GU surgery (Kane) Exam 3 Flashcards by Kimberly Diane Hill

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.

How well did you know this?

Not at all

Perfectly

Normal GFR is ___ mL/min.

A) 50
B) 75
C) 100
D) 125

D) 125

How well did you know this?

Not at all

Perfectly

At what point do symptoms usually become apparent in relation to GFR drop?

A) 10%
B) 25%
C) 50%
D) 75%

C) 50%

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

At what percentage of normal GFR does BUN typically elevate in kidney disease?

A) 25%
B) 50%
C) 75%
D) 90%

C) 75%

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

can be falsey elevated with dehydration

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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” *

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Many antibiotics and drugs like ___ are of concern in patients with renal insufficiency.

A) Digoxin
B) Propofol
C) Zofran
D) Diltiazem

A) Digoxin

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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.

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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 ## Footnote 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 ## Footnote 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 ## Footnote 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 ## Footnote 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

Which imaging technique is used extensively during percutaneous nephrolithotomy? A) Ultrasound B) MRI C) PET D) Fluoroscopy

D) Fluoroscopy | 18

# True of False In Percutaneous Nephrolithotripsy cases the patient is positioned in lateral decubitus.

True ## Footnote Slide 18

Percutaneous Nephrolithotomy Which of the following are intraoperative anesthesia considerations for patients undergoing surgery? (5) a.) General ETT b.) Short NMBD's c.) Lateral position d.) Lead apron for provider e.) Eye protection if laser used f.) Single PIV g.) Consider anxiolytic

a.) General ETT b.) Short NMBD's c.) Lateral position d.) Lead apron for provider e.) Eye protection if laser used | 19 ## Footnote Preop - single IV,anxiolytic,antibiotics within 1 hr cut time

# 19 Percutaneous Nephrolithotomy Which position is used intraoperatively for patients undergoing surgery? A) Supine B) Lateral C) Prone D) Trendelenburg

B) Lateral | 19

Percutaneous Nephrolithotomy: Intraoperatively, ______ NMBD's are used to facilitate muscle relaxation.

Short-acting | 19 ## Footnote vec/roc

Which of the following statements are true about scrotal operations? Select 4 a.) Orchiectomy is almost always bilateral. b.) Orchiectomy involves clamping, cutting, and suturing the spermatic cord. c.) Hydrocelectomy involves excising the wall of the hydrocele and suturing the edges. d.) Testicular torsion surgery must be performed within 6 hours to prevent irreversible ischemic damage. e.) Orchiectomy is used primarily for testicular cancer. f.) Hydrocelectomy is used to treat prostate cancer.

a.) Orchiectomy is almost always bilateral. b.) Orchiectomy involves clamping, cutting, and suturing the spermatic cord. c.) Hydrocelectomy involves excising the wall of the hydrocele and suturing the edges. d.) Testicular torsion surgery must be performed within 6 hours to prevent irreversible ischemic damage. | 20

Which of the following are true about the conditions that require scrotal operations? (3) a.) Metastatic prostate cancer can be an indication for orchiectomy. b.) Testicular torsion requires urgent surgical intervention. c.) Hydrocele does not require surgical intervention. d.) Orchiectomy is a common treatment for metastatic prostate cancer

a.) Metastatic prostate cancer can be an indication for orchiectomy. b.) Testicular torsion requires urgent surgical intervention. d.) Orchiectomy is a common treatment for metastatic prostate cancer | 20 ## Footnote Older men have higher risk of penile/prostate cancer if have foreskin

What is the primary purpose of an orchiectomy in patients with metastatic prostate cancer? A) To remove the hydrocele B) To treat testicular torsion C) To remove sources of testosterone which can fuel prostate cancer D) To remove a tumor from the testes

C) To remove sources of testosterone which can fuel prostate cancer | 20

Which procedure involves excising the wall of the hydrocele and suturing the edges to prevent recurrence? A) Orchiectomy B) Hydrocelectomy C) Testicular torsion surgery D) Vasectomy

B) Hydrocelectomy | 20

Within how many hours must surgery for testicular torsion be performed to prevent irreversible ischemic damage? A) 2 hours B) 6 hours C) 12 hours D) 24 hours

