GU surgery (Kane) Exam 3 Flashcards
Which of the following are true regarding Glomerular Filtration Rate (GFR)? (2)
a.) It is the best measure of glomerular function.
b.) Normal GFR is 150 mL/min.
c.) Severe insufficiency results in profound uremia and acidemia.
d.) You are asymptomatic until GFR drops by 60%
a.) It is the best measure of glomerular function.
c.) Severe insufficiency results in profound uremia and acidemia.
S2
Normal GFR is ___ mL/min.
A) 50
B) 75
C) 100
D) 125
D) 125
S2
At what point do symptoms usually become apparent in relation to GFR drop?
A) 10%
B) 25%
C) 50%
D) 75%
C) 50%
S2
Severe glomerular insufficiency may present with:
Select 3
A) Profound uremia
B) Acidemia
C) Alkalemia
D) Increased energy levels
E) Dehydration
F) Volume overload
A) Profound uremia,
B) Acidemia
F) Volume overload
S2
Which of the following are characteristic of moderate glomerular insufficiency? (Select 3)
A) Increased BUN/Creatinine levels
B) Anemia
C) Increased energy levels
D) Profound uremia
E) Acidemia
F) Decreased energy
A) Increased BUN/Creatinine levels
B) Anemia
F) Decreased energy – tired all the time
S2
What are the normal BUN levels?
A) 4-12 mg/dL
B) 8-18 mg/dL
C) 10-20 mg/dL
D) 5-15 mg/dL
B) 8-18 mg/dL
*BUN is not a good indicator of renal fx because can be affected by hydration status
S2
At what percentage of normal GFR does BUN typically elevate in kidney disease?
A) 25%
B) 50%
C) 75%
D) 90%
C) 75%
S2
Which of the following statements about creatinine are correct? (Select 3)
A) Normal range is 0.8-1.2 mg/dL
B) Creatinine levels vary with age
C) Creatinine is influenced by exercise and dehydration
D) Creatinine is influenced by gender
A) Normal range is 0.8-1.2 mg/dL
B) Creatinine levels vary with age
D) Creatinine is influenced by gender/sex
Normal BUN:Creatinine ratio is 10:1
S2
Which factors can influence Blood Urea Nitrogen (BUN) levels? Select 3
a.) Exercise
b.) Steroids
c.) Dehydration
d.) Diet
e.) Age
a.) Exercise
b.) Steroids
c.) Dehydration
S2
can be falsey elevated with dehydration
Which of the following are preoperative evaluations for patients with chronic renal failure (CRF)? Select 3
a.) Hypervolemia
b.) Acidosis
c.) Hyperkalemia
d.) Hypokalemia
e.) Hypovolemia
a.) Hypervolemia
b.) Acidosis
c.) Hyperkalemia
S3
What causes hypervolemia in patients with CRF?
A) Decreased fluid intake
B) Increased urinary output
C) Increased total body sodium and water
D) Decreased total body sodium and water
C) Increased total body sodium and water
Don’t want to give them more volume
S3
What symptom is precipitated by hemorrhage, transfusions, and metabolic acidosis in CRF patients?
A) Hypokalemia
B) Hyperkalemia
C) Hyponatremia
D) Hypernatremia
B) Hyperkalemia
Might decide on what NMD blocker you will/will not give since can elevate k
S3
In patients with CRF, acidosis is characterized by a decreased production of ___ and an elevated ___ as the disease progresses.
A) Ammonia/ bicarbonate
B) Sodium / ammonium
C) Sodium / anion gap
D) Creatinine/ anion gap
E) Ammonia/ anion gap
E) Ammonia/ anion gap
Starts off as a normal anion gap, but patient can become uremic which increases the anion gap over time.
