CUA Surgical Procedures & Perioperative Care 1 — Questions and Answers
Question 1: What is the standard patient positioning for transurethral resection of the prostate (TURP)?
- Prone
- Lithotomy (Correct answer)
- Lateral decubitus
- Supine with hip elevation
Correct answer