MISCELLANEOUS FACTS FROM PASSMED Flashcards Preview

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Flashcards in MISCELLANEOUS FACTS FROM PASSMED Deck (5)
1

A 23-year-old man is admitted with left sided loin pain that radiates to his groin. His investigations demonstrate a 1 cm left sided ureteric calculus with no associated hydronephrosis. What is the best way to manage this patient?

Extra corporeal shock wave lithotripsy

Percutaneous nephrostomy

Pyeloplasty

Conservative management

Percutaneous nephrolithotomy

Extra corporeal shock wave lithotripsy


Stones with a total volume of less than 2cm can be considered for lithotripsy. If it is impacted in the upper ureter then some may consider a ureteroscopy.

2

A 23-year-old male is admitted with left sided loin pain and fever. His investigations demonstrate a left sided ureteric calculi that measures 0.7 cm in diameter and associated hydronephrosis. What is the best way to manage this patient?

Extra corporeal shock wave lithotripsy

Percutaneous nephrostomy

Pyeloplasty

Conservative management

Percutaneous nephrolithotomy

Percutaneous nephrostomy

An obstructed, infected system is an indication for urgent decompression. This may be achieved by ureteroscopy or nephrostomy. In addition to this the patient should also receive broad spectrum, intravenous antibiotics.

3

A 30-year-old male presents with left sided loin pain. His investigations demonstrate a large left sided staghorn calculus that measures 2.3cm in diameter. What is the best way to manage this patient?

Extra corporeal shock wave lithotripsy

Percutaneous nephrostomy

Pyeloplasty

Conservative management

Percutaneous nephrolithotomy

Percutaneous nephrolithotomy


Large, proximal stones are generally best managed with a percutaneous nephrolithotomy. The use of lithotripsy has low clearance rates. Where stones remain after the initial procedure a repeat percutaneous nephrolithotomy is generally preferred over follow up lithotripsy.

4

A 56-year-old man presents with lethargy, haematuria and haemoptysis. On examination he is hypertensive and has a right loin mass. A CT scan shows a lesion affecting the upper pole of the right kidney, it has a small cystic centre. Which of the options below is the most likely diagnosis?

Squamous cell carcinoma of the kidney

Nephroblastoma

Renal adenocarcinoma

Transitional cell carcinoma of the kidney

Polycystic kidney disease

Renal adenocarcinoma

Renal adenocarcinoma are the most common renal tumours. These will typically affect the renal parenchyma. Transitional cell carcinoma will usually affect urothelial surfaces. Nephroblastoma would be very rare in this age group. Renal adenocarcinoma may produce cannon ball metastasis in the lung which cause haemoptysis, this is not a feature of PKD.

5

You are called to the medical ward to review an 82-year-old man with severe suprapubic pain and dribbling of urine. He is known to have a tight bladder neck stenosis after a previous prostatectomy. On examination there is dullness on percussion from his symphysis pubis to his umbilicus associated with underlying tenderness. Attempts at urinary catheterisation on the ward were unsuccessful using a 12 and 14F catheter.
How would you manage this patient?


Flexible cystoscopy guided urinary catheterisation

Suprapubic catheterisation on the ward

Ultrasound guided suprapubic catheterisation

Urethral catheterisation with 10F

Urethral catheterisation with 16F catheter

Ultrasound guided suprapubic catheterisation


Flexible cystoscopy guided urinary catheterisation is not suitable in this case because a cystoscope is 17F and a 12F and 14F have already been unsuccessful. A smaller 10F catheter could be possible, however with repeated catheterisation bleeding is likely which can cause clots to form which easily block these small catheters.
USS guided suprapubic catheterisation is now recommended as this reduces the risk of damage to surrounding structures such as the bowel as the catheter can be inserted under direct vision. Suprapubic catheters are inserted approximately two finger breadths above the symphysis pubis.