RENAL CALCULI

Question 1

True or False

Men are more frequently affected by urolithiasis than women, with a ratio of 2.5:1

Answer 1

True

Question 2

The initial presentation predominates between what decades of life?

Answer 2

Third and fifth decade

Question 3

How many major types of urinary stones are there?

Answer 3

Five

Question 4

The most common types of urinary stones are composed of what?

Answer 4

85% calcium

Question 5

Are most urinary stones radiopaque (visible) on plain abdominal radiographs?

Answer 5

Yes

Question 6

What time of year are ureteral stones most symptomatic?

Answer 6

hot summer months

Question 7

Higher incidence rates of stones have also been associated with what?

Answer 7

1. sedentary lifestyle
2. HTN
3. carotid calcification
4. Cardiovascular disease

Question 8

What are the most important dietary factors in the development of urinary stones?

Answer 8

1. High protein and salt intake

2. inadequate hydration

Question 9

What are these signs and symptoms of?

1. Pain that occurs suddenly
2. typically localized to flank
   a. may have nausea/vomiting
   b. pts will constantly move and try to find a comfortable position
3. pain may be episodic and radiate anteriorly over the abdomen
   a. stone progression down ureter, pain may be referred into ipsilateral groin
4. obstructing stones present with acute, unremitting and severe colic
5. minimal pain with passage through urethra
6. stone size doesn’t correlate with severity of symptoms

Answer 9

Renal calculi (urinary stone)

Question 10

In 90% of the cases with patients with a possible urinary stone a urinalysis usually reveals what?

Answer 10

microscopic or gross hematuria

Question 11

Does the absence of hematuria exclude urinary stones?

Answer 11

NO

Question 12

What is a valuable clue in the urinalysis into the cause of the possible stone?

Answer 12

Urinary pH

Question 13

What imaging should be used for the diagnosis of urinary stones?

Answer 13

1. plain abdominal radiograph (KUB)
2. renal ultrasound
3. spiral ct with pt in prone position

Question 14

A KUB plain abdominal radiograph along with a renal ultrasound will diagnose up to what percentage of stones?

Answer 14

80%

Question 15

Can forced diuresis be counterproductive and exacerbate pain for a patient with a urinary stone?

Answer 15

Yes

Question 16

Stones smaller that how many mm’s in diameter on a plain abdominal radiograph usually pass spontaneously?

Answer 16

5-6mm

Question 17

What kind of meds could you use to help increase the rate of spontaneous stone passage and is most effective for distal stones?

Answer 17

1. Tamsulosin (alpha-blocker) 0.4mg PO once daily
2. Ibuprofen 800mg PO TID
3. Prednisone 10mg PO daily 3-5 days

Question 18

Stones that require surgical removal include those that are showing signs of what?

Answer 18

obstruction or infection

Question 19

What are some procedures for urinary stone removal?

Answer 19

1. Ureteroscopic stone extraction

2. Extracoporeal shock wave lithotripsy

Question 20

What is the greatest method of importance in reducing urinary stone recurrence?

Answer 20

increased fluid intake

Question 21

Sodium intake should be restricted to keep urinary sodium levels less that what?

Answer 21

150mEq/day

Question 22

Animal protein intake should be spread throughout the day and limited to how much daily?

Answer 22

1g/kg/day

Question 23

True or False

Obstructing stones with associated infections are medical emergencies (MEDEVAC)

Answer 23

True

Question 24

True or False

Obstructing stones with associated infections require urology consultation and prompt drainage by a ureteral stent or a percutaneous nephrostomy tube

Answer 24

True

Question 25

If patients present with the below symptoms a referral to where is warranted?

1. obstructing stone with signs of infection
2. stone fails to pass within 4 weeks
3. fever
4. intolerable pain
5. persistnet nausea and vomiting

Answer 25

Urology