Pediatric Stones Flashcards
Clinical Vignette: A 10-year-old child presents with colicky pain in the abdomen. Upon imaging, a 7 mm ureteral stone is found. The parents are anxious and ask for treatment options.
Multiple-Choice Options:
A. Offer immediate surgical intervention.
B. Offer observation with or without medical expulsive therapy using α-blockers.
C. Proceed with percutaneous nephrolithotomy (PCNL) right away.
D. Order a CT scan.
Correct Answer: B
Explanation: According to the 2016 American Urological Association and Endourological Society Recommendations, in pediatric patients with uncomplicated ureteral stones less than 10 mm, observation with or without medical expulsive therapy using α-blockers should be offered. This offers a moderate net benefit and is supported by moderate certainty evidence.
Memory Tool: Think of “Small Stone, Small Steps” for ureteral stones less than 10 mm to remember observation or medical therapy.
Reference Citation: Table 43.3, Recommendation 1
Rationale: This information is vital for informing treatment decisions for pediatric patients with small ureteral stones. It sets a standard for when more invasive treatments should be considered.
Clinical Vignette: A 14-year-old boy is scheduled for PCNL to treat a renal stone. What imaging test should be performed before the procedure?
Multiple-Choice Options:
A. High-dose CT scan
B. Ultrasound
C. Low-dose CT scan
D. MRI
Correct Answer: C
Explanation: According to the guidelines, clinicians should obtain a low-dose CT scan on pediatric patients before performing PCNL. This is to ensure optimal treatment and is supported by low certainty evidence.
Memory Tool: Think “Low Dose, Less Risk” to remember a low-dose CT scan before PCNL.
Reference Citation: Table 43.3, Recommendation 3
Rationale: This question tests knowledge on preoperative imaging guidelines specific to pediatric patients, essential for minimizing radiation exposure.
Clinical Vignette: You’re planning to perform a ureteroscopy (URS) for a 9-year-old with a 15 mm ureteral stone. Should a stent be placed prior to the URS?
Multiple-Choice Options:
A. Yes, always
B. No, not routinely
C. Only if the stone is larger than 20 mm
D. Only if the patient has anatomical abnormalities
Correct Answer: B
Explanation: The guidelines recommend not routinely placing a stent before URS in pediatric patients. This is a panel consensus based on members’ clinical training, experience, knowledge, and judgment for which there is no evidence.
Memory Tool: Think “URS, No Strings Attached” to remember that stents are not routinely placed.
Reference Citation: Table 43.3, Recommendation 4
Rationale: Stent placement can cause additional discomfort and complications, and it’s critical to know when it’s not routinely recommended.
Clinical Vignette: A 12-year-old girl has been under observation for a ureteral stone. However, she shows no signs of passing the stone. What treatment options should you consider?
Multiple-Choice Options:
A. Continue with observation and medical expulsive therapy (MET) indefinitely.
B. Ureteroscopy (URS) or shock wave lithotripsy (SWL).
C. Open/laparoscopic/robotic surgery.
D. Active surveillance with periodic ultrasonography.
Correct Answer: B
Explanation: For pediatric patients with ureteral stones who are unlikely to pass the stones or who have failed observation and/or MET, URS or SWL should be offered. This is strongly recommended with moderate certainty.
Memory Tool: Think “Plan B, Go Big” for cases that fail observation and MET, indicating the need for URS or SWL.
Reference Citation: Table 43.3, Recommendation 2
Rationale: Knowing the next step after failed observation/MET is crucial in patient management to prevent complications like obstruction and infection.
Clinical Vignette: You are treating a 13-year-old boy with a total renal stone burden of 18 mm. What would be your first-line therapy for this patient?
Multiple-Choice Options:
A. Open/laparoscopic/robotic surgery.
B. Shock wave lithotripsy (SWL) or ureteroscopy (URS).
C. Percutaneous nephrolithotomy (PCNL).
D. Active surveillance with periodic ultrasonography.
Correct Answer: B
Explanation: For pediatric patients with a total renal stone burden ≤ 20 mm, SWL or URS can be offered as first-line therapy. This comes with moderate net benefits and is supported by low certainty evidence.
Memory Tool: For stones “20 or Less, SWL or URS is Best.”
Reference Citation: Table 43.3, Recommendation 5
Rationale: It helps differentiate the first-line treatment options based on the total renal stone burden, ensuring targeted and effective treatment.