B) 6 hours | 20

Which of the following steps are involved in an orchiectomy? Select 3 a.) Clamping the spermatic cord b.) Cutting the spermatic cord c.) Suturing the spermatic cord d.) Removing the prostate gland e.) Treating hydrocele

a.) Clamping the spermatic cord b.) Cutting the spermatic cord c.) Suturing the spermatic cord | 20

Which of the following are indications for penile operations? select 5 a.) Phimosis b.) Penile/prostate cancer risk c.) Squamous cell carcinoma d.)Hydrocele e.) Diabetes f.) Spinal cord injury

a.) Phimosis b.) Penile/prostate cancer risk c.) Squamous cell carcinoma e.) Diabetes f.) Spinal cord injury | 21

Which conditions might necessitate a penile prosthesis? select2 a.) Diabetes b.) Spinal cord injury c.) Phimosis d.) Squamous cell carcinoma

a.) Diabetes - can cause impotence b.) Spinal cord injury | ***Prosthesis can get infected easily! Remember SCIP ## Footnote Blocks can also be used to perform this, mostly quick procedure

Which penile operation might include an inguinal lymph node biopsy? A) Circumcision B) Hypospadias repair C) Penectomy D) Penile prosthesis

C) Penectomy | S21 ## Footnote squamous cell carcinoma

Which penile operation is performed to correct phimosis? A) Circumcision B) Hypospadias repair C) Penectomy D) Penile prosthesis

A) Circumcision | 21 ## Footnote Phimosis - cannot retract foreskin, constrics tip of penis and can become ischemic

Hypospadias repair is indicated for: A) Diabetes B) Abnormal placement of the urethral opening C) Spinal cord injury D) Squamous cell carcinoma

B) Abnormal placement of the urethral opening | 21

______ is a surgical procedure that may include inguinal lymph node biopsy and is performed for squamous cell carcinoma.

Penectomy | 21

______ is a condition where the foreskin cannot be retracted over the glans penis and is often treated by circumcision.

Phimosis | 21

A ______ is often implanted in patients with erectile dysfunction due to diabetes or spinal cord injury.

penile prosthesis | 21

Which conditions can be treated by circumcision? (2) a.) Phimosis b.) Penile/prostate cancer risk c.) Hypospadias d.) Testicular torsion

a.) Phimosis b.) Penile/prostate cancer risk | 21

T/F For anesthesia implication for penile procedures, LMA is usually sufficent.

True General anesthesia is typically used - ETT or LMA are acceptable but LMAs are usually sufficent. ## Footnote Slide 22

Which position is commonly used for scrotal and penile operations? a) Prone b) Supine c) Lateral d) Lithotomy

b) Supine | 22

Which nerve is targeted in a penile block during penile surgery? A) Sciatic nerve B) Femoral nerve C) Pudendal nerve (S2-S4) D) Tibial nerve

C) Pudendal nerve (S2-S4) | 22

What are potential concerns during the manipulation of genitals during penile surgery? (2) a.) Vagal response b.) Bradycardia c.) Tachycardia d.) Hypertension

a.) Vagal response b.) Bradycardia *Have glycopyrrolate (Robinul) ready - slower onset but not as extreme tachy as atropine* ## Footnote 22

Which condition is a radical cystectomy primarily indicated for? a) Hemorrhagic cystitis b) Radiation cystitis c) Invasive bladder cancer d) Benign prostatic hyperplasia (BPH)

c) Invasive bladder cancer ## Footnote Slide 24

Which of the following are indications for a cystectomy? a.) Hemorrhagic cystitis b.) Radiation cystitis c.) Invasive bladder cancer d.) invasive badder cancer Including ureters, prostate/uterus, ovaries e.) all of the above

all the above * a.) Hemorrhagic cystitis * b.) Radiation cystitis * c.) Invasive bladder cancer * d.) Includes ureters, prostate/uterus, ovaries ## Footnote Slide 24

Which of the following are preoperative anesthesia considerations for cystectomy? Select 3 a.) Risk factors for CAD or pulmonary disease b.) Anticoagulant use? EKG c.) Bowel prep likely d.) General ETT e.) Supine position

a.) Risk factors for CAD or pulmonary disease b.) Anticoagulant use? EKG c.) Bowel prep likely Technically d,e also applies but they are intraop ## Footnote Slide 25

