Stone Disease & Endourology

A 34-year-old with acute flank pain; non-contrast CT shows a 5 mm distal ureteral stone; best initial management?

Radiolucent stone on KUB but visible on CT; most likely composition?

Obstructed and infected kidney with fever, leukocytosis, and hydronephrosis; next best step?

Contraindication to shock wave lithotripsy (SWL) includes:

A 2.2 cm lower-pole renal stone; most effective first-line procedure?

Stone analysis shows hexagonal crystals on urinalysis; diagnosis?

Target urine pH to dissolve uric acid stones with alkalinization?

First-line pharmacologic prevention in recurrent calcium oxalate stone former with hypercalciuria?

Which imaging modality has the highest sensitivity for ureteral stones?

Steinstrasse is most commonly a complication of which therapy?

A 1.4 cm hard lower-pole renal stone with high density (>1200 HU); SWL outcome?

24-hour urine shows low volume, high sodium, and hyperoxaluria; cornerstone lifestyle change?

Distal ureteral stone 8 mm with uncontrolled pain after 72 hours despite MET; next step?

Infection stone composition is typically:

Recurrent uric acid stones with normal uric acid excretion; preventive drug?

Best imaging for suspected renal colic in pregnancy?

Which factor most increases risk of SWL-related perinephric hematoma?

A 2.8 cm staghorn stone with recurrent UTIs; preferred management?

After URS with ureteral stent placement, severe flank pain and fever develop; first concern?

Which dietary advice reduces calcium oxalate stone risk?

Radiographic clue favoring cystine stone on CT?

Indication to place a ureteral access sheath during flexible ureteroscopy?

Hyperparathyroidism causes stones via which mechanism?

A 9 mm proximal ureteral stone; reasonable first-line options include:

Best long-term test to guide metabolic prevention after a first calcium stone in high-risk patient?

Which medication increases stone risk and should be reviewed?

A 1.1 cm lower-pole stone with unfavorable infundibulopelvic angle; best endoscopic option?

Optimal perioperative antibiotic strategy for PCNL?

Stone analysis shows calcium oxalate monohydrate (COM); SWL responsiveness?

Patient with ileal disease/resection has recurrent calcium oxalate stones; mechanism?

Preferred first-line therapy for 1.8 cm renal pelvis stone in non-obese patient with HU 700?

Which step reduces risk of post-URS sepsis?

Classic urine finding in distal renal tubular acidosis (type 1) stone former?

Medical prevention for cystinuria when alkalinization and fluids insufficient?

Imaging sign of a recently passed stone on CT?

Which factor most strongly predicts SWL success?

Definitive treatment for 3.5 cm complete staghorn calculus?

Which dietary recommendation lowers urinary oxalate absorption?

Best management for symptomatic 12 mm proximal ureteral stone in pregnancy failing conservative therapy?

For recurrent calcium oxalate stones with hypocitraturia and normal potassium, the preferred agent is:

An alkaline urine pH of 8.0 with urease-positive bacteriuria suggests which stone type?

A 1.3 cm brushite (calcium phosphate) stone, HU 1300; best expectation with SWL?

Hypercalciuric CaOx stone former already on thiazide; which diet change improves efficacy?

Recurrent CaOx stones with hypocitraturia; best pharmacologic prevention?

Minimum target urine volume to reduce recurrent stones?

During MET for a 6 mm distal ureteral stone, appropriate reassessment timing is:

Which is NOT a typical indication for ureteral stent after uncomplicated URS?

Post-URS stent discomfort is best mitigated by:

Absolute contraindication to PCNL?

Optimal PCNL access typically targets:

Laser lithotripsy “dusting” during URS uses:

Which factor most reduces SWL success?

HU threshold on CT predicting poor SWL fragmentation?

Preferred stone procedure in a patient who must continue anticoagulation?

Intraoperative ureteral perforation during URS; best immediate management?

Ureteral avulsion during URS requires:

Most common cause of pediatric nephrolithiasis?

Impacted distal ureteral stone complication risk increased for:

Optimal metabolic workup for recurrent stones includes:

Calcium phosphate (brushite) stone formers typically have:

Hyperuricosuric CaOx stone formation prevention when diet fails?

Recommended dietary calcium intake for stone prevention in adults?

After Roux-en-Y gastric bypass with recurrent CaOx stones, best preventive step?

Definitive management of struvite staghorn calculus?

Antiretroviral-associated stones poorly visible on CT are classically due to:

Key benefit of potassium citrate in CaOx prevention is:

To minimize bleeding during PCNL access, puncture should be:

Risk factor for ureteral perforation during URS includes:

Strong predictor of stent encrustation is:

Preoperative factor most predictive of post-URS sepsis?

Most sensitive test to detect residual fragments after URS?

A common working definition of clinically insignificant residual fragments (CIRF) is:

CT feature suggesting uric acid stone and possible dissolution therapy candidacy?

Radiolucent stones in Lesch–Nyhan or excess allopurinol therapy are typically:

Relative contraindication to SWL due to risk of vascular injury is:

Supracostal PCNL access increases risk of which complication?

Compared with serial fascial dilators, balloon dilation for PCNL tract offers:

Advantage of mini‑PCNL compared with standard PCNL is:

For 1.5–2.0 cm lower‑pole stones with unfavorable anatomy, which has higher stone-free rates?

Before PCNL, which preoperative goal reduces infectious complications?

A recurrent stone former has hyperuricosuria with normal urine calcium; best pharmacologic prevention?

