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EAU, Chapter 6 MCQs
EAU · MBBS / Medicine · 25 practice questions
- Aetiology and risk factors for stone formation
- Management of renal colic and medical expulsive therapy
- Antibiotic prophylaxis before SWL
- Shock wave lithotripsy practice
- Risk stratification for stone recurrence
- Stenting practices prior to shock wave lithotripsy
- Laboratory work-up in emergency stone patients
- Diagnostic evaluation of urolithiasis
1. A 28-year-old pregnant woman at 24 weeks gestation presents with acute flank pain and microscopic haematuria. Ultrasound shows mild hydronephrosis but is inconclusive regarding a ureteral stone. According to the recommended imaging pathway for pregnant patients, what is the most appropriate next step?
- ARepeat ultrasound only and avoid all further imaging
- BPerform magnetic resonance imaging as the second-line modality
- CPerform kidney-ureter-bladder (KUB) radiography for comparison
- DProceed directly to low-dose non-contrast-enhanced CT
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B. Perform magnetic resonance imaging as the second-line modality The guidance specifies ultrasound as first-line, then MRI as second-line, with low-dose CT reserved as a last-line option in pregnancy; going straight to CT skips the recommended second-line step, KUB is not part of the pregnancy-specific pathway, and simply repeating ultrasound would not resolve an inconclusive finding.
2. A 38-year-old woman with a 9mm proximal ureteral stone is being considered for shock wave lithotripsy. She has no bleeding disorder, is not pregnant, and has no untreated UTI, but imaging reveals an arterial aneurysm adjacent to the stone. What is the most appropriate course of action?
- AProceed with SWL using a lower energy setting to reduce risk
- BProceed with SWL since aneurysms are not a contraindication if untreated UTI is absent
- CAvoid SWL due to the aneurysm and consider an alternative treatment modality
- DDelay SWL for 24 hours to allow the aneurysm to stabilize before proceeding
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C. Avoid SWL due to the aneurysm and consider an alternative treatment modality Arterial aneurysm in the vicinity of the stone is explicitly listed as a contraindication to SWL, so an alternative modality (such as ureteroscopy) should be pursued. Lowering the energy setting does not address the fundamental contraindication. It is incorrect to say aneurysms are not a contraindication. There is no guideline support for a 24-hour delay resolving this risk.
3. A 62-year-old woman presents with fever, flank pain, and hypotension. Imaging reveals a 12mm obstructing ureteral stone with hydronephrosis and she is diagnosed with urosepsis. What is the most appropriate immediate management priority?
- AUrgent decompression of the collecting system via percutaneous drainage or ureteral stenting
- BStart broad-spectrum antibiotics and delay any drainage until sepsis improves
- CImmediate ureteroscopic stone removal to eliminate the source of infection
- DEmergency nephrectomy to prevent progression of sepsis
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A. Urgent decompression of the collecting system via percutaneous drainage or ureteral stenting The obstructed, infected kidney is a urological emergency requiring urgent decompression using percutaneous drainage or ureteral stenting; definitive stone treatment should be delayed until sepsis resolves. Immediate stone removal is inappropriate before decompression and antibiotics. Delaying drainage while only giving antibiotics is incorrect because decompression must occur urgently alongside antibiotics. Emergency nephrectomy is reserved for exceptional cases with severe sepsis or abscess formation, not as first-line management.
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