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 ## Footnote Slide 25

What is a common complication during a cystectomy procedure? a) Low blood loss b) Hyperthermia c) Third space losses d) Hypotension

c) Third space losses | 25 ## Footnote Use colloids to help bring fluids in intravascularly - albumin

Which complications are commonly associated with cystectomy? (3) a.) Blood loss up to 3 liters b.) Third space losses c.) Hypothermia d.) Hyperthermia

a.) Blood loss up to 3 liters - obtain type and cross, 1-2PIV b.) Third space losses c.) Hypothermia | 25

What type of conduit or substitution is required for a cystectomy? a.) Jejunal conduit b.) Ileal conduit c.) Colonic substitution d.) Gastric substitution

b.) Ileal conduit | 24

For a radical cystectomy, it may include removal of the ureters, prostate/uterus, and ____.

ovaries ## Footnote Slide 24

Intraoperative anesthesia management for cystectomy should include a ____ due to the potential for significant blood loss.

Type and crossmatch ## Footnote Slide 25

What is a common age range for patients undergoing TURP (Transurethral Resection of Prostate)? a.) 20-30 years b.) 30-40 years c.) 50-60 years d.) 70-80 years

c.) 50-60 years | 27

The TURP procedure is the "________" standard for BPH (Benign Prostatic Hyperplasia).

gold *Uses electrocautery or laser | 27 ## Footnote Follows failure of medical therapy and recurrent symptoms

Men over 80 years old have a greater than ________% chance of being affected by BPH.

90 Also prevelant in people in 50-60s with obesity,HTN, CAD,family history, CRI | 28

Intraoperative complications during a TURP procedure might include: (2) a.) TUR syndrome b.) Possible transfusion c.) Ureteral injury d.) Nerve damage

a.) TUR syndrome b.) Possible transfusion - blood loss usually 100-200 cc | 29

What anesthesia considerations should be made preoperatively for TURP? (2) a.) No comorbidities check b.) Large bore IV c.) Check for anticoagulant use d.) No specific preparations

b.) Large bore IV c.) Check for anticoagulant use | 29 - check for comorbidities, anything that needs to be optimized?

During a TURP procedure, which type of anesthesia might be used? (2) a.) Local anesthesia b.) General anesthesia c.) Spinal anesthesia d.) Epidural anesthesia

b.) General anesthesia c.) Spinal anesthesia | 29 - Book says SAB gold standard but in practice most use general ## Footnote ***Place in lithomy for general surgery

Which symptoms are related to TUR Syndrome? (3) a.) Hypervolemic water intoxication b.) Excessive volume expansion through venous sinuses c.) Hyponatremia d.) Hypernatremia

a.) Hypervolemic water intoxication b.) Excessive volume expansion through venous sinuses c.) Hyponatremia | 30

Which CNS changes can occur at a serum sodium level of 115 meq/L during TUR Syndrome? (2) a.) Somnolence b.) Nausea c.) Seizures d.) Confusion

a.) Somnolence b.) Nausea | 30

What ECG changes might you expect to see at a serum sodium level of 120 meq/L? a.) Elevated ST segments b.) Widening of QRS c.) Vtach or Vfib Fd.) lattened T waves

b.) Widening of QRS | 30

Which of the following is a symptom of TUR Syndrome at a serum sodium level of 110 meq/L? a.) Confusion b.) Restlessness c.) Nausea d.) Seizures

d.) Seizures | 30 ## Footnote +coma

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 of the following are types of irrigants used during TURP? (4) a.) Saline b.) Glycine c.) Water d.) Sorbitol e.) Dextrose

a,b,c,d a.) Saline - can cause volume overload,Current dispersion with monopolar cautery --> can cause internal burns b.) Glycine - Metabolized in liver to ammonia , caution liver dz c.) Water - Intravascular hemolysis d.) Sorbitol - Metabolized to CO2 and fructose, volume overload. Don't give to diabetes, some data shows can also cause seizure | 31

