Nephrolithiasis

Question 1

Stones Presentation

Answer 1

Barely noticeable to severe pain.
Hematuria (gross or micro)
N/V
Dysuria and urgency

Question 2

Most likely stone location

Answer 2

Ureter at abdominal crease

ureterovesicular junction

Question 3

Imaging for stones

Answer 3

Helical CT (gold standard)
U/S (Gold in pregnancy)
KUB
IVP

Question 4

Whats the most common stone composition?

Answer 4

Calcium oxalate

Question 5

Stone size <5 mm

Answer 5

90% pass spontaneously

Question 6

Stone size 5 - 10 mm

Answer 6

Alpha and beta blockers increase chance of passage

Question 7

Stone size > 10 mm

Answer 7

<10 % chance of passage

Question 8

Acute stone tx

Answer 8

Increase fluid intake
2L urine output/day
Pain control
Strain urine for stone retrieval and analysis

Question 9

What is the relapse rate of stones?

Answer 9

50% in the first 5-10 years.

Question 10

Tx for calcium oxalate stones

Answer 10

Hypercalcemia:
** Thiazide diuretics
** Decrease sodium intake
Hyperoxaluria:
Decrease intake
Hypocitrauria:
Potassium citrate

Question 11

Uric acid stone tx

Answer 11

Allopurinol for hyperuricemia

Potassium citrate to raise pH

Question 12

Struvite stones

Answer 12

Recurrent UTI with urea-splitting organisms
Proteus and Ureaplasma
Staghorn Calculus

Question 13

Medications the promote stone formation

Answer 13

Loop diuretics
Antacids
Glucocorticoids
Theophylline
VItamin D and C

Question 14

Drugs that precipitate into stones

Answer 14

Acyclovir
Indanavir
Triamterene

Question 15

When to refer

Answer 15

Stone >5 mm

Failure to pass stone after conservative mgmt

Question 16

Shock wave lithotripsy

Answer 16

Shock wave breaks up stones from the outside allowing them to pass.

Question 17

Percutaneous Nephrolithotomy

Answer 17

Stones sucked out with a cath

Question 18

Should analgesia be given before or after lab work?

Answer 18

After (in fake life)

In real life, hook a brutha up.