Clinical Vignette: In which situation should open/laparoscopic/robotic surgery be considered for treating upper tract stones in pediatric patients?
Multiple-Choice Options:
A. Always, as it ensures complete stone removal.
B. Only in cases of coexisting anatomic abnormalities.
C. Never, as it is too invasive for pediatric patients.
D. When the total renal stone burden is > 20 mm.
Correct Answer: B
Explanation: Open/laparoscopic/robotic surgery should not be routinely performed for upper tract stones in pediatric patients, except in cases of coexisting anatomic abnormalities. This is a panel consensus based on clinical training, experience, knowledge, and judgment for which there is no evidence.
Memory Tool: Think “Anomaly? Open Policy” to remember when open/laparoscopic/robotic surgery is an option.
Reference Citation: Table 43.3, Recommendation 7
Rationale: The question emphasizes the need to understand exceptions to the rule against more invasive surgeries in pediatric patients.
Question 7: Treatment for Pediatric Patients with Total Renal Stone Burden > 20 mm
Clinical Vignette: A 16-year-old patient presents with a total renal stone burden of 25 mm. What are acceptable treatment options for this patient?
Multiple-Choice Options:
A. Percutaneous nephrolithotomy (PCNL) only.
B. Shock wave lithotripsy (SWL) only.
C. Either PCNL or SWL, with stent or nephrostomy tube if SWL is used.
D. Ureteroscopy (URS) only.
Correct Answer: C
Explanation: For pediatric patients with a total renal stone burden > 20 mm, both PCNL and SWL are acceptable options. If SWL is utilized, clinicians should place an internalized ureteral stent or nephrostomy tube. This is a panel consensus.
Memory Tool: Think “Over 20? Two Ways with a Twist” to remember that both PCNL and SWL are options, but SWL requires an additional step.
Reference Citation: Table 43.3, Recommendation 6
Rationale: Knowing the tailored treatment options based on the size of the stone burden ensures that clinicians can offer the most appropriate care.
Clinical Vignette: A 7-year-old girl is found to have a nonobstructing renal stone on ultrasound but is asymptomatic. What’s the next course of action?
Multiple-Choice Options:
A. Immediate surgical intervention.
B. Active surveillance with periodic ultrasonography.
C. Medical expulsive therapy using α-blockers.
D. Low-dose CT scan.
Correct Answer: B
Explanation: For pediatric patients with asymptomatic and nonobstructing renal stones, active surveillance with periodic ultrasonography may be utilized. This is a panel consensus based on members’ clinical experience and judgment.
Memory Tool: Think “Silent Stone? Just Watch” to remember that asymptomatic and nonobstructing stones can be actively surveilled.
Reference Citation: Table 43.3, Recommendation 8
Rationale: The question focuses on conservative management options when surgical intervention is not necessary, providing an alternative approach in specific cases.
Clinical Vignette: You are planning a percutaneous nephrolithotomy (PCNL) for a 14-year-old boy. What preoperative imaging study is recommended?
Multiple-Choice Options:
A. Standard-dose CT scan
B. MRI
C. Low-dose CT scan
D. Ultrasound
Correct Answer: C
Explanation: Clinicians should obtain a low-dose CT scan on pediatric patients before performing PCNL. This is strongly recommended and supported by low certainty evidence.
Memory Tool: “Low-dose for the Little Ones” to remember that a low-dose CT scan is recommended before PCNL in pediatric patients.
Reference Citation: Table 43.3, Recommendation 3
Rationale: Knowing the correct preoperative imaging modality for a specific procedure can guide clinicians in ensuring patient safety and surgical success.
Clinical Vignette: You are considering ureteroscopy (URS) for an 11-year-old with a ureteral stone. Should you place a stent before the procedure?
Multiple-Choice Options:
A. Always, as it helps in guiding the URS
B. Never, as it increases the risk of complications
C. Only in cases with severe hydronephrosis
D. It should be individualized based on patient-specific anatomy
Correct Answer: B
Explanation: Clinicians should not routinely place a stent before URS in pediatric patients. This is a panel consensus based on clinical training, experience, knowledge, and judgment for which there is no evidence.
Memory Tool: “Stents Before? No More” to remember that stenting is not routinely recommended before URS.
Reference Citation: Table 43.3, Recommendation 4
Rationale: The question ensures that the examinee is aware of the recommendation against routine stent placement before URS, avoiding unnecessary interventions.
