WorksheetsRenal colic pain's quiz
Total questions: 22
Worksheet time: 19mins
Which of the following is the most common cause of renal colic?
Retroperitoneal fibrosis
Ureteral stone
Congenital ureteral stricture
Blood clot in the ureter
A patient with post-renal AKI may present with "oliguria." This clinical sign is specifically defined as:
A significantly reduced or scanty urine output.
The presence of blood in the urine.
Painful or difficult urination.
The complete absence of urine production.
Which of the following is listed as a key clinical feature of post-renal Acute Kidney Injury (AKI)?
Rapid rise in serum creatinine and urea
Respiratory alkalosis
Rapid decrease in serum creatinine
Polyuria and hypokalemia
A 78-year-old female with a history of Stage 3 chronic kidney disease and healed peptic ulcer disease is admitted for severe renal colic. Due to her contraindications to NSAIDs, the physician decides to use intravenous hydromorphone for analgesia. Several hours after administration, the nurse reports that the patient has become lethargic, has slurred speech, and her respiratory rate has decreased to 10 breaths/minute. This clinical presentation is an manifestation of which adverse effect of opioids?
Respiratory depression and sedation.
Reactive hypertension.
Reduced gastrointestinal motility.
An allergic drug reaction.
Which of the following is an example of extrinsic obstruction causing renal colic?
Sloughed renal papilla
Retroperitoneal tumor
Ureteral stricture
Blood clot in the ureter
Which of the following is mentioned as a risk factor for developing a Urinary Tract Infection (UTI) in the context of an obstructing stone?
Diabetes mellitus
Hypertension
Male gender
High fluid intake
Which of the following associated symptoms is most common in renal colic?
A. Diarrhea
B. Chest pain
C. Nausea and vomiting
D. Productive cough
What finding is most typical in urinalysis of renal colic patients?
A. Proteinuria
B. Hematuria
C. Glucosuria
D. Pyuria
A patient in the ICU for obstructed urosepsis has a SOFA score that increases by 3 points from baseline. They are oliguric and hypotensive. According to the text, which combination of interventions is most crucial and time-sensitive?
Starting renal replacement therapy and performing a metabolic workup for stone prevention.
Gaining source control via decompression and administering IV antibiotics within 1 hour.
Aggressive blood pressure control with beta-blockers and starting long-term prophylaxis.
Administering oral antibiotics within 24 hours and monitoring vital signs.
The term "pyuria," a key finding in a urinalysis suggesting a UTI, refers to the presence of what substance in the urine?
Ketone bodies
Red blood cells
White blood cells
Glucose
A 58-year-old female with a history of recurrent UTIs was admitted for acute pyelonephritis. She was started on IV ceftriaxone 24 hours ago. A nurse calls you to report that the patient has become increasingly lethargic and difficult to arouse. Her heart rate is 130 bpm, her respiratory rate is 28/min, and her blood pressure is 85/50 mmHg despite receiving 2.5 liters of normal saline over the past few hours. Her urine output has dropped to less than 10 mL/hour. Laboratory results show her serum lactate has increased to 4.2 mmol/L. Given her persistent hypotension despite fluid resuscitation, what is the most appropriate next step in her hemodynamic management according to the provided material?
Send her for an urgent contrast-enhanced CT scan to definitively rule out a perinephric abscess before altering the treatment plan.
Administer a diuretic like furosemide to challenge the kidneys and treat the oliguria.
Broaden antibiotic coverage to include vancomycin for MRSA and wait another hour to see if her blood pressure improves with the new antibiotic.
Initiate vasopressor support, such as a norepinephrine infusion, to maintain mean arterial pressure, as she is now in septic shock.
Why might severe obesity be considered an indication for open surgery?
Because laparoscopic surgery is technically impossible in obese patients.
Because obese patients always prefer a single, definitive surgery.
Because obesity is an absolute contraindication for all medical management.