The absorption rate of irrigating fluid that can lead to TUR Syndrome is: a.) 5 ml/min to 100 ml/min b.) 10 ml/min to 150 ml/min c.) 20 ml/min to 200 ml/min d.) 300 ml/min to 400 ml/min

c.) 20 ml/min to 200 ml/min **>2L of absorption usually required for TUR syndrome Ex: absorbing 100 ml/min → in 20 min absorb 2L 🙁 | 31-34 ## Footnote IRRIGATION rates can be at highest 300 ml/min

# TUR Preventive measures for TUR Syndrome include: (3) a.) Limiting resection time to 1 hour b.) Suspending the irrigating fluid less than 30 cm above the table c.) Administering large volumes of intravenous fluids d.) Treating hypotension from SAB with vasopressors

a.) Limiting resection time to 1 hour b.) Suspending the irrigating fluid less than 30 cm above the table d.) Treating hypotension from SAB with vasopressors - NOT IVF | 33

To prevent TUR Syndrome, it is recommended to limit resection time to ________.

1 hour | 33 TUR can be seen in TURP and percutaneous nephrolithotomy case

Treatment of TUR syndrome includes which of the following? (3) a)ABCs b)Terminate procedure as soon as possible c)Continue procedure but treat hyponatermia d)Consider invasive lines for cardiac instability

A,B,D ## Footnote Slide 34

For symptoms of mild TUR Syndrome, when Na⁺ is greater than 120, treatment includes ________ and ________.

fluid restriction loop diuretics ## Footnote Slide 34

For severe symptoms of TUR Syndrome with Na less than 120, the treatment is: a.) Oral saline b.) Loop diuretics c.) 3% saline d.) Fluid restriction

c.) 3% IV saline ## Footnote Slide 34

During a robotic prostatectomy, what is the purpose of using phenylephrine drips? a.) To increase sedation b.) To manage blood pressure c.) To reduce blood clotting d.) To enhance muscle relaxation

b.) To manage blood pressure | 35 ## Footnote make sure to get an Art-line

Why is it important to limit IV fluids during a robotic prostatectomy? a.) To prevent infection b.) To reduce the risk of fluid overload c.) To enhance the effect of anesthesia d.) To improve surgical precision

b.) To reduce the risk of fluid overload | 35 ## Footnote less than 500 ml

During a robotic prostatectomy, an ________ is used to continuously monitor blood pressure.

arterial line | 35

Which of the following is a common postoperative complication of a nephrectomy? a) Hypertension b) Pneumonia c) Hemorrhage d) Urinary tract infection (UTI)

c) Hemorrhage ## Footnote Slide 37

During a nephrectomy, post-operative complications can include which of the following? a. mortality (death) b. peritonitis c. acute renal failure d. hernia e. visceral injury f. hemorrhage g. pneumothorax h. all of the above

h. all of the above Up to 20% have post op complications ## Footnote Slide 37

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 ## Footnote 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 ## Footnote Slide 38

Types of nephrectomy include simple, radical, and __________.

Donor ## Footnote 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 ## Footnote Slide 39

Which of the following are commonly associated with Anesthetic Implications for a nephrectomy? Select 3 a.) CAD b.) CRI/ESRD c.) HTN d.) Anxiolytics e.) SCIP

a.) CAD b.) CRI/ESRD c.) HTN ## Footnote Slide 40

Which of the following are preoperative considerations for a nephrectomy? a.) Anxiolytics b.) SCIP c.) Type/screen or type/cross d.) 2 large bore IV's e.) Arterial line f.) all of the above

a.) Anxiolytics b.) SCIP c.) Type/screen or type/cross d.) 2 large bore IV's e.) Arterial line **All of the above** ## Footnote Slide 40 and 41

Which type of anesthesia is suggested in the slides for a nephrectomy? a.) Local b.) Regional c.) GETA d.) Monitored Anesthesia Care (MAC)

c.) GETA ## Footnote Slide 41

The central line should be considered ___ to the surgical site for a nephrectomy.

ipsilateral (same side) *also consider arterial line for nephrectomy* ## Footnote Slide 41

# True or False Regional anesthesia can be used in conjunction with general anesthesia for enhanced postoperative pain control after nephrectomy.