S3
Which of the following are cardiac and pulmonary symptoms associated with CRF? Select 4
a.) Hypertension due to the RAAS
b.) Pulmonary edema
c.) Ventricular hypotrophy
d.) Ventricular hypertrophy
e.) Bradycardia
f.) Atherosclerosis
a.) Hypertension due to the renin-angiotensin system RAAS
b.) Pulmonary edema
d.) Ventricular hypertrophy
f.) Atherosclerosis
*Do they need more of a workup, get cardiology involved “tuned up” *
S3
What type of anemia is commonly seen in CRF patients? Select 2
A) Microcytic, hypochromic anemia
B) Normochromic, normocytic
C) Hemolytic anemia
C) Macrocytic anemia
D) Iron-deficient anemia
B) Normochromic -normal color
normocytic - normal size
D) iron-deficient anemia
S3
Hematologic symptoms in CRF patients include abnormal ___ aggregation and _____________ consumption.
A) Platelet/Red blood cell
B) White blood cell/Prothrombin
C) Platelet/ Prothrombin
D) Prothrombin/Protein
C) Platelet/ Prothrombin
S3
Which of the following drugs are of concern in patients with renal insufficiency due to their high ionization and elimination unchanged in the urine? (4)
a.) Muscle relaxants
b.) H2 receptor blockers
c.) Cholinesterase inhibitors
d.) Loop Diuretics
e.) Beta-blockers
f.) Calcium channel blockers
g.) Thiazide diuretics
a.) Muscle relaxants (Pancuronium)
b.) H2 receptor blockers
c.) Cholinesterase inhibitors
g.) Thiazide diuretics
S4
What is true about active metabolites of drugs like morphine, meperidine, ketamine, and midazolam of concern in patients with renal insufficiency?
A) They are highly lipid soluble.
B) They are excreted changed in urine.
C) They are metabolized by the liver.
D) They require smaller doses
D) They require smaller doses or avoidance altogether.
They are unchanged in the urine… meds will last longer
S4
Many antibiotics and drugs like ___ are of concern in patients with renal insufficiency.
A) Digoxin
B) Propofol
C) Zofran
D) Diltiazem
A) Digoxin
S4
The body eliminates lipid soluble drugs in a non-ionized state by either using ____________ and metabolism to excrete them as ________-soluble compounds.
A) Redistribution/ lipid
B) Absorption/water
C) Redistribution/water
D) Conjugation/lipid
C) Redistribution/water
S4
Most drugs are lipid soluble in a non-ionized state. Which of the following statements is true about their termination in patients with renal insufficiency?
A) Termination depends on renal excretion.
B) Termination does not depend on renal excretion.
C) Termination depends solely on hepatic metabolism.
D) Termination is not affected by renal insufficiency.
B) Termination does not depend on renal excretion.
S4
Which of the following statements is true about highly ionized drugs in renal insufficiency?
A) They are easily metabolized by the liver.
B) They are eliminated unchanged in the urine.
C) They have a reduced effect.
D) They are excreted through the lungs.
B) They are eliminated unchanged in the urine.
S4
Which conditions are associated with an increased risk of renal insufficiency? (Select 4)
A) Gastrointestinal diseases
B) Sepsis
C) Burns
D) Hyperthyroidism
E) CAD
F) Use of NSAIDs
B) Sepsis
C) Burns
E) CAD - cardiac/valve surgery
F) NSAIDs
*crush injury
**Toxins **and traumatic release of high levels of myoglobin, protein, potassium
S5
What is the approximate mortality rate of acute kidney injury (AKI)?
A) 25%
B) 35%
C) 50%
D) 75%
C) 50%
Patients die post-operative d/t preoperative co-morbidities
S5
Which of the following is NOT mentioned as a method for renal protection in patients with moderate renal insufficiency?
A) Adequate hydration
B) Adequate renal blood flow
C) Use of mannitol
D) Use of beta-blockers
D) Use of beta-blockers
A) Adequate hydration - dilute the badness – dye, myoglobin or protein in urine..
