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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
RTA - low ___ levels in serum and low ___ levels in urine
Hypokalemia | Hypocitraturia
26
Young female with calcium phosphate stones, nephrocalcinosis, urine pH >6.5, hypocitraturia, hypokalemia
Distal RTA
27
35 yo M with calcium oxalate stones, acidic urine, hypocalciruia, and hypocitraturia, and prior bowel surgery
Enteric hyperoxaluria
28
Contraindications to K Citrate
Hyperkalemia Active gastric ulcer Cr > 2.5
29
Cheaper alternative to K Citrate
Na Bicarbonate
30
Urine pH in uric acid stone formers
pH < 5.5
31
Obese patients have an independent increased risk of ___ stones
Uric acide
32
Offer ____ to patients with uric acid or cystine stones to raise urinary pH
K Citrate
33
To dissolve cystine stones, urine pH must be above ____
pH 7.5
34
Pharmaceutical therapy for struvite stones
Acetohydroxamuc acid (Lithostat)
35
Before PCNL, one must obtain ____
PCNL
36
ESWL contraindicated with skin to stone distance >___cm
10 cm
37
Alpha-blockers can be offered for patients with ureteral stones
10mm
38
Treatment for enteric hyperoxaluria
Oral Calcium & Mg
39
How to address thiazide-induced hypocitraturia?
Add potassium citrate
40
Contraindications to Potassium Citrate ____ Potassium Active ____ disease Cr > ____
High K Active peptic ulcer disease Cr >2
41
Uric Acid stones pH < ____
pH < 5.5
42
UA with cystinuria - ____ Crystals
Hexagonal
43
Cystine stones rapidly dissolve at pH > ___
pH > 7.5
44
Urease producing bacteria SHP
Staph Aureus Hemophilus Influenza Proteus
45
Obtain a repeat 24 hour after ____ of initiating pharmaceutical treatment
6 months
46
Optimal imaging prior to PCNL is a ____
CT A/P non-contrast
47
ESWL parameters Hounsfield units < ____ Skin to stone distance
<1000 HU <10 cm
48
If hydronephrosis or cortical thinning is seen on imaging, obtain ____ lab test
Cr, BUN, electrolytes aka BMP
49
____ should be offered after 1 month trial of MET or suspicious of stone passage
Repeat imaging (KUB, RBUS, or CT)
50
SWL has the ____ complication rate, but the ____ stone free rate
lowest..... worst
51
1st line treatment for mid & distal ureteral stones - ____
URS
52
Only proven therapy to reduce stent discomfort is ____
alpha-blocker
53
Only proven therapy to reduce stent discomfort is ____
alpha-blocker
54
In Symptomatic Patients With A Total Renal Stone Burden >20 mm, Clinicians Should Offer____ As First- line Therapy
PCNL
55
May Offer ___ or ____ to Patients With Symptomatic <10 mm Lower Pole Renal Stones
ESWL or URS
56
Pts With Lower Pole Stones >10 Mm Should Be Informed That ____ Has A Higher Stone-free Rate But Greater Morbidity
PCNL
57
____ should Not Be Offered As First-line Therapy To Pts With >10mm Lower Pole Stones
ESWL
58
In the absence of a UTI, SWL does not require ____
peri-op antibiotics
59
Prescribe ____ to facilitate stone passage after ESWL
alpha-blockers
60
If ESWL fails, next therapy should be ____
URS
61
____ is 1st line in patients on anti-platelet or anti-coag
URS

AUA Fundamentals 2021 (11 decks)

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