True *Consider regional anesthesia for postoperative pain* | block or epidural appreciated ;) ## Footnote Slide 41

For nephrectomy procedures, it is important to have available: a) colloid b) blood c) rapid transfusion set up d) Mannitol e) Furosemide.

all of of the above | Lots of blood loss! have type and cross and blood warmer ready ## Footnote Slide 41

# True or False Vena Cava Tumor Thrombus Exist

True ## Footnote Slide 42 -Renal cell carcinoma common to have big thrombus and it can go up vena cava

The transplanted kidney is connected to which blood vessels? Select 2. a.) Aorta b.) Iliac Vein c.) Iliac Artery d.) Renal Artery

b.) Iliac Vein c.) Iliac Artery ## Footnote Slide 43

The transplanted ureter is connected to the __________

Bladder ## Footnote Slide 43

Living donor nephrectomies make up __________ of all renal nephrectomies

1/3 ## Footnote Slide 44

What are the benefits of living donor nephrectomies? (Select 3) a.) Decreased surgical risk for the recipient b.) No physiologic alterations from DBD ((donor after brain death) or DCD (donor after cardiac death) c.) Waiting times avoided d.) Decreases ischemic time e.) Higher chance of rejection

b.) No physiologic alterations from DBD or DCD *Healthy; Two kidneys* c.) Waiting times avoided - if matching family member d.) Decreases ischemic time ## Footnote Slide 44

Which conditions must a living donor be free from? (Select 4) a.) Diabetes b.) HIV c.) Liver disease d.) Cancer e.) Hypertension f.) Hyperlipidemia

a.) Diabetes b.) HIV c.) Liver disease d.) Cancer ## Footnote Slide 44

# True or False Nephrectomy for a living donor typically starts a couple of hours prior to the recipient surgery.

True ## Footnote Slide 45

Which side kidney is preferred for living donor nephrectomy? A) Right kidney B) Left kidney C) Either side D) Both sides equally preferred

B) Left kidney *simple nephrectomy (anesthesia-wise) | Take the L one bc longer artery and vein ## Footnote Slide 45

What is the recommended rate for aggressive isotonic hydration during nephrectomy for a living donor? a.) 5-10 ml/kg/hr b.) 10-20 ml/kg/hr c.) 20-30 ml/kg/hr d.) 30-40 ml/kg/hr

b.) 10-20 ml/kg/hr *rationale:Aggressive isotonic hydration is important to ensure adequate perfusion and function of the remaining kidney, prevent dehydration, and support overall hemodynamic stability during and after the nephrectomy.* ## Footnote Slide 45

What is the purpose of using Protamine in living donor nephrectomies? A) To induce anticoagulation B) To reverse anticoagulation C) To enhance diuresis D) To maintain blood pressure

B) To reverse anticoagulation *pt. given low-level anticoagulation so the kidney doesn't clot when it is taken out* -5000 Units of heparin ## Footnote Slide 45

What **2** diuretics are used to maintain a urine output of 2 ml/kg/hr in living donors?

* Furosemide * Mannitol ## Footnote Slide 45

Which of the following are physiologic alterations seen in DBD (donation after brain death)? a.) Neurologic instability b.) Cardiac instability c.) Pulmonary instability d.) Metabolic instability e.) All

E.) ALL a.) Neurologic instability b.) Cardiac instability c.) Pulmonary instability d.) Metabolic instability ## Footnote Slide 46

Which of the following are signs of neurologic instability in DBD? (3) a.) Cushing’s sign b.) Bradycardia c.) Tachycardia d.) Hypertension

a.) Cushing’s sign b.) Bradycardia d.) Hypertension also wide pulse pressure | ++Catastrophic ICP elevation ## Footnote Slide 46

Catastrophic ICP elevation in DBD is a sign of: a.) Cardiac instability b.) Neurologic instability c.) Pulmonary instability d.) Metabolic instability

b.) Neurologic instability ## Footnote Slide 46

What is a common cardiac complication in DBD physiologic alterations? A) Congestive heart failure B) Acute myocardial infarction C) Atrial fibrillation D) Ventricular tachycardia

B) Acute myocardial infarction ## Footnote Slide 46

What causes cardiac instability in DBD? (2) A) Congestive heart failure B) Massive release of catecholamines C) Cardiovascular collapse D) Hyperkalemia

B) Massive release of catecholamines C) Cardiovascular collapse ## Footnote Slide 46

DBD Physiologic Alterations Neurogenic pulmonary edema and SIRS are an example of ___ instability.

