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Q1: Renal colic presentation (2 min)
"A patient has sudden flank pain radiating to the groin. What's the diagnosis and key imaging?"
- Renal colic (ureteric stone) - loin to groin pain, restless patient, haematuria
- CT KUB gold standard (97%)
- US first-line in pregnancy/children
Q2: Stone types (2 min)
"Name the 4 types of urinary stones and one key feature of each."
- Calcium oxalate (75%): radio-opaque, spiky
- Uric acid (10%): radiolucent, dissolvable with alkalinisation
- Struvite (10%): staghorn, infection (Proteus)
- Cystine (1%): hexagonal, genetic (autosomal recessive)
Q3: Management by size (3 min)
"How do you manage a 4mm, 8mm, and 25mm stone?"
- 4mm: conservative (80% pass). Hydration + NSAIDs + tamsulosin
- 8mm: medical expulsive therapy trial (50% pass). If failed: ureteroscopy + laser (distal) or ESWL (kidney/proximal)
- 25mm kidney: PCNL (percutaneous nephrolithotomy) - gold standard for large stones over 20mm
Q4: Emergency (2 min)
"A patient with a ureteric stone has fever and hypotension. What do you do?"
- Infected obstructed system = UROLOGICAL EMERGENCY
- IV broad-spectrum antibiotics + IV fluids/resuscitation
- Urgent decompression: JJ stent (cystoscopic) or percutaneous nephrostomy
- Do NOT treat the stone during acute infection - decompress first
- Definitive stone treatment once infection resolves