B) Adequate renal blood flow -maintain blood pressure, MAP, pressure at the afferent arteriole is normal
C) Use of mannitol -inconsistent data that it protects the kidneys
S5
Which of the following medications are used for renal protection in patients with renal insufficiency but have inconsistent data? Select 4
a.) Manetee
b.) Low-dose dopamine
c.) Fenoldopam
d.) Loop diuretics
e.) Bicarbonate drips
f.) Beta-blockers
b.) Low-dose dopamine
c.) Fenoldopam (dopamine D1 receptor agonist)
d.) Loop diuretics (lasix)
e.) Bicarbonate drips old doctor technique -RIP
S5
Which medication is specifically mentioned as beneficial for renal protection by potentially preventing contrast-induced nephropathy?
A) Mannitol
B) Dopamine
C) N-acetylcysteine
D) Bicarbonate
C) N-acetylcysteine
S5
Which is an imaging test that uses X-rays and a contrast dye to produce detailed pictures of the urinary tract?
A) Laparoscopy
B) Ultrasound
C) Retrograde pyelography
D) CT scan
C) Retrograde pyelography
S6
What is a common indication for performing urological surgery?
A) Resecting masses
B) Evaluating bleeding
C) Treating stricture
D) Removing stones
E) All of the above
E) All of the above
Biopsies/evaluate bleeding
Laser/retrieve stones
Remove/treat stricture
Resect masses
S6
Urological surgery involving direct visualization is commonly performed on the Urethra, _______, bladder and kidney.
A) Vagina
B) Penis
C) Ureter
D) Pyloris
C) Ureter
S6
Urological Surgery
Which of the following is a common nerve injury associated with the lithotomy position? (2)
A) Sciatic nerve
B) Ulnar nerve
C) Femoral nerve
D) Radial nerve
E) Peroneal nerve
C) Femoral nerve
E) Peroneal nerve
S7
Slide 7
Finger injuries in the lithotomy position are often caused by ___.
A) Improper padding
B) Sharp instruments
C) The foot of the bed
D) Incorrect glove size
C) The foot of the bed coming back up
S7
What is a possible vascular complication of the lithotomy position?
A) Aneurysm
B) DVT
C) SVT
D) Arterial occlusion
B) Deep vein thrombosis (DVT)
S7
Skin breakdown in the lithotomy position is often due to pressure from ___.
A) Bandages
B) Stirrup pressure
C) Surgical instruments
D) Clothing
B) Stirrup pressure – candy canes (pad the pole)
Can create compartment syndrome
S7
Hip dislocation or back strain in the lithotomy position can occur if ___.
A) Legs are not picked up at the same time
B) Arms are not positioned correctly
C) Head is not supported
D) Patient is not sedated
A) Legs are not picked up at the same time
S7
Which of the following procedures can be performed using endoscopic evaluation of the lower urinary tract? (3)
a.) Urethroscopy
b.) Cystoscopy
c.) Ureteroscopy
d.) Laparoscopy
e.) MRI
a.) Urethroscopy - through the urethra
b.) Cystoscopy - through the bladder
c.) Ureteroscopy - through the ureteral orifice
S 9
What type of scope can be used for endoscopic evaluation of the lower urinary tract?
A) Only rigid scopes
B) Only flexible scopes
C) Both flexible and rigid scopes
D) Only fiberoptic scopes
C) Both flexible and rigid scopes
S 9
What is the purpose of injecting radiopaque dye through a catheter during urological scope procedures?
A) To anesthetize the area
B) To reduce inflammation
C) To enhance visualization
D) To remove stones
C) To enhance visualization of the urinary tract
S 9
Which of the following are features of flexible or rigid scopes used in urological procedures? select 2
a.) Hooked to an irrigating system
b.) Guide wire inserted through the scope
c.) Used only for biopsies
d.) Limited to lower urinary tract procedures
a.) Hooked to an irrigating system
b.) Guide wire inserted through the scope
Catheter/instruments placed over wire
Radiopaque dye injected through catheter
S 9
Which of the following are indications for using a urethroscope/cystoscope in urological procedures to visualize the urethra/bladder d/t urinary symptoms? Select 4
a.) Painful urination
b.) Burning
c.) Hematuria
d.) Difficult urination
e.) Frequent urination without pain
a.) Painful urination
b.) Burning
c.) Hematuria
d.) Difficult urination
Kane - prostatic hypertrophy BPH
S 10
What conditions can be diagnosed using urethroscopy or cystoscopy?