Pulmonary ## Footnote Slide 46

Which systems are affected by metabolic instability in DBD physiologic alterations? A) Cardiovascular and renal systems B) Gastrointestinal and hepatic systems C) Hypothalamus and pituitary systems D) Musculoskeletal and integumentary systems

C) Hypothalamus and pituitary systems *causes: Thermoregulation, hormones, insulin, electrolytes, DIC* ## Footnote Slide 46

What is the primary goal of anesthesia management in cadaver donors? A) Provide deep sedation B) Maintain stabilization until organ retrieval C) Manage postoperative pain D) Ensure complete unconsciousness

B) Maintain stabilization until organ retrieval | don’t need anesthethic for procedure but to control physiologic changes until organ retrieval ## Footnote Slide 47

Which of the following are a short-acting medications can be used to manage hemodynamics in cadaver donors? Select 3 A) Labetalol B) Cardene (Nicardipine) C) Esmolol D) Diltiazem E) Volatiles

B) Cardene (Nicardipine) C) Esmolol E) Volatiles ## Footnote Slide 47

The pressor choice for hemodynamics in cadaver donors includes: (2) a.) Epinephrine b.) Norepi c.) Isuprel d.) Vasopressin

b.) Norepi d.) Vasopressin also Dopamine and Dobutamine ## Footnote Slide 47

Which medication is mentioned for use in cadaver donors to manage significant bradycardia that is not responsive to anticholinergics? A) Dobutamine B) Phenylephrine C) Dopamine D) Isoproterenol (Isuprel)

D) Isoproterenol (Isuprel) ## Footnote Slide 47

Which of the following are part of fluid resuscitation for cadaver donors? Select 2 a.) Crystalloids b.) PRBC’s c.) Albumin d.) D5

a.) Crystalloids b.) PRBC’s *Avoid glucose containing solutions!* ## Footnote Slide 47

# True or False Glucose containing solutions are acceptable for use in cadaver donors.

False! **Avoid** glucose containing solutions ## Footnote Slide 47

What is the recommended settings for lung protective ventilation in cadaver donors? (2) A) 4-6 ml/kg of ideal body weight B) 6-8 ml/kg of ideal body weight C) 8-10 ml/kg of ideal body weight D) 3-5 cm H2O E) 5-10 cm H2O F) 10-15 cm H2O

B) 6-8 ml/kg of ideal body weight E) 5-10 cm H2O ## Footnote Slide 47

What is the primary reason for administering steroids to cadaver donors? A) To reduce pain B) To improve organ perfusion C) To attenuate the immune response in the recipient D) To enhance hemodynamic stability

C) To attenuate the immune response in the recipient ## Footnote Slide 47

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 ## Footnote Slide 47

What is the ischemic time for a kidney during transplantation? A) 12-24 hours B) 24-48 hours C) 48-72 hours D) 72-96 hours

C) 48-72 hours ## Footnote Slide 49

Kidney Transplant Which of the following occurs during ischemia of the kidney? A) Lack oxygen supply B) Depletion of ATP/glycogen C) Failure Na/K pump function D) Increased intracellular sodium

All of the above ## Footnote Slide 49

Kidney Recipient What is an important parameter to check during the last dialysis session before kidney transplant surgery? A) Sodium B) Potassium (K+) C) Calcium D) Magnesium

B) Potassium (K+) ## Footnote Slide 50

Kidney recipient What test is suggested to check for diabetes in preoperative evaluation of kidney transplant? A) Hemoglobin A1c B) Fasting blood glucose C) Random blood sugar (RBS) D) Oral glucose tolerance test

C) Random blood sugar (RBS) ## Footnote Slide 50

What percentage of patients have coronary artery disease (CAD) and hypertension (HTN) needing kidney transplant? A) 20% B) 30% C) 40% D) 50%

