Question

Referring Physician: D. Neilson, MD, Emanuel Hospital Emergency Room

Reason for Consultation: Mr. Depanfilis is a 60-year-old Caucasian male who is brought to the ER with a rapid onset of severe right-sided flank pain. He was last well approximately three hours ago when he was awakened suddenly by sharp stabbing right-sided episodic back pain every five or so minutes. He arrived in the ER ambulatory and in great distress, as any jarring motion caused severe pain in his flank. He was assisted by his wife. He denies hesitancy, and dysuria.

Examination: Abdomen was rigid, Murphy’s punch positive for sharp right flank pain.

Laboratory: Radiology KUB series showed approximately 4-5 small renal calculi in the right kidney. Ultrasound: Revealed that the patient also had small calculi in the right proximal ureter. Urinalysis: cultures were sterile, +3 hematuria; no casts or protein noted. White count 5,400; Hematocrit 42.6; BUN, PSA, and creatinine were normal; partial thromboplastin and prothrombin times were normal.

Impression:

1. Renal calculi
2. Ureterolith

Procedure: Extracorporeal Shockwave Lithotripsy

Operative Report

The patient was transferred to the lithotripsy unit, and placed in the supine position on the table. Anesthesia was administered by Dr. Nophfeal. The patient was properly positioned on the table, in the foci of the shockwaves, via fluoroscopy. Mr. Depanfilis was given a total of 3,000 shocks at a maximum power setting of 2.0. He tolerated the procedure well and was transferred to recovery after it was determined that fragmentation was complete, and the debris was eliminated from the bladder.

Submitted D. Neilson, M.D. Urologist

What type of procedure was performed on Mr. Depanfilis?

Question 29 options:

	Removal of fluid using endoscopic procedures
	Breaking of the concretion of mineral salts by puncturing the skin
	Breaking of the stones by shockwave from outside the body
	Removal of the concretion of mineral salts using surgery

What did Mr. Depanfilis deny having when he was brought to the ER?

Question 1 options:

	Pain on the right side between the ribs and the hip bone
	Pain in the back on the right side
	Severe right sided flank pain
	Painful urination

Answer 1

1) Mr. Depanfilis undergone the procedure - the answer option is breaking of stone by shockwave from out side the body this procedure is called Lithotripsy

2) Removal of fluid using endoscopic procedure - is nothing but pancreatic fluid collection drainage by endoscopy.

3) breaking of the concretion of mineral salts by puncturing the skin - percutaneous nephrolitholapaxy

4) removal of the concretion of mineral salt using surgery - percutaneous nephrolithotomy

A) The answer is - severe right sided flank pain when Mr. Depanfills brought to the ER.

B) Pain on the right side between the ribs and hip bone _ there is no complaint like this in Mr. Depanfils case history.

C) Pain in the back on the right side - He compalints about this he was well approximately 3 hours ago when he was awakened suddently .

D) painful urination or dysuria - this symptom was there when his wife was assisted him but he denies.