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Block 19 Module 3 > Stone Formation and Urolithiasis > Flashcards

Stone Formation and Urolithiasis Flashcards

1
Q

T/F. Stone formation is multifactorial

A

True (e.g. genetic, diet, physical environment, stress)

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2
Q

T/F. Rate of stone formation is not proportional to % of large crystals and crystal aggregates.

A

False (proportional)

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3
Q

Determines stone production

A

Saturation of each salt and the concentrations of inhibitors and promoters

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4
Q

3 anatomic ureteral constrictions

A

[1] Ureteropelvic junction, [2] crossing of ureter at level of iliac vessels, [3] ureterovesical junction

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5
Q

5 surgical constrictions of the ureter

A

3 anatomic constrictions + [4] ureter crossing vas deferens/broad ligament, [5] ureteral meatus

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6
Q

T/F. Stone <4 mm can’t pass through GUT

A

False (readily pass)

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7
Q

T/F. Nephrocalcinosis is a medical emergency

A

False (do not have potential for obstruction)

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8
Q

Central event in stone formation

A

Supersaturation

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9
Q

Most important urinary ion

A

Calcium

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10
Q

Amount of Ca reabsorption

A

<2 % excreted in urine (the rest is reabsorbed)

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11
Q

T/F. Increase in monosodium urates and a decrease in urinary pH further interfere with Ca complexation and therefore promote crystal aggregation

A

True

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12
Q

T/F. Ca affects amount of oxalate absorption in small bowel

A

True

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13
Q

T/F. Uric acid is a product of pyrimidine metabolism

A

False (purine metabolism)

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14
Q

T/F. Na directly affects Ca stone formation

A

False (indirectly as it regulates Ca metabolism)

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15
Q

Most active inhibitory component of urine

A

Citrate

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16
Q

Inhibitor which is a component of struvite calculi

A

Magnesium

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17
Q

T/F. Sulfate is not a stone formation inhibitor

A

False

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18
Q

Pathogenesis of calcium stones

A

↑ urinary calcium
↑ urinary oxalate
↓ level of urinary citrate

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19
Q

Tx for type I absorptive hypercalciuria

A

Cellulose phosphate

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20
Q

Most common absorptive hypercalciuria

A

Type II

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21
Q

Tx for Type II absorptive hypercalciuria

A

Dietary calcium restriction to 400 to 600 mg/day

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22
Q

Tx for type III absorptive hypercalciuria

A

Orthophosphate

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23
Q

Hypercalciuria 2⁰ to Primary hyperparathyroidism (most commonly due to adenoma)

A

Resorptive Hypercalciuric Nephrolithiasis

24
Q

Infection stone 2⁰ to urea splitting organisms e.g. Proteus, Pseudomonas and assoc. with staghorn calculi

A

Struvite

25
Q

Composition of struvite

A

Mg, Ammonium (gives alkaline pH), Phosphate

26
Q

T/F. Uric acid stone more common in women

A

False (men)

27
Q

Struvite vs uric acid stones

A

Struvite: dissolve in acid just like xanthine

Uric acid: dissolve in alkaline

28
Q

Tx if serum uric acid is high

A

Allopurinol

29
Q

Stone due to inborn error of metabolism i.e. intestinal absorption of dibasic amino acid

A

Cystine

30
Q

Signs and symptoms of stone

A

Pain (renal colic), hematuria, fever, nausea and vomiting

31
Q

Common nerve pathway of kidney and stomach

A

Celiac ganglion

32
Q

Classic signs of appendicitis

A

Dull pain navel area that progresses to sharp pain in LRQ; loss of appetite; abdominal pain after nausea and vomiting; abdominal swelling; fever; inability to pass gas

33
Q

Radiation of pain in proximal ureter stone

A

Radiates to the groin and testicle in male, labia majora and round ligament in female

34
Q

Simplest, minimally invasive, cheapest imaging

A

UTZ

35
Q

Next line imaging if negative in initial imaging

A

Retrograde pyelography

36
Q

Series of x-rays (plain KUB)

A

Scout films

37
Q

Contraindication for IV pyelography

A

↑ serum creatinine; dye is nephrotoxic

38
Q

Uric acid and xanthine stone on pyelography

A

Radiolucent

39
Q

Calcium oxalate and calcium phosphate stones on pyelography

A

Radio opaque

40
Q

Obliterated psoas line on imaging might mean

A

Mass in retroperitoneal area

41
Q

May be performed to delineate the entire ureter to check for stones, masses, or strictures using dynamic fluoroscopy

A

Retrograde pyelography

42
Q

Stones on CT

A

Hyperintense regardless of nature

43
Q

Benefits of stent

A

Allows medication to come in contact with stone or else all meds will to the contralateral kidney

44
Q

Management of obstructed and infected kidney and fever

A

Emergency drainage

45
Q

Ureterolithic agents to relax ureter and reduce peristalsis

A

Hyoscine butylbromide (buscopan) and alpha adrenergic blockers

46
Q

Agents for acidification of struvite stone

A

Suby’s G solution and hemiacidrin

47
Q

Effect of orange juice on urine

A

Alkalinize

48
Q

Oral alkalinizing agents

A

Na or K bicarbonate and K citrate

49
Q

Pain relievers for colic pain

A

IM 50-100 mg meperidine or 10-15 mg morphine, NSAIDs

50
Q

Chance of spontaneous passing of 4-5 mm stone

A

40-50%

51
Q

Chance of spontaneous passing of >6 mm stone

A

<5%

52
Q

Extracorporeal shock wave lithotripsy effective on

A

<2 cm stone

53
Q

Can be used to drain obstructed, infected, dilated kidney if catheters can’t pass through

A

Nephrostomy tube

54
Q

Indicated for staghorn calculi and bigger stones

A

Percutaneous nephrolithotomy

55
Q

Complication of percutaneous nephrolithotomy

A

Bleeding

56
Q

T/F. No need to assess renal function before treating a stone.

A

False (assess first!)

57
Q

For proximal ureteral stone, be it retroperitoneal or transperitoneal

A

Laparoscopy

Block 19 Module 3 (9 decks)

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