- A 45-year-old male presents with severe right flank pain. Imaging reveals a 7mm renal stone. What is the most appropriate initial management?
- A. Observation
- B. Ureteroscopy
- C. Percutaneous nephrolithotomy
- D. Extracorporeal shock wave lithotripsy (ESWL)
- E. Open surgery
- Which of the following is a contraindication to extracorporeal shock wave lithotripsy (ESWL)?
- A. Pregnancy
- B. Hypertension
- C. Hyperthyroidism
- D. Obesity
- E. Diabetes mellitus
- A patient with a 1.2 cm lower pole renal stone is being considered for lithotripsy. What is the ideal patient positioning during ESWL?
- A. Supine
- B. Prone
- C. Lateral
- D. Trendelenburg
- E. Reverse Trendelenburg
- Which type of lithotripter uses an electrohydraulic shock wave source?
- A. Electromagnetic lithotripter
- B. Piezoelectric lithotripter
- C. Electrohydraulic lithotripter
- D. Laser lithotripter
- E. Ultrasonic lithotripter
- What is the primary mechanism by which ESWL fragments renal calculi?
- A. Mechanical compression
- B. Thermal ablation
- C. Shock wave energy
- D. Chemical dissolution
- E. Radiofrequency ablation
- Which of the following is a common complication following ESWL?
- A. Urosepsis
- B. Nephrocalcinosis
- C. Hematuria
- D. Chronic kidney disease
- E. Renal artery stenosis
- A 60-year-old woman undergoes ESWL for a 9mm kidney stone. What post-procedure symptom should she be advised about?
- A. Dark stools
- B. Dysphagia
- C. Hematuria
- D. Melena
- E. Visual disturbances
- ESWL is least effective for which type of renal calculi?
- A. Uric acid stones
- B. Calcium oxalate stones
- C. Cystine stones
- D. Struvite stones
- E. Calcium phosphate stones
- What imaging modality is most commonly used to guide ESWL?
- A. MRI
- B. Ultrasound
- C. CT scan
- D. X-ray fluoroscopy
- E. PET scan
- Which of the following factors does NOT influence the success rate of ESWL?
- A. Stone composition
- B. Stone location
- C. Stone size
- D. Patient age
- E. Patient’s BMI
- What is the maximum size of renal stone that is generally considered appropriate for treatment with ESWL?
- A. 5 mm
- B. 10 mm
- C. 20 mm
- D. 25 mm
- E. 30 mm
- After ESWL, a patient develops a large hematoma around the kidney. Which of the following was most likely the predisposing factor?
- A. Hypercalcemia
- B. Recent anticoagulant use
- C. Diabetes mellitus
- D. Previous abdominal surgery
- E. Hyperlipidemia
- What is the recommended follow-up imaging after ESWL to check for stone clearance?
- A. KUB (Kidneys, Ureters, Bladder) X-ray
- B. MRI
- C. Non-contrast CT scan
- D. Ultrasound
- E. IV Pyelogram
- Which of the following patient conditions is a relative contraindication for ESWL?
- A. Osteoporosis
- B. Pacemaker
- C. Active urinary tract infection
- D. Previous kidney transplant
- E. Mild hypertension
- What is the typical duration of an ESWL procedure?
- A. 15-30 minutes
- B. 30-60 minutes
- C. 60-90 minutes
- D. 90-120 minutes
- E. Over 120 minutes
- ESWL has a lower success rate for stones located in which part of the kidney?
- A. Upper pole
- B. Middle pole
- C. Lower pole
- D. Renal pelvis
- E. Ureter
- What is the main advantage of ESWL over percutaneous nephrolithotomy (PCNL)?
- A. Higher success rate
- B. Lower complication rate
- C. Shorter hospital stay
- D. Better for larger stones
- E. Reduced recurrence rate
- During ESWL, what is the purpose of using a water bath or cushion?
- A. Enhance patient comfort
- B. Focus shock waves
- C. Reduce procedure time
- D. Increase stone fragmentation
- E. Prevent skin burns
- What type of anesthesia is typically used for ESWL?
- A. General anesthesia
- B. Spinal anesthesia
- C. Local anesthesia
- D. Conscious sedation
- E. No anesthesia
- Which of the following is an absolute contraindication to ESWL?
- A. Severe obesity
- B. Skeletal deformities
- C. Coagulopathy
- D. Single kidney
- E. Hypertension
- Which laboratory test is most relevant before performing ESWL?
- A. Serum calcium
- B. Serum creatinine
- C. Blood urea nitrogen
- D. Urine culture
- E. Complete blood count
- A patient experiences severe colicky pain after ESWL. What is the most likely cause?
- A. Infection
- B. Stone fragments passing
- C. Renal artery stenosis
- D. Nephritis
- E. Hemorrhage
- Which stone composition is most resistant to fragmentation by ESWL?
- A. Calcium oxalate monohydrate
- B. Calcium oxalate dihydrate
- C. Uric acid
- D. Struvite
- E. Cystine
- In ESWL, shock waves are generated at a rate of how many shocks per minute?
- A. 30-60
- B. 60-90
- C. 90-120
- D. 120-150
- E. 150-180
- Which factor increases the risk of renal injury during ESWL?
- A. High BMI
- B. Younger age
- C. Low-energy shock waves
- D. Increased number of shock waves
- E. Small stone size
- What is the primary benefit of using ultrasound guidance during ESWL?