C) 40% ## Footnote Slide 50

What cardiovascular evaluations might be necessary for patients with CAD and HTN before kidney transplant? Select 2. A) Chest X-ray B) EKG C) Heart catheterization C) Stress test D) Echocardiogram

B) EKG and C) possibly heart catheterization ## Footnote Slide 50

Kidney recipient In which condition might a nephrectomy be performed concurrently with a kidney transplantation? A) Acute kidney injury B) Polycystic Kidney Disease (PCKD) C) Chronic urinary tract infections D) Renal artery stenosis

B) Polycystic Kidney Disease (PCKD) ## Footnote Slide 50

Which of the following is a preferred anesthetic agent if potassium levels are appropriate during kidney transplantation? A) Propofol B) Anectine C) Cisatracurium D) Fentanyl

B) Anectine (Succinylcholine) | Use GETA ## Footnote Slide 51

Intraoperatively - Kidney Transplant Which muscle relaxant should be considered as an alternative during the intraoperative period? A) Vecuronium B) Rocuronium C) Cisatracurium D) Pancuronium

C) Cisatracurium ## Footnote Slide 51

Intraoperatively - Kidney Transplant What patient position is recommended during the procedure? A) Prone B) Supine C) Lateral D) Trendelenburg

B) Supine **watch IV access!** | Laprotomy Incision will be made ## Footnote Slide 51

Kidney Transplant -Intraop What line should be placed with strict sterile technique during the procedure? (2) A) Peripheral IV line B) CVP (Central Venous Pressure) line C) Pulmonary artery catheter D) Arterial line

B) CVP (Central Venous Pressure) line D) Arterial line | Transplanted ppl are already immunocompromised! ## Footnote Slide 51

What is the correct order of anastomosis during a kidney transplantation? A) Artery, vein, ureter B) Vein, ureter, artery C) Artery, ureter, vein D) Vein, artery, ureter

D) Vein, artery, ureter *1. Vein – for blood to go out of kidney 2. Artery – blood going in the kidney and keep going but have nothing for it to drain to 3. Ureter – can’t carry pee until artery puts blood in the kidney* ## Footnote Slide 51

Which medication is used to manage inflammation during kidney transplantation? A) Antibiotics B) Steroids C) Diuretics D) Anticoagulants

B) Steroids ## Footnote Slide 51

Which medications are used to promote diuresis during kidney transplantation? (3) A) Spironolactone B) Furosemide (Lasix) C) Mannitol D) Acetazolamide E) Bumex

B) Furosemide (Lasix) C) Mannitol E) Bumex ## Footnote Slide 51

Which medication is used to maintain colloid osmotic pressure during kidney transplantation? A) Albumin B) Saline C) Dextrose D) Ringer’s lactate

A) Albumin ## Footnote Slide 51

What is the immediate step after the patient is extubated on the operating table following a kidney transplant? A) Transfer to the recovery room B) Transfer to the Intensive Care Unit (ICU) C) Transfer to the general ward D) Discharge home

B) Transfer to the Intensive Care Unit (ICU) ## Footnote Slide 51

When is a kidney transplant patient typically discharged from the ICU? A) On the same day of surgery B) The next day after surgery C) 3 days after surgery D) 1 week after surgery

B) The next day after surgery ## Footnote Slide 51

Kidney transplant The infusion of rabbit-derived antibodies against human T cells to prevent/treat acute rejection is known as ___.

Anti-thymocyte ## Footnote Slide 52

Kidney Transplant Which condition is commonly associated with the infusion of anti-thymocyte therapy? A) Hypertension B) Cytokine release syndrome C) Hypoglycemia D) Arrhythmias

B) Cytokine release syndrome ## Footnote Slide 52

# True or False Cytokine release syndrome is characterized by high-grade fevers (over 39), chills, and possibly rigors

True *Kane: treat the symptoms, not the syndrome* ## Footnote Slide 52

Kidney Transplant Cytokine release syndrome can be treated with: (3) A) Antibiotics B) Diphenhydramine C) Steroids D) Acetaminophen C) Aspirin D) Naproxen

B) Diphenhydramine 25-50 mg C) Steroids (normally Methylprednisolone) D) Acetaminophen 650 mg ## Footnote Slide 52