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
Correct Answer :
D. making the puncture during full expiration
full expiration brings up the kidney close to the supracostal access area and pushes the lung and pleura away inside the thoracic cage.
Related Questions
Invasive intervention in stone patients is NOT indicated in the following condition:
stone size
unrelieved obstruction
infection and septicemia
recurrent stone formation
What is the most favorable stone characteristics for laparoscopic and robotic approaches for the treatment of a kidney stone?
a stone in the lower calyx with a wide mouth of infundibulum and obtuse lower calyx to ureter angle
a stone in an anterior group calyceal diverticulum with thin overlying renal parenchyma
5 mm calcium-containing stone in an intrarenal pelvis and wide UPJ
6 years post anatrophic nephrolithotomy, recurrent mid calyceal stone
What does NOT appear as a filling defect in the renal pelvis on IVU?
fungal ball
radiolucent stone
urothelial growth
upper end of DJ ureteral stent
On treating uric acid stones, excessive alkalinization with potassium citrate could result in all of the following, EXCEPT:
formation of triple-phosphate stones
infection with Proteus species
increase production of endogenous uric acid
increase level of uric acid in THE blood
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
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
A 24-hr urine collection of a recurrent Ca. oxalate stone former patient having Crohn`s disease might reveal:
high citrate, high oxalate
low citrate, low oxalate
high citrate, low oxalate
low citrate, high oxalate
What is false concerning PCNL in horseshoe kidneys?
the preferred access into the collecting system is through a posterior calyx
the posterior calyceal group is typically more medial than in the normal kidney
in most cases the lower pole calyces are posterior
it is desirable to make an upper pole collecting system puncture
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
What is the proper sequence of the following stones when ordered from most radiopaque to most radiolucent as they appear on plain Xray film?
Ca.oxalate, Ca.phosphate, Na.urate, cystine
Ca.phosphate, Ca.oxalate, cystine, Na.urate
Ca.oxalate, Ca.phosphate, cystine, Na.urate
Ca.phosphate, Ca.oxalate, Na.urate, cystine
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
Which of the following factors, positively, affect lower calyceal stone clearance after ESWL?
short and wide infundibulum
large lower-pole infundibulo-pelvic angle
the adjunct usage of PCNL
all of the above
What is the preferred irrigation fluid during PCNL?
physiological saline 0.9%
glycine 1.5%
balanced salt solution
distilled water
Which method of the following stone analysis techniques is based on the interaction of polarized light with the stone crystals?
wet chemical analysis
thermogravimetry
scanning electron microscopy
none of the above
What is the most common organism that might complicate PCNL?
Proteus mirabilis
E. coli
Pseudomonas aeruginosa
Staphylococcus epidermidis
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
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 incidence risk of ureteral strictures following ureteroscopy?
3 6 %
12 15 %
0.4 0.8 %
0.09 0.14 %
What could the discomfort experienced during ESWL session be related to?
the energy density of the shock waves as they pass through the skin
the size of the focal point
a & b
none of the above
What is the most common composition of ureteral stones?
Ca.phosphate
Ca.oxalate
Na.urate
struvite
What is false concerning cystine stones?
result from an inherited defect of renal tubular reabsorption of cysteine
characteristically, urate and cysteine stone are radiolucent
cysteine is a dibasic amino acid
on plain X-ray, cysteine stones exhibit ground-glass appearance
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 stone is inherited as an autosomal recessive trait?
xanthine
ammonium urate
cystine
calcium oxalate dihydrate
What parameter impairs the kidney stone-free rate, after ESWL?
short skin-to-stone distance (SSD)
end-stage renal failure
a stone in the upper calyx
the presence of a 30 cm, 4.7 Fr ureteral stent in situ
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
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 the most appropriate antibiotic class for prophylaxis before urologic surgery?
aminoglycosides
macrolides
cephalosporins
fluoroquinolones
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 bowel surgery could result in enteric hyperoxaluria?
right hemicolectomy
small bowel resection
Roux-en-Y gastric bypass
b & c
What is the Hounsfield density range of uric acid stones?
400 600 HU
600 800 HU
800 1000 HU
1000 1200 HU