What could carry the least risk of colon injury during PCNL?
subcostal puncture performed during full expiration
previous open nephrolithotomy
access lateral to the posterior axillary line
horseshoe kidney
Correct Answer :
B. previous open nephrolithotomy
previous open renal surgery might stick the kidney to the lateral abdominal wall making PCNL, technically, easier with least chances of colonic injury.
Related Questions
What type of urinary diversion carries the highest risk of stone formation?
Kock pouch
Neobladder-to-urethra diversion
Florida pouch
Indiana pouch
Which statement is false concerning renal stones related to hyperparathyroidism (HPT)?
renal stones are found in 20% of patients with primary HPT
acidic arrest promotes crystallisation of calcium phosphate stones related to HPT
HPT, vitamin D excess, and malignancy could lead to hypercalcemia and hypercalciuria
only surgery can cure primary HPT
What is the fatality risk if a triple-phosphate staghorn stone left untreated?
0 10%
10 20%
20 30%
30 40%
What risk factor(s) promote(s) stone formation?
dehydration
metabolic disorders
congenital anomalies
all of the above
What could carry the least risk of colon injury during PCNL?
subcostal puncture performed during full expiration
previous open nephrolithotomy
access lateral to the posterior axillary line
horseshoe kidney
In what kind of renal stones do antibiotics help most?
indinavir
magnesium ammonium phosphate
xanthine
matrix
Invasive intervention in stone patients is NOT indicated in the following condition:
stone size
unrelieved obstruction
infection and septicemia
recurrent 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 is the preferred drug for medical expulsive therapy for lower ureteral stones?
furosemide
tamsulosin
nifedipine
diclofenac
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 is true concerning uric acid stones?
they are metabolic stones that form at high urinary pH
they score 800 1000 HU on CT
only 25% of affected patients have Gout disease
affected patients must stop eating animal protein
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 the most important parameter that determines the treatment modality of a kidney stone?
stone chemical composition
stone burden
first stone vs. recurrent
stone density
What is true concerning the use of intravenous fluids in renal colic cases?
patients should be given large amounts of fluids to hasten stones passage
fluids are given to keep the patient well hydrated
the recommended regimen is 2 L of ringer lactate over 2 hours
fluids are contraindicated if desmopressin (DDAVP) was given
What bowel surgery could result in enteric hyperoxaluria?
right hemicolectomy
small bowel resection
Roux-en-Y gastric bypass
b & c
As per the fixed particle theory of stone formation:
the initial step is papillary plaque formation
crystals formation occurs inside the nephron
tubular precipitates form harmless crystalluria
the attraction of organic compounds and activation crystallization is regulated by osteopontin
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
For how long a completely obstructed ureter could be respited with no expected permanent damage to renal functions?
2 days
2 weeks
2 months
4 6 hrs.
What is false concerning staghorn calculus?
commonly unilateral
commonly due to repeated infections
urate stones are the second most common cause of staghorn calculi
ESWL monotherapy with ureteral stenting is the ideal treatment
What kind of stones is more likely to recur with infections if not removed completely?
urate
triple phosphate
oxalate monohydrate
matrix
What is (are) the indication(s) of ureteral stenting before ESWL?
stones in a solitary kidney
ureteral stones causing bilateral obstructions
a kidney stone of ≥ 2.5 cm in size
all of the above
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 does the treatment of hyperuricemia with urate stones include?
oral potassium sodium hydrogen citrate granules
increase hydration
allopurinol
all of the above
What parameter is NOT considered in the stone burden concept?
the surface area of the stones
the volume of the stones
the density of the stones
the number of the stones
What is false concerning cystine stones?
have diagnostic hexagonal crystals
dont respond to ESWL therapy
are highly soluble in water
inherited in an autosomal recessive fashion
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
Expectant therapy for ureteral stones is indicated when:
stone size of ≤ 4 mm
stone burden of ≥ 22 mm
there is a distal partial obstruction
the patient has end-stage renal failure
What condition might NOT cause uric acid stones?
Tumor lysis syndrome
hypoparathyroidism
myeloproliferative disorder
Lesch-Nyhan syndrome
What is (are) the indication(s) of hospitalization of ureteral stone patients?
steinstrasse
a stone in ureterocele
fever, leucocytosis, pain
brushite stones
What is false concerning patient`s preparation for PCNL?
active UTI is an absolute contraindication
fluoroquinolone is the first choice for antimicrobial prophylaxis
withholding aspirin for only 10 days is enough
despite sterile urine, stone fragmentation might release hidden bacterial endotoxins and viable bacteria