Urinary tract calculi/Ureteric obstruction

Question 1

Dynamic Renography can be used to infuse the kidneys and look for signs of obstruction. Which radiotracer is most commonly used?

1 - fluorodeoxyglucose (FDG)
2 - mercapto acetyl tri glyceride (MAG3)
3 - 123I-Ioflupane
4 - iodine

Answer 1

2 - mercapto acetyl tri glyceride (MAG3)

• initially measures uptake
• then measures wash out
• reduced wash out indicates obstruction

Question 2

There are a large number of renal calculi. Which of the following is most common?

1 - cysteine
2 - uric
3 - calcium oxalate and phosphate
4 - triple (calcium, magnesium, ammonium) phosphate

Answer 2

3 - calcium oxalate and phosphate

• often contain a mixture of calciumoxalatestones andcalcium phosphate

Question 3

There are a large number of renal calculi. Which of the following are most commonly associated with infection and are the most difficult to treat?

1 - cysteine
2 - uric
3 - calcium oxalate and phosphate
4 - triple (calcium, magnesium, ammonium) phosphate

Answer 3

4 - triple (calcium, magnesium, ammonium) phosphate

• largest stones are called staghorn calculi

Question 4

There are a large number of renal calculi. Which of the following is associated with gout?

1 - cysteine
2 - uric
3 - calcium oxalate and phosphate
4 - triple (calcium, magnesium, ammonium) phosphate

Answer 4

2 - uric

Question 5

There are a large number of renal calculi. Which of the following are rare and typically due to genetic disorder in cystinuria?

1 - cysteine
2 - uric
3 - calcium oxalate and phosphate
4 - triple (calcium, magnesium, ammonium) phosphate

Answer 5

1 - cysteine

Question 6

All of the following are common symptoms associated with renal calculi, EXCEPT which one?

1 - severe pain
2 - nausea and vomiting
3 - constant pain
4 - radiates from loin to groin
5 - urinary frequency (strangury)
6 - blood in the urine

Answer 6

3 - constant pain
- pain comes in waves as urine tries to move from the kidneys to the bladder

Question 7

If a patient is suspected of having renal calculi, what is the 1st line imaging?

1 - whole body CT
2 - MRI
3 - ultrasound
4 - CT KUB

Answer 7

4 - CT KUB
- KUB = kidney, ureters and bladder

Question 8

If a patient is confirmed with having renal calculi, which of the following should be performed?

1 - admit the patient or refer to clinical the following day
2 - refer back to GP
3 - provide antibiotics and fluid to patient and discharge
4 - all of the above

Answer 8

1 - admit the patient

• if severe admitted and referred to urology team
• if non- severe referred to outpatient clinic the following day

Question 9

All of the following are treatments for renal calculi:

1 - Cystolitholapaxy (most common) a crushing device, lasers or ultrasound waves will break stones
2 - Holmium laser stone fragmentation
3 - Ureteric baskets
4 - Shockwave Lithotripsy

Question 10

The Pelviureteric Junction (PUJ) is where the pelvis of the kidney meets the ureters. Which of the following can cause a PUJ obstruction?

1 - Failure of peristalsis through PUJ
2 - Chronic obstruction
3 - Congenital vs acquired
4 - all of the above

Answer 10

4 - all of the above

Imaging
- USS
- CT urogram
- MAG3 Renogram

Question 11

The Pelviureteric Junction (PUJ) is where the pelvis of the kidney meets the ureters. Which of the following is the key indicator that suggests a patient has PUJ obstruction?

1 - haematuria
2 - severe pain with excessive fluid and alcohol
3 - severe pain with tea and coffee
4 - pain in the back only

Answer 11

2 - severe pain with excessive fluid and alcohol

Question 12

The Pelviureteric Junction (PUJ) is where the pelvis of the kidney meets the ureters. What is the treatment of choice for PUJ obstruction?

1 - Laparoscopic or robotic pyeloplasty
2 - Cystolitholapaxy
3 - Holmium laser stone fragmentation
4 - Ureteric baskets
5 - Shockwave Lithotripsy

Answer 12

1 - Laparoscopic or robotic pyeloplasty