A) Kidney stones
B) Urinary tract infections
C) Lesions and strictures
D) Hypertension
C) Lesions and strictures
11
Which of the following treatments can be performed during urethroscopy or cystoscopy? Select 4
a.) Dilate stricture
b.) Treat cystitis
c.) Stent placement
d.) Resect tumors
e.) Kidney biopsy
a.) Dilate stricture - stenosis
b.) Treat cystitis
c.) Stent placement -into the ureters for stones in kidney
d.) Resect tumors
11
Which of the following are true regarding ureteroscopy as a procedure of choice? Select 3
a.) It is used for mid/distal ureter stones.
b.) It can incorporate laser technology.
c.) It is effective for bilateral stones.
d.) It is the first-line treatment for kidney stones.
e.) It has a high complication rate.
a.) It is used for mid/distal ureter stones.
b.) It can incorporate laser technology.
c.) It is effective for bilateral stones.
12
What percentage of men experience ureteral stones in their lifetime?
A) 5%
B) 7%
C) 10%
D) 12%
C) 10%
5% for women
12
What imaging techniques are used to diagnose ureteral stones? Select 3
A) MRI
B) Ultrasound
C) CT
D) PET scan
E) KUB
F) IVP
C, E, F
CT, KUB, IVP
IVP - intravenous pyelogram
12
Ureteroscopy can incorporate ______ technology to treat stones in the mid/distal ureter.
laser
12
Which of the following are complications associated with ureteroscopy? Select 2
a.) Perforation
b.) Extensive bleeding
c.) High recurrence rate
d.) Severe infection
e.) Stricture formation
a.) Perforation (5%)
e.) Stricture formation (<2%)
12
What is the recurrence rate of ureteral stones after initial treatment?
A) 25%
B) 50%
C) 75%
D) 10%
B) 50%
12
What is the composition of most ureteral stones that makes them radiopaque?
A) Uric acid
B) Cystine
C) Calcium
D) Struvite
C) Calcium
If you can catch a stone and test it, if its calcium then you can probably just change your diet
12
Which of the following are components of medical expulsive therapy (MET) for urological conditions? Select 4
a.) NSAIDs
b.) Aggressive fluid administration
c.) Calcium channel blockers
d.) Alpha blockers
e.) Antibiotics
a.) NSAIDs
b.) Aggressive fluid administration
c.) Calcium channel blockers - relaxes
d.) Alpha blockers - relaxes
13
Which of the following are alternative treatments if medical expulsive therapy (MET) fails? (select 2)
a.) Surgery
b.) Antibiotics
c.) Chemotherapy
d.) Endoscopic procedures
e.) Radiation therapy
a.) Surgery
d.) Endoscopic procedures
13
What is the role of aggressive fluid administration in medical expulsive therapy (MET)?
A) To increase blood pressure
B) To reduce pain
C) To promote stone passage
D) To prevent infection
C) To promote stone passage
13
If medical expulsive therapy (MET) is unsuccessful, the next step may involve ______.
surgery 😭
13
Which procedure uses sound waves to break up kidney stones?
A) Stone basket retrieval
B) Shock Wave Lithotripsy
C) Laser
D) Percutaneous Nephrolithotomy
B) Shock Wave Lithotripsy
14
What is the purpose of using a stone basket in urological procedures?
A) To dissolve the stones
B) To physically retrieve the stones
C) To break up the stones using sound waves
D) To prevent stones from forming
B) To physically retrieve the stones - through a flexible ureteroscope, sometimes use a laser
14
may laser it first to make smaller
Which method involves accessing the kidney through the skin to remove stones?
