Renal Stones

Question 1

X

Answer 1

C

Question 2

C

Answer 2

C

Question 3

C

Answer 3

C

Question 4

C

Answer 4

C

Question 5

C

Answer 5

C

Question 6

C

Answer 6

C

Question 7

C

Answer 7

C

Question 8

C

Answer 8

C

Question 9

Diagnosis of renal stones

Answer 9

First line BAUS now recommend that non-contrast CT KUB should be performed on all patients, within 14 hours of admission

CT KUB has a sensitivity of 97% for ureteric stones and a specificity of 95%

ultrasound still has a role but given the wider availability of CT now and greater accurary it is no longer recommend first-line.

Question 10

C

Answer 10

C

Question 11

Management of renal colic ?

Answer 11

NSAID as the analgesia of choice for renal colic

CKS guidelines suggest for patients who require admission: Administer a parenteral analgesic such as intramuscular diclofenac for rapid relief of severe pain

BAUS no longer endorse the use of alpha-adrenergic blockers to aid ureteric stone passage routinely.

Question 12

X

Answer 12

X

Question 13

Management of renal stones?

Answer 13

Stones < 5 mm will usually pass spontaneously.

Most renal stones measuring less than 5mm in maximum diameter will typically pass within 4 weeks of symptom onset

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extra corporeal shock wave lithotripsy,
percutaneous nephrolithotomy, ureteroscopy,

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Ureteric obstruction due to stones together with infection is a surgical emergency

nephrostomy tube placement, insertion of ureteric catheters and ureteric stent placement.

Question 14

Complication of shockwave lithotripsy

Answer 14

Fragmentation of larger stones may result in the development of ureteric obstruction.

The procedure is uncomfortable for patients and analgesia is required during the procedure and afterwards.

Question 15

When is ureteroscopy indicated

Answer 15

Stone burden of less than 2cm in pregnant females

It is indicated in individuals (e.g. pregnant females) where lithotripsy is contraindicated and in complex stone disease.

In most cases a stent is left in situ for 4 weeks after the procedure.

Question 16

What is percutaneous nephrolithotomy

Answer 16

access is gained to the renal collecting system. Once access is achieved, intra corporeal lithotripsy or stone fragmentation is performed and stone fragments removed.

Question 17

Indication of Lithotripsy?

Answer 17

Stone burden of less than 2cm in aggregate

Question 18

Indication for Percutaneous nephrolithotomy

Answer 18

Complex renal calculi and staghorn calculi

Question 19

C

Answer 19

C

Question 20

C

Answer 20

C

Question 21

C

Answer 21

C

Question 22

Prevention of Calcium stones

Answer 22

high fluid intake

low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet)

!thiazides diuretics! (increase distal tubular calcium resorption)

Question 23

Prevention of oxolate stones?

Answer 23

cholestyramine reduces urinary oxalate secretion

pyridoxine reduces urinary oxalate secretion

Question 24

Prevention of urine acid stones?

Answer 24

allopurinol
urinary alkalinization e.g. oral bicarbonate