- A. Higher fragmentation rate
- B. Real-time stone localization
- C. Reduced anesthesia requirements
- D. Shorter procedure time
- E. Lower cost
- How long should anticoagulants be discontinued before undergoing ESWL?
- A. 24 hours
- B. 3 days
- C. 7 days
- D. 14 days
- E. No need to discontinue
- Which imaging modality is most sensitive for detecting residual stone fragments after ESWL?
- A. KUB X-ray
- B. MRI
- C. Ultrasound
- D. Non-contrast CT scan
- E. IV Pyelogram
- What is the most common adverse effect experienced immediately following ESWL?
- A. Urosepsis
- B. Flank pain
- C. Hematuria
- D. Hypertension
- E. Renal failure
- What stone size is considered too large for ESWL, requiring alternative treatments?
- A. Greater than 1 cm
- B. Greater than 2 cm
- C. Greater than 3 cm
- D. Greater than 4 cm
- E. Greater than 5 cm
- During ESWL, what factor primarily determines the energy level of the shock waves?
- A. Patient’s age
- B. Stone location
- C. Stone composition
- D. Lithotripter type
- E. Stone size
- A patient with a staghorn calculus is being evaluated for treatment. Why is ESWL not the first-line treatment?
- A. High recurrence rate
- B. Incomplete fragmentation
- C. High complication rate
- D. Long procedure time
- E. High cost
- Which of the following is the least likely to be a cause of treatment failure with ESWL?
- A. Incorrect stone targeting
- B. Patient non-compliance
- C. Inadequate shock wave energy
- D. Stone composition
- E. Stone location
- How is the success of ESWL typically assessed?
- A. Stone-free rate at 1 month
- B. Stone-free rate at 3 months
- C. Immediate post-procedure imaging
- D. Symptom resolution
- E. Urine pH normalization
- A patient with a pacemaker is scheduled for ESWL. What special precaution should be taken?
- A. Discontinue pacemaker
- B. Use only low-energy shock waves
- C. Consult with a cardiologist
- D. Avoid fluoroscopy
- E. Administer prophylactic antibiotics
- What is the role of pre-treatment with alpha-blockers in patients undergoing ESWL?
- A. Reduce blood pressure
- B. Increase stone clearance
- C. Reduce hematuria
- D. Prevent infection
- E. Enhance anesthesia
- Which of the following stones is most likely to pass spontaneously after ESWL?
- A. Stones in the renal pelvis
- B. Stones in the upper ureter
- C. Stones in the mid-ureter
- D. Stones in the lower ureter
- E. Stones in the bladder
- What is the typical recovery time after an ESWL procedure?
- A. 24 hours
- B. 48 hours
- C. 72 hours
- D. 1 week
- E. 2 weeks
- In which of the following scenarios is ESWL most likely to be successful?
- A. 5mm uric acid stone in the renal pelvis
- B. 10mm calcium oxalate stone in the lower pole
- C. 12mm cystine stone in the renal pelvis
- D. 15mm struvite stone in the mid-ureter
- E. 20mm calcium phosphate stone in the upper pole
- Why is it important to achieve proper hydration before and after ESWL?
- A. Prevent infection
- B. Reduce hematuria
- C. Facilitate stone fragment passage
- D. Minimize pain
- E. Enhance anesthesia
- Which complication is most directly related to the shock wave mechanism in ESWL?
- A. UTI
- B. Renal hematoma
- C. Hypertension
- D. Acute kidney injury
- E. Stone recurrence
- What is the role of repeat ESWL sessions in stone management?
- A. Enhance initial fragmentation
- B. Reduce stone recurrence
- C. Manage residual fragments
- D. Prevent infection
- E. Minimize hematuria
- Which of the following medications should be withheld before undergoing ESWL?
- A. Beta-blockers
- B. NSAIDs
- C. ACE inhibitors
- D. Calcium channel blockers
- E. Statins
- A patient with recurrent kidney stones is evaluated for ESWL. Which of the following is least likely to impact the decision?
- A. Stone history
- B. Stone composition
- C. Stone size
- D. Patient’s diet
- E. Previous surgical history
- What is the recommended management for a patient with a large (>2 cm) renal pelvis stone?
- A. Observation
- B. ESWL
- C. Ureteroscopy
- D. Percutaneous nephrolithotomy
- E. Medical management
- What is the main advantage of using piezoelectric lithotripters over electrohydraulic lithotripters?
- A. Higher success rate
- B. Lower complication rate
- C. Shorter procedure time
- D. Better patient tolerance
- E. Reduced need for anesthesia
- Which lifestyle modification is recommended to reduce the risk of stone recurrence after ESWL?
- A. Low-calcium diet
- B. High-protein diet
- C. Increased fluid intake
- D. Reduced physical activity
- E. High-sodium diet
- Which of the following is NOT a benefit of using ESWL?
- A. Non-invasive
- B. High success rate for all stone types
- C. Outpatient procedure
- D. Short recovery time
- E. Can be repeated if necessary
- What is the primary endpoint for assessing the effectiveness of ESWL?
- A. Reduction in stone size
- B. Patient satisfaction
- C. Complete stone clearance
- D. Improvement in symptoms
- E. Reduction in hematuria
- In a patient with a history of recurrent UTIs and a renal stone, what is the preferred treatment?
- A. Observation
- B. ESWL
- C. Ureteroscopy
- D. Percutaneous nephrolithotomy
- E. Open surgery