What sequence of ureteral parts represents the most to least favorable stone response to ESWL treatment?
upper, lower, mid
lower, upper, mid
mid, upper, lower
mid, lower, upper
Correct Answer :
A. upper, lower, mid
upper ureteral stones respond to ESWL in 98%, lower respond in 85%, while mid respond only in 70%.
Related Questions
What is the most common organism that might complicate PCNL?
Proteus mirabilis
E. coli
Pseudomonas aeruginosa
Staphylococcus epidermidis
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 is the Hounsfield density range of uric acid stones?
400 600 HU
600 800 HU
800 1000 HU
1000 1200 HU
What type of urinary diversion carries the highest risk of stone formation?
Kock pouch
Neobladder-to-urethra diversion
Florida pouch
Indiana pouch
What does the treatment of hyperuricemia with urate stones include?
oral potassium sodium hydrogen citrate granules
increase hydration
allopurinol
all of the above
What medication could help in managing carbonate apatite stones?
α-Mercaptopropionylglycine
acetohydroxamic acid
carbonic anhydrase inhibitors
xanthine oxidase inhibitors
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
Ureteral stones of ≥ 7 mm:
should be treated with more analgesics
must undergo metabolic worked out
are unlikely to pass out spontaneously
chemolysis should be tried first
Where do Randall plaques originate from?
transitional epithelium lining minor calyces
transitional epithelium lining major calyces
basement membrane of the loops of Henle
papillary tips of polar pyramids
Which of the following is a relative contra-indication to ESWL?
renal insufficiency
active urinary tract infection
uncorrected bleeding disorder
third trimester pregnancy
What is the sure diagnostic finding of Ca.oxalate stones?
chemical analysis of a recovered stone
hypercalcemia
CT finding
high breakability on ESWL
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
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
Invasive intervention in stone patients is NOT indicated in the following condition:
stone size
unrelieved obstruction
infection and septicemia
recurrent stone formation
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
What is the composition of brushite stones?
calcium phosphate
calcium oxalate monohydrate
sodium urate
2,8 dihydroxyadenine
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 situation carries lower risk for lung injury during supracostal upper pole access for PCNL?
placing the patient in anti-Trendelenburg position
making the puncture under local anesthesia
injection Co2 gas to create a safety space under the diaphragm before puncturing
making the puncture during full expiration
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 is false concerning prostatic stones?
composed of calcium phosphate and calcium carbonate
the vast majority are asymptomatic
most of the calculi are found in the transitional zone
they dont affect PSA levels
What is the least serious complications of PCNL?
uncontrollable bleeding
incomplete removal of stones
pneumothorax
colonic perforation
What sequence of ureteral parts represents the most to least favorable stone response to ESWL treatment?
upper, lower, mid
lower, upper, mid
mid, upper, lower
mid, lower, upper
What type of shockwaves is generated by spark-gap technology?
piezoelectric
electrohydraulic
electromagnetic
microexplosive
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
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
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 stone is inherited as an autosomal recessive trait?
xanthine
ammonium urate
cystine
calcium oxalate dihydrate
What is false concerning primary bladder stones?
commoner in females than in males
in pediatrics, are of calcium oxalate and/or ammonium urate composition
caused by bladder outlet obstruction
might result in bladder cancer
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
ESWL in pediatric patients is characterized by all of the following, EXCEPT:
often need sedation or anesthesia
vesico-ureteral reflux must be excluded
pediatrics have a higher clearance rate of stones when compared to adults
safety measures must be taken to avoid lung contusions