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AUA Fundamentals 2021 > Stones > Flashcards

Stones Flashcards

1
Q

1 year recurrence rate after 1st stone

A

10-15%

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2
Q

5 year recurrence rate after 1st stone

A

50-60%

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3
Q

10 year recurrence rate after 1st stone

A

70-80%

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4
Q

Initial work-up for new stone former

A 
Dietary History (fluids, meat, calcium)
Medical History (DM, gout, obesity, bowel surgery, RTA, parathyroid)
BMP
UA
Urine Culture
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5
Q

What medications increase stone risk?

A 
Topiramate
Zonisamide
Acetazolamide
Triamterene
Probenecid
Protease Inhibitors (-navir)
Vitamin C
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6
Q

If serum calcium is high, next lab?

A

PTH

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7
Q

1 risk factor for uric acid stones

A

low urine pH

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8
Q

1 risk factor for struvite stones

A

recurrent UTIs

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9
Q

Radiolucent stones

A

uric acid & cystine

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10
Q

Indications for 24hr urine

A

Interested 1st time stone formers

Recurrent stone formers

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11
Q

Initial dietary recommendations for ALL stone formers

A 
>2.5L fluid intake daily
Na & oxalate restriction
Normal calcium intake (1000-1200mg/day)
Decrease animal protein
Increase citrus intake
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12
Q

Increased sodium intake leads to _____ in urinary calcium excretion

A

increase

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13
Q

Excess urinary ____ blocks hypocalciuric action of thiazies

A

sodium

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14
Q

Consumption of ____ enhances GI binding of Oxalate and decreased oxaluria

A

calcium

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15
Q

Clinicians should counsel patients with CaOx stones & hyperoxaluria to limit ____ rich food intake and maintain normal ___ consumption

A

limit oxalate rich foods

normal calcium consumptions

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16
Q

Congenital, primary hyperoxaluria is due to a ____ deficiency. Only treatment option is ____

A

hepatic enzyme (alanine aminotransferase)

renal & liver transplant

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17
Q

Enteric hyperoxaluria is due to ____ malabsorption leading to limited calcium to bind to oxalate

A

fat

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18
Q

Clinicians should encourage patients with Calcium stones & hypocitraturia to increase intake of ____ & limit intake of ____

A

increase fruits & veggies

limit animal protein

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19
Q

1st line therapy for hypercalciuria and recurrent stones

A

Thiazide diuretics

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20
Q

Thiazide diuretics work at the _____ to promote calcium resorption

A

Distal renal tubule

20% RR in stone formation

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21
Q

Side effects of thiazides

A

Hypokalemia
Hypocitraturia
High urine uric acid

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22
Q

Supplement thiazides with ___ to overcome hypokalemia

A

Potassium Citrate 40-60 mEq daily

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23
Q

1st line therapy for low urinary citrate and recurrent calcium stones

A

Potassium citrate

  • alkalizes urine
  • promotes citrate excretion
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24
Q

Citrate reduces stone formation by inhibiting ____

A

crystallization of calcium salts

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25
Q

RTA - low ___ levels in serum and low ___ levels in urine

A

Hypokalemia

Hypocitraturia

26
Q

Young female with calcium phosphate stones, nephrocalcinosis, urine pH >6.5, hypocitraturia, hypokalemia

A

Distal RTA

27
Q

35 yo M with calcium oxalate stones, acidic urine, hypocalciruia, and hypocitraturia, and prior bowel surgery

A

Enteric hyperoxaluria

28
Q

Contraindications to K Citrate

A

Hyperkalemia
Active gastric ulcer
Cr > 2.5

29
Q

Cheaper alternative to K Citrate

A

Na Bicarbonate

30
Q

Urine pH in uric acid stone formers

A

pH < 5.5

31
Q

Obese patients have an independent increased risk of ___ stones

A

Uric acide

32
Q

Offer ____ to patients with uric acid or cystine stones to raise urinary pH

A

K Citrate

33
Q

To dissolve cystine stones, urine pH must be above ____

A

pH 7.5

34
Q

Pharmaceutical therapy for struvite stones

A

Acetohydroxamuc acid (Lithostat)

35
Q

Before PCNL, one must obtain ____

A

PCNL

36
Q

ESWL contraindicated with skin to stone distance >___cm

A

10 cm

37
Q

Alpha-blockers can be offered for patients with ureteral stones

A

10mm

38
Q

Treatment for enteric hyperoxaluria

A

Oral Calcium & Mg

39
Q

How to address thiazide-induced hypocitraturia?

A

Add potassium citrate

40
Q

Contraindications to Potassium Citrate

____ Potassium
Active ____ disease
Cr > ____

A

High K
Active peptic ulcer disease
Cr >2

41
Q

Uric Acid stones

pH < ____

A

pH < 5.5

42
Q

UA with cystinuria - ____ Crystals

A

Hexagonal

43
Q

Cystine stones rapidly dissolve at pH > ___

A

pH > 7.5

44
Q

Urease producing bacteria

SHP

A

Staph Aureus
Hemophilus Influenza
Proteus

45
Q

Obtain a repeat 24 hour after ____ of initiating pharmaceutical treatment

A

6 months

46
Q

Optimal imaging prior to PCNL is a ____

A

CT A/P non-contrast

47
Q

ESWL parameters

Hounsfield units < ____
Skin to stone distance

A

<1000 HU

<10 cm

48
Q

If hydronephrosis or cortical thinning is seen on imaging, obtain ____ lab test

A

Cr, BUN, electrolytes aka BMP

49
Q

____ should be offered after 1 month trial of MET or suspicious of stone passage

A

Repeat imaging (KUB, RBUS, or CT)

50
Q

SWL has the ____ complication rate, but the ____ stone free rate

A

lowest….. worst

51
Q

1st line treatment for mid & distal ureteral stones - ____

A

URS

52
Q

Only proven therapy to reduce stent discomfort is ____

A

alpha-blocker

53
Q

Only proven therapy to reduce stent discomfort is ____

A

alpha-blocker

54
Q

In Symptomatic Patients With A Total Renal Stone Burden >20 mm, Clinicians Should Offer____ As First- line Therapy

A

PCNL

55
Q

May Offer ___ or ____ to Patients With Symptomatic <10 mm Lower Pole Renal Stones

A

ESWL or URS

56
Q

Pts With Lower Pole Stones >10 Mm Should Be Informed That ____ Has A Higher Stone-free Rate But Greater Morbidity

A

PCNL

57
Q

____ should Not Be Offered As First-line Therapy To Pts With >10mm Lower Pole Stones

A

ESWL

58
Q

In the absence of a UTI, SWL does not require ____

A

peri-op antibiotics

59
Q

Prescribe ____ to facilitate stone passage after ESWL

A

alpha-blockers

60
Q

If ESWL fails, next therapy should be ____

A

URS

61
Q

____ is 1st line in patients on anti-platelet or anti-coag

A

URS

AUA Fundamentals 2021 (11 decks)

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