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
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
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
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
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
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
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
squamous cell carcinoma
Which penile operation is performed to correct phimosis?
A) Circumcision
B) Hypospadias repair
C) Penectomy
D) Penile prosthesis
A) Circumcision
21
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.
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
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
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
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
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
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
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
Slide 24
Intraoperative anesthesia management for cystectomy should include a ____ due to the potential for significant blood loss.
Type and crossmatch
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
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
***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
+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
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
TUR can be seen in TURP and percutaneous nephrolithotomy case
33
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
Slide 34
For symptoms of mild TUR Syndrome, when Na+ is greater than 120, treatment includes ________ and ________.
fluid restriction
loop diuretics
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
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
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
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
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
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
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
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
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
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
Slide 41
The central line should be considered ___ to the surgical site for a nephrectomy.
ipsilateral (same side)
also consider arterial line for nephrectomy
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 ;)
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
Slide 41
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
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
Slide 43
The transplanted ureter is connected to the __________
Bladder
Slide 43
Living donor nephrectomies make up __________ of all renal nephrectomies
1/3
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
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
Slide 44
True or False
Nephrectomy for a living donor typically starts a couple of hours prior to the recipient surgery.
True
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
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.
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
Slide 45
What 2 diuretics are used to maintain a urine output of 2 ml/kg/hr in living donors?
- Furosemide
- Mannitol
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
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
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
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
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
Slide 46
DBD Physiologic Alterations
Neurogenic pulmonary edema and SIRS are an example of ___ instability.
Pulmonary
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
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
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
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
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)
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!
Slide 47
True or False
Glucose containing solutions are acceptable for use in cadaver donors.
False!
Avoid glucose containing solutions
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
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
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
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
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
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+)
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)
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%
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
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)
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
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
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
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!
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
Slide 51
Which medication is used to manage inflammation during kidney transplantation?
A) Antibiotics
B) Steroids
C) Diuretics
D) Anticoagulants
B) Steroids
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
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
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)
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
Slide 51
Kidney transplant
The infusion of rabbit-derived antibodies against human T cells to prevent/treat acute rejection is known as ___.
Anti-thymocyte
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
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
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
Slide 52