A) Stone basket retrieval
B) Shock Wave Lithotripsy
C) Percutaneous Nephrolithotomy
D) Laser
C) Percutaneous Nephrolithotomy
This goes better/faster with experienced surgeons
14
Which of the following are characteristics of the old shock wave lithotripsy (SWL) method?
a.) Water baths
b.) Hyperthermia
c.) Painful
d.) Lower pressured pulse
e.) Water-filled coupler device
f.) Hypothermia
a.) Water baths
F.) Hypothermia
c.) Painful -pounding of shock waves - blunt force trauma
Outside in a 14wheeler truck - candy
15
What is the primary risk associated with shock wave lithotripsy (SWL)?
A) Infection
B) Bleeding
C) Sub-capsular hematoma
D) Allergic reaction
C) Sub-capsular hematoma
15
Which of the following improvements are associated with newer SWL technology? Select 2
A) Higher energy pulses
B) More tightly focused beam
C) Increased treatment time
D) Use of ultrasound guidance
E) Water-filled coupler device
B) More tightly focused beam
E) Water-filled coupler device
15
Shock wave lithotripsy (SWL) is best suited for which types of stones? (2)
a.) Small intranephric stones
b.) Medium intranephric stones
c.) Large intranephric stones
d.) Ureteral stones
e.) Bladder stones
a.) Small intranephric stones
b.) Medium intranephric stones
15
What advantage does the lower pressured pulse of newer SWL provide?
A) Higher success rate
B) Shorter procedure time
C) Decreased pain
D) Reduced equipment cost
C) Decreased pain
15
Which of the following are absolute contraindications to Shock Wave Lithotripsy (SWL)? Select 2
a.) Bleeding disorder/anticoagulation
b.) Pregnancy
c.) Large calcified aortic/renal aneurysms
d.) Untreated UTI
e.) Pacemaker
a.) Bleeding disorder/anticoagulation
b.) Pregnancy
16
Which of the following is a relative contraindication to SWL? Select 2
A) Bleeding disorder
B) Pregnancy
C) Morbid obesity
D) Recent surgery
E) Untreated UTI
C) Morbid obesity -harder to get the shockwave to the kidney
E) Untreated UTI
16
True or False
Large calcified aortic/renal aneurysms are an absolute contraindication for SWL procedures.
FALSE
They are relative contraindications
Which of the following devices or conditions are considered relative contraindications to SWL? Select 3
a.) Pacemaker
b.) ICD
c.) IUD
d.) Neuro-stimulator
e.) Anticoagulation therapy
f.) Pregnancy
a.) Pacemaker
b.) ICD
d.) Neuro-stimulator
Don’t want to disrupt the rhythm of anything
16
Which of the following are considered relative contraindications to SWL?
Select 5
a.) Bleeding disorder/anticoagulation
b.) Large calcified aortic/renal aneurysms
c.) Untreated UTI
d.) Obstruction distal to the renal calculi
e.) Pacemaker, ICD, neuro-stimulator
f.) Morbid obesity
b.) Large calcified aortic/renal aneurysms
c.) Untreated UTI
d.) Obstruction distal to the renal calculi
e.) Pacemaker, ICD, neuro-stimulator
f.) Morbid obesity
Slide 16
Which of the following are preoperative anesthesia considerations for Shock wave lithotripsy? (4)
a.) Single PIV
b.) Two PIV
c.) Consider anxiolytic
d.) Antibiotics within 1 hour of incision
e.) Check for iodine allergy
f.) Heavy narcotic use
a.) Single PIV
c.) Consider anxiolytic
d.) Appropriate antibiotics within 1 hour of “cut time”
e.) Check for iodine allergy - prevent with some antihistamines d/t them getting lots of dye
17
What should be considered intraoperatively if laser is used in SWL?
