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 the 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)