections if not removed completely?
urate
triple phosphate
oxalate monohydrate
matrix
What is the first-line treatment of kidney stones of a burden greater than 2 cm?
ESWL
URS
PCNL
none of the above
What medications do NOT cause renal stones?
ciprofloxacin
indinavir
thiazides
triamterene
What is true regarding DJ ureteral stents?
can be placed through perc. nephrostomy
might slip out, especially in females
usually radiopaque
all of the above
What type of stones do laxative abusers might develop?
ammonium urate
sodium urate
calcium oxalate
calcium phosphate
What is a remarkable disadvantage of ultrasonic imaging for ESWL?
localization of stones in the ureter is difficult or impossible
inability to visualize stones breaking down in real time
c. patient`s position on ESWL table is uncomfortable
d. inability to visualize radiolucent stones
What condition might NOT cause uric acid stones?
Tumor lysis syndrome
hypoparathyroidism
myeloproliferative disorder
Lesch-Nyhan syndrome
Two weeks of prolonged wound drainage after a non-stented Anderson-Hynes pyeloplasty. What would be next step in the management?
watchful waiting
open surgical correction
IVU with possible endoscopic ureteral stenting
perc. nephrostomy tube insertion
Why do patients with cystic fibrosis form stones?
because urine and body secretions are highly concentrated
due to renal leak hypercalciuria
as a result of distal renal tubular acidosis type I
because of reduced or absent of oxalobacter formigenes colonization