Kidney 7

Question 1

Irrigation fluid for TURP is absorbed through

Answer 1

the open venous sinuses of the prostate

Question 2

The height of the solution for TURP should be kept no more than

Answer 2

60 cm above the OR table

Question 3

The ideal irrigation fluid

Answer 3

provides good surgical visibility (should be clear)
is isotonic
is absent of toxicity

Question 4

0.9% NaCl or LR would be great choices for TURP, however

Answer 4

they’re highly ionized and good conductors of electricity- contraindicated when monopolar electrocautery is used

Question 5

Free water absorption can lead to

Answer 5

decreased serum osmolality
dilutional hyponatremia
hemolysis

Question 6

Which solutions have decreased risk of TURP syndrome?

Answer 6

glycine
sorbitol 3.3%

Question 7

Cons of sorbitol include

Answer 7

hyperglycemia
osmotic diuresis
lactic acidosis

Question 8

Mannitol 5% can lead to

Answer 8

osmotic diuresis
transient plasma expansion (risk of LV failure)

Question 9

Serum Na+ of ________- increases the risk of complications with TURP syndrome

Answer 9

<120 mEq/L

Question 10

Serum Na+ <110 mEq/L is associated with

Answer 10

seizure
coma
lethal ventricular dysrhythmias

Question 11

Cardiopulmonary problems with TURP syndrome include

Answer 11

Circulatory overload
hypertension
reflex bradycardia
CHF
pulmonary edema
dysrhythmias
myocardial infarction

Question 12

CNS problems with TURP syndrome include

Answer 12

restlessness
N/V
cerebral edema
seizures
coma

Question 13

Additional problems with TURP syndrome include

Answer 13

hyponatremia
hemolysis
hypo-osmolality

Question 14

Correcting Na+ too quickly increases the risk of

Answer 14

central pontine myelinolysis

Question 15

Lab data for TURP syndrome should include

Answer 15

electrolytes
hematocrit
creatinine
glucose
12 lead EKG

Question 16

If Na+ >120 mEq/L with turp syndrome, then

Answer 16

restrict fluids and give furosemide (loop diuretic)

Question 17

If Na+ <120 mEq/L with TURp syndrome then give

Answer 17

3% NaCl at <100 mL/hr & discontinue once Na+ >120 mEq/L

Question 18

Treatment of bladder perforation includes

Answer 18

supportive with IVF, vasopressers
serial assessment of H&H and transfuse as indicated

Question 19

The patient with a perforated bladder will require

Answer 19

emergent suprapubic cystostomy or possible exploratory laparotomy

Question 20

Inadvertent stimulation of _______________ through the bladder wall can cause lower extremity movement which may cause the resectoscope to puncture the bladder wall

Answer 20

the obturator nerve

Question 21

What is a rough estimate of blood loss during a TURP procedure?

Answer 21

2-5mL of blood loss per minute of resection time

Question 22

Which findings represents an absolute contraindication to extracorpeal shock wave lithotripsy?
a. pregnancy
b. pacemaker
c. morbid obesity
d. diabetes

Answer 22

a. pregnancy

Question 23

Lithotripsy is a procedure that

Answer 23

breaks up stones in the kidney
ureter or bladder

Question 24

Extracorpeal shock wave lithotripsy delivers

Answer 24

shock waves in rapid succession that are directed at the stone

Question 25

Absolute contraindications to ESWL include

Answer 25

pregnancy coagulopathy

Question 26

the presence of ___________ is a relative contraindication for ESWL

Answer 26

pacemaker

Question 27

the shock wave can produce

Answer 27

dysrhythmias

Question 28

The pulse wave of ESWL is timed to the _______ on the EKG to minimize the risk of

Answer 28

R wave; R on T phenomenon

Question 29

______________ is often been used when ESWL has been ineffetive

Answer 29

percutaneous nephrolithotomy

Question 30

The anesthetic for percutaneous nephrolithotomy is

Answer 30

GETA and the patient in the prone position

Question 31

_____________ uses a laser to break up the stone

Answer 31

laser lithotripsy

Question 32

Laser lithotripsy considerations include

Answer 32

TURP syndrome/considerations laser precautions

Question 33

Nephrolithiasis is a

Answer 33

kidney stone

Question 34

ureterolithiasis is a

Answer 34

ureter stone

Question 35

Cystolithiasis is a

Answer 35

bladder stone

Question 36

Relative contraindications to ESWL includes

Answer 36

pacemaker/ICD morbid obesity (further distance from energy source to stone) obstruction beyond the renal stone (can't eliminate fragments) UTI (untreated) calcified aneurysm of the aorta or renal artery (problem of density)

Question 37

Any internal organ in the path of the shock wave is at risk for

Answer 37

perforation

Question 38

Common side effects of ESWL include

Answer 38

skin bruising petechiae hematuria

Question 39

Possible complication of percutaneous nephrolithotripsy include

Answer 39

pneumothorax

Question 40

The position for laser lithotripsy is typically

Answer 40

lithotomy