Because excess body mass can make percutaneous or endoscopic approaches difficult due to inadequate imaging or instrument reach.
How do corticosteroids contribute to the passage of a ureteral stone?
By reducing local inflammation and edema around the stone, thus widening the ureteral lumen.
By breaking down the stone's chemical structure.
By increasing the glomerular filtration rate to flush the stone out.
By directly relaxing the smooth muscle of the ureter.
Which of the following stones is radiolucent on plain X-ray?
Uric acid stone
Struvite stone
Calcium phosphate stone
Calcium oxalate stone
A 35-year-old man presents with an acute, sudden onset of excruciating left flank pain, which he describes as far more severe and sharp than his previous episodes of renal colic. He has a low-grade fever of 38.1°C (100.6°F). On physical exam, he has marked costovertebral angle tenderness and guarding, with signs suggestive of localized peritonism in the left upper quadrant. His hemoglobin has dropped from a baseline of 15 g/dL to 12.5 g/dL. A CT scan is ordered to investigate this atypical presentation. Which imaging finding would be most definitive for diagnosing a urinoma secondary to forniceal rupture?
Severe hydronephrosis due to a 9mm stone at the ureteropelvic junction, but with the collecting system remaining intact.
Diffuse thinning of the renal cortex and evidence of significant interstitial fibrosis throughout the kidney.
A large perinephric fluid collection with clear evidence of contrast material leaking from a renal calyx into the surrounding space on the delayed excretion phases of the CT scan.
A well-defined, thick, rim-enhancing fluid collection within the renal parenchyma, consistent with a renal abscess.
Which investigation is most sensitive for detecting ureteric stones?
A. Abdominal X-ray
B. Ultrasound
C. Intravenous pyelogram
D. Non-contrast CT (CT KUB)
Ultrasound of the kidney in renal colic may show
A. Hydronephrosis
B. Thickened bladder wall
C. Gallstones
D. Enlarged spleen
A patient with renal colic complains of burning during urination and visible blood in urine. What is the most likely cause of hematuria?
A. Infection of the kidney
B. Glomerular disease
C. Trauma to urinary tract mucosa by the stone
D. Bleeding disorder
A 68-year-old male with a known history of coronary artery disease (managed with a permanent pacemaker) and chronic atrial fibrillation (for which he takes warfarin daily) is referred to you. He has a symptomatic 1.9 cm stone located in the renal pelvis causing intermittent pain and mild hydronephrosis. He is also morbidly obese with a BMI of 42. Considering his complex medical history and physical characteristics, which of the following treatment modalities is most clearly contraindicated
Flexible Ureterorenoscopy with laser lithotripsy (fURS).
Extracorporeal Shock Wave Lithotripsy (ESWL).
Open nephrolithotomy as a final option if other methods are not feasible.
Percutaneous Nephrolithotomy (PCNL), after careful management of his anticoagulation.
Which of the following types of urinary stones is most commonly associated with urinary tract infection (UTI)?
Uric acid
Cystine
Calcium oxalate
Struvite (magnesium ammonium phosphate)
A ureteral stone measuring 12 mm in diameter is classified as which size category?
Large stone
Medium stone
Very large stone
Small stone
A 32-year-old female is diagnosed with a 5 mm distal ureteral stone after her acute pain was controlled with NSAIDs in the emergency department. She is considered a suitable candidate for outpatient conservative management. To maximize the chance of spontaneous stone passage, the physician decides to prescribe a combination drug regimen. Based on the mechanisms of action described in the text, which of the following combinations is most logical?
An antibiotic (to prevent infection) and an anti-edematous agent.
An opioid (for potential breakthrough pain) and a smooth muscle relaxant.
An alpha-blocker (e.g., tamsulosin) to promote ureteral relaxation and a corticosteroid to reduce local mucosal edema.
An NSAID (to reduce spasm) and a calcium channel blocker (to reduce spasm).
