E3 - Genitourinary Procedures Flashcards
What position will the patient most likely be in for Urological Surgery?
A. left lateral decubitus
B. lithotomy
C. prone
D. supine
B. Lithotomy
so consider all the possible nerve/finger/vessel injuries
common peroneal, femoral and obturator nerve injuries; fingers crushed by bed; lift legs up at same time to prevent torsion
What lab is the best measure of glomerular function?
- GFR
What is normal GFR?
When will patients become symptomatic?
- 125 mL/min
- asymptomatic until a 50% drop (so at 75 mL/min)
What will be the result of moderate GFR insufficiency? select 3.
A. increased BUN/creat
B. decreased BUN/creat
C. increased energy
D. decreased energy
E. acidemia
F. anemia
A. ↑ BUN/Creat
D. Decreased energy
F. Anemia
What will be the result of severe GFR insufficiency?
A. profound uremia
B. alkalosis
C. volume overload
D. A & C
E. all of the above
D. A & C
- Profound uremia (high levels of waste product in the blood)
- volume overload
- acidemia
What is a Normal BUN?
8-18 mg/ dL
influenced by exercise, steroids, dehydration
BUN will not be elevated in kidney disease until GFR is ____% of normal.
A. 45
B. 50
C. 60
D. 75
D. 75%
What is normal Creatinine?
- 0.8 - 1.2 mg/dL
Higher in men d/t more muscle mass
Expected findings on a preop evaluation of a pt with Chronic Renal Failure include: select 3.
A. a fib
B. acidosis
C. volume deficiency
D. HTN
E. iron deficient anemia
F. hypokalemia
B. Acidosis (↓ production of ammonia, ↑ Anion Gap)
D. HTN d/t RAAS dysfunction
E. Hematologic Symptoms like iron deficient anemia & abnormal plt aggregation
* Hyperkalemia
* Hypervolemia (↑Na = ↑H2O)
Because most anesthetic drugs are lipid soluble in a non-ionized state, termination doesn’t depend on ____.
A. metabolism
B. redistribution
C. renal excretion
D. hepatic clearance
C. Renal Excretion
Metabolite of these drugs are excreted as water-soluble compounds
Drugs of concern for patients with Renal Insufficiency are:
Select 2
A. highly ionized and eliminated lipid-soluble in urine
B. nonionized and eliminated lipid-soluble in urine
C. highly ionized and eliminated unchanged in urine
D. nonionized and eliminated unchanged in urine
C. Drugs that are highly ionized and eliminated unchanged in urine
List:
* Muscle relaxants (Pancuronium)
* H2-R Blockers (ranitidine, cimetidine)
* Cholinesterase inhibitors (neostigmine)
* Thiazide diuretics
* Digoxin
* Many antibiotics (PCNs, tetracycline)
* Active metabolites (morphine/codeine/meperidine/ketamine/midazolam)
An endoscopic evaluation of the lower urinary tract that goes thru the urethra is called:
A. colonoscopy
B. hysteroscopy
C. urethroscopy
D. cystoscopy
what about scope thru the bladder? thru the ureteral orifice?
C. Through urethra = urethroscopy
Through bladder = cystoscopy
Through ureteral orifice = ureteroscopy
Describe the process of a scope urologic procedure:
A. guide wire inserted thru scope
B. catheter/instruments placed over wire
C. radiopaque dye injected thru catheter
D. all of the above
D. all of the above
can be rigid or flexible scope
A urethroscopy/cystoscopy visualizes the urethra and/or bladder due to urinary symptoms like pain, burning, hematuria, and difficulty urinating. What diagnosis can be made from these procedures?
A. kidney stones
B. duodenal ulcers
C. lesions and strictures
D. bowel perforations
C. lesions and/or strictures
can dilate stricture, treat cystitis, stent placement, and/or resect tumors
What is the procedure of choice for mid/distal ureter or bilateral stones?
A. cystoscopy
B. ureteroscopy
C. urethroscopy
D. colposcopy
B. Ureteroscopy (flexible scope)
Can incorporate laser technology
What percentage of men and women lifetime will experience ureter stones?
What is the recurrence percentage?
- Men: 10%
- Women: 5%
- Recurrence: 50%
Fill in the blanks:
Ureter stones are diagnosed on ____, ____, and/or _____. Select 3.
A. MRI
B. CXR
C. CT
D. KUB xray
E. IV pyelogram
C. CT
D. KUB (kidneys, ureter, bladder) xray
E. IVP (Intravenous Pyelogram)
What are some examples of medical expulsive therapy (MET) for ureter stones? Select 3.
A. loop diuretics
B. aggressive fluid admin
C. antibiotics
D. CCB or alpha-blockes
E. NSAIDs
F. bicarb drip
B. Aggressive Fluid intake (↑ Water, ↑ Cranberry Juice)
D. CCB and alpha blockers to vasodilate
E. NSAIDs
or they can proceed to surgery/procedures (stone basket, SWL, perc nephrolithotomy)
Shock wave Lithotripsy (SWL) is best suited for what size intranephric stones?
small/medium
Shock Wave Lithotripsy (SWL) runs a risk of:
A. hypothermia
B. TUR syndrome
C. sub-capsular hematoma
D. severed ureter
C. Risk of kidney injury or sub-capsular hematoma
Compare the Old SWL vs New SWL.
- Old SWL: Water baths, hypothermia, painful
- New SWL: Water-filled coupler device, focus beam, decrease pressure pulse, less painful
What are the 2 ABSOLUTE contraindications to SWL?
A. large calcified aortic/renal aneurysms
B. bleeding disorder/AC
C. untreated UTI
D. pacemaker/ICD
E. pregnancy
B. Bleeding disorder/ anticoagulants
E. Pregnancy (we do not thump babies)
Relative CIs: Large calcified aortic/renal aneurysm, untreated UTI, Obstruction distal to renal calculi, Pacemaker, ICD, neurostimulator, Morbid Obesity.
What are preoperative anesthetic considerations for SWL and percutaneous nephrolithotomy? select 2
A. cannot use a laser with either procedure
B. single PIV
C. no versed
D. appropriate abx w/in 1 hr of cut time
B. Single PIV
D. Appropriate ABX within 1 hour “cut time”
and:
* Consider anxiolytics
* Iodine Allergy?
What are intraoperative anesthetic considerations for Shock Wave Lithotripsy? select 2.
A. only done under general with an ETT
B. minimal narcotic
C. lateral position
D. use eye coverings if laser used
B. Minimal narcotics
D. Eye covering for laser (document!)
and:
* Local vs. General (most people will be general)
* LMA vs ETT
* Consider antiemetic
* Lead for providers (cover breast, thyroid, sex organs, corneas)
What procedure will be indicated for large intranephric stone removal?
A. percutaneous nephrolithotomy
B. SWL
C. stone basket
D. laser therapy
A. Percutaneous Nephrolithotomy
A percutaneous nephrolithotomy is useful for large intranephric stones but not as commonly done as SWL. What does this procedure require in order to prevent obstruction as fragments pass?
A. water bath
B. stone basket
C. water-filled coupled device
D. initial placement of ureteral stents
D. initial placement of ureteral stents
Minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin.
What are 2 drawbacks to percutaneous nephrolithotomy?
A. hypothermia risk
B. uses more fluoroscopy
C. transurethral resection syndrome is possible
D. risk of subcapsular hematoma
B. Uses more fluoroscopy
C. Transurethral Resection syndrome possible
What are some intraoperative anesthetic considerations for percutaneous nephrolithotomy? Select 2
A. local anesthesia usually
B. GETA
C. might need a pudendal nerve block
D. should use short-acting NMBDs
E. no narcotics
B. General ETT
D. Short NMBD’s (vec/roc)
Also:
* Lateral position (bean bag, pillows)
* Lead apron for provider
* Eye covering for laser (document!)
what position do we want the pt for perc nephrolithotomy? and what kind of protection should be used for the provider?
A. supine; lead apron
B. lateral; eye protection and lead apron
C. prone; eye protection
D. lithotomy; eye protection and lead apron
B. lateral position; should use eye protection if using laser and wear a lead apron
Name the 3 scrotal operations discussed.
- orchiectomy (remove testicles)
- hydrocelectomy (remove fluid-filled sac around testicle)
- testicular torsion (spermatic cord twists, cutting off blood supply to testicle, medical emergency!)
Testicular torsion is a MEDICAL EMERGENCY and must be performed within ____ hours to prevent irreversible ischemic damage.
A. 24 hrs
B. 12 hrs
C. 6 hrs
D. 4 hrs
C. 6 hours
he’s gonna lose his testicle if u dont hurry
What are 2 main indications for circumcision in adult males?
A. phimosis
B. penile/prostate cancer risk
C. cosmetic
D. squamous cell carcinoma
A. Phimosis (tight foreskin)
B. Penile/ prostate cancer risk
What is a Penectomy? And what may the procedure include?
A. surgical removal of one or both testicles; may include prosthesis
B. surgical removal of the penis; may include prosthesis
C. surgical removal of one or both testicles; may include inguinal lymph node biopsy
D. surgical removal of the penis; may include inguinal lymph node biopsy
D. Removal of the penis; usually to remove squamous cell carcinoma on the penis. This procedure may include inguinal lymph node biopsy.
What 2 patient populations may require a penile prosthesis?
- Diabetic patients
- Spinal cord injury patients
What are 2 specific anesthesia considerations for penile operations? select 2.
A. careful with prosthesis touching skin prior to insertion
B. need to change to lateral positioning mid-case
C. need a pudendal nerve block
D. tachycardia is likely
A. SCIP + take care with prosthesis touching skin before insertion
C. Penile Block: pudendal nerve (S2-S4)
other general considerations:
* Preop anxiolytics
* General: ETT vs LMA
* Supine
* Manipulation of genitals = will vagal down/bradycardia, have glycopyrrolate ready