PAEA Surgery End Of Rotation (EOR) Practice Exam

What intervention is recommended for managing stones larger than 10mm?

1. Ureteral stent

2. Extracorporeal Shock Wave Lithotripsy

3. Percutaneous Nephrolithomy

4. Open Surgery

The correct answer is: Ureteral stent

For managing stones larger than 10mm, the recommended intervention is typically Extracorporeal Shock Wave Lithotripsy (ESWL). This non-invasive procedure uses shock waves generated outside the body to break the kidney stones into smaller fragments, which can then be passed more easily through the urinary tract. ESWL is particularly effective for stones that are at least 4mm but generally less so for stones larger than 10mm, where alternative procedures may be necessary. Ureteral stenting is a procedure that helps relieve urinary obstruction caused by a stone, but it does not directly manage the stone itself. It can be utilized as a temporary measure to allow for the passage of a stone or to facilitate drainage, but it does not eliminate the stone. Percutaneous nephrolithomy is a more invasive approach suitable for larger stones (typically over 2cm), which involves making a small incision in the back and directly accessing the kidney to remove the stones. This method is highly effective for very large stones or those that are difficult to reach but is not the first line of management solely for stones over 10mm. Open surgery is usually reserved for complicated cases where other methods have failed or when there are associated anatomical considerations, but it is less