A) General anesthesia
B) Local anesthesia
C) Eye covering
D) Spinal anesthesia
C) Eye covering
Intraoperatively you want to have laser glasses or covering for the patient and everyone in the room
17
What is the preferred location for patient recovery postoperatively for an SWL?
A) Intensive Care Unit (ICU)
B) General ward
C) Post-Anesthesia Care Unit (PACU)
D) Outpatient clinic
C) Post-Anesthesia Care Unit (PACU)
17
Which of the following are intraoperative anesthesia considerations for SWL procedure? Select 4
a.) Local vs general anesthesia
b.) LMA vs ETT
c.) Minimal narcotic use
d.) Consider an emetic
e.) Lead for providers
a.) Local vs general anesthesia
b.) LMA vs ETT - normally done with LMA and GETA
c.) Minimal narcotic use - usually no pain, no incisions
e.) Lead for providers
17
What should be considered intraoperatively to reduce the risk of nausea and vomiting?
A) Increase narcotic use
B) Administer more fluids
C) Use an antiemetic
D) Use a muscle relaxant
C) Use an antiemetic
17
What is the primary use of percutaneous nephrolithotomy?
A) Small kidney stones
B) Large intranephric stones
C) Ureteral stones
D) Bladder stones
B) Large intranephric stones
Done d/t stones not able to make it out of the kindey, down the ureters
Blunt force dissection to the kidney through the retroperitoneal layers
18
Uncommon due to SWL
What is a potential complication of percutaneous nephrolithotomy?
A) Proteinuria
B) TUR syndrome
C) Hypothermia
D) Hyperkalemia
B) TUR syndrome
there can also be some blood loss
18
Percutaneous nephrolithotomy is less common due to the use of ______.
SWL (Shock Wave Lithotripsy)
18
Why are ureteral stents placed initially in percutaneous nephrolithotomy?
a.) Prevent obstruction
b.) Enhance imaging
c.) Reduce pain
d.) Increase stone fragmentation
a.) Prevent obstruction as fragments pass
18
What are the intraoperative anesthesia implications for a cystectomy? Select all that apply (5)
a) Lithotomy
b) Supine
c) GETA
d) LMA
e) SAB
f) Epidural
g) SCIP
b) supine
c) GETA
e) SAB - not commonly done
f) epidural - not commonly done
g) SCIP
Slide 25
At a serum sodium level of 115 meq/L, TUR Syndrome may cause ECG changes such as ________ ST segments and ________ QRS.
- Elevated
- Widened
30
Which type of nephrectomy is performed for irreversible non-malignant disease (autoimmune), trauma, congenital disease (PKD)?
a) Radical nephrectomy
b) Simple nephrectomy
c) Donor nephrectomy
d) Partial nephrectomy
b) Simple nephrectomy
Slide 38
Which type of nephrectomy includes the removal of adrenal glands?
a) Simple nephrectomy
b) Radical nephrectomy
c) Donor nephrectomy
b) Radical nephrectomy
Renal cell carcinoma
Slide 38
Types of nephrectomy include simple, radical, and __________.
Donor
Slide 38
Indications: Renal transplant, trauma, polycystic kidney disease pain, cancer
What positioning is depicted in the provided slides for a nephrectomy?
a.) Supine
b.) Prone
c.) Lateral
d.) Lithotomy
c.) Lateral
Slide 39
True or False
Vena Cava Tumor Thrombus Exist
True
Slide 42 -Renal cell carcinoma common to have big thrombus and it can go up vena cava
Which of the following are goals for donor management?
CVP 4-10 (6-8 for lungs)
MAP 60-120mmHg
PaO2 >300 on 5cm PEEP/100% O2
PaCO2 35-45 mmHg
ABG: pH 7.3-7.45
UO >1ml/kg/hr
Sodium 135-160
Glucose < 150
Ejection fraction > 50%
Hemoglobin > 9
Pressors 1 and low dose
Slide 47