In cystinuria, target urine parameters to prevent stones include:

A 1.8 cm renal pelvis stone, BMI 38, skin‑to‑stone distance 12 cm; preferred approach?

Post‑URS day 3 fever 39.5°C, tachycardia, hypotension; first critical step?

Optimal initial management of a 3.0 cm partial staghorn in upper pole with favorable access?

Which medication reduces stone risk by increasing urinary citrate?

Percutaneous access is planned; which structure marks the relatively avascular “line of Brodel”?

For pregnant patient with obstructing ureteral stone and urosepsis, the most immediate action is:

Which laser setting combination favors “dusting” over fragmentation?

Criteria supporting stent omission after uncomplicated URS include:

In thiazide therapy for hypercalciuria, which lab requires periodic monitoring?

A 5 mm distal ureteral uric acid stone not passing; best dissolution adjunct?

After PCNL, which finding most strongly suggests vascular complication requiring angiography?

Micro‑PCNL is characterized by:

Which metabolic abnormality drives ammonium acid urate stones?

A 10 mm proximal ureteral stone with 1300 HU; preferred treatment?

Preferred imaging to limit radiation in recurrent stone former needing follow‑up?

A 7 mm distal ureteral stone patient on apixaban; needs definitive treatment. Safest approach?

Post‑URS severe colic from stent; best symptomatic strategy?

In enteric hyperoxaluria, which supplement taken with meals reduces urinary oxalate?

Which CT feature supports cystine stone diagnosis?

When using a ureteral access sheath, the main physiologic benefit is:

A patient with medullary sponge kidney forms recurrent CaP stones; key urine finding?

For PCNL positioning, a benefit of supine over prone is:

Forgotten ureteral stent 12 months; most important next step?

Which antibiotic strategy best reduces post‑PCNL sepsis in high‑risk positive culture patient?

Most reliable method to confirm complete ureteral stone clearance intraoperatively?

Which scenario favors tubeless PCNL (no nephrostomy tube)?

APRT deficiency causes which stone type?

Mechanism of topiramate‑associated stones?

For residual 3 mm asymptomatic fragment after URS, reasonable plan is:

Which maneuver reduces retropulsion during laser lithotripsy?

A patient with primary hyperoxaluria shows which classic feature?

Struvite stone definitive management requires:

During URS, keeping intrarenal pressure below which level helps reduce forniceal rupture/sepsis risk?

For pediatric stones, first‑line metabolic evaluation includes:

In obstructing ureteral stone with rising creatinine but no infection, initial management?

A 2.2 cm lower‑pole stone with narrow infundibulum; best single‑session clearance strategy?

Which nutritional advice is CORRECT for most calcium stone patients?

Timing of first follow‑up after initiating prevention therapy in recurrent stone former?

Compared with holmium:YAG, thulium fiber laser (TFL) lithotripsy typically offers which advantage?

During SWL, a “ramp‑up” strategy (gradual energy increase with initial pause) primarily aims to:

Which is a contraindication to performing SWL today?

Obstructing ureteral stone with rising creatinine but afebrile; best initial approach?

For recurrent CaOx stones, which supplement should be avoided due to higher oxalate risk?

Key counseling point for “lemonade therapy” in hypocitraturia is:

When is sodium bicarbonate preferred over potassium citrate for uric acid stone dissolution?

In cystinuria, a positive screening test on fresh urine is:

Which patient factor most strongly predicts struvite stone formation?

Preferred therapy for heavily encrusted forgotten stent with large bladder calculus is usually:

After SWL for 2.2 cm renal stone, patient develops colic and anuria; imaging shows steinstrasse without infection. Next best step?

Which semi‑rigid ureteroscopy indication is most appropriate?

Advantage of pre‑stenting before difficult RIRS for large renal stones is:

Best definition of stone‑free status after URS/PCNL in many trials is:

In patients with spinal cord injury and recurrent stones, which stone type is most typical?

For renal transplant recipients with ureteral stones, preferred definitive approach is often:

A matrix stone is best described as:

For impacted proximal ureteral stone with ureteral edema preventing passage of flexible scope, a reasonable plan is:

Which dietary pattern reduces stone risk and blood pressure?

Ureteral access sheath selection should consider:

Most appropriate timing for removing a routine stent after uncomplicated URS?

Which scenario favors a stent‑on‑string for home removal?

In hyperparathyroidism causing stones, the most definitive management is:

Which antibiotic principle is correct for endourologic procedures?

For a 1.6 cm lower‑pole stone with steep infundibulopelvic angle and long infundibulum, the single‑session strategy with highest SFR is:

What is the primary mechanism of allopurinol in CaOx stone prevention with hyperuricosuria?

Which feature suggests enteric hyperoxaluria rather than primary hyperoxaluria?

Following PCNL, persistent urinary leakage from nephrostomy site is most commonly due to:

In suspected distal RTA, which preventive therapy is central?

For ureteral stricture after impacted stone, first‑line endoscopic option is often:

Which CT feature favors a uric acid stone treatable with dissolution?

Thiazide‑treated patients should receive which diet advice to maximize effect?

In pediatrics, first‑line imaging for suspected stones is:

A patient with 10 mm distal ureteral stone on DOAC declines temporary cessation; best definitive option?

Which perioperative tactic lowers sepsis risk during URS?

For recurrent ammonium acid urate or struvite stones when infection source cannot be eradicated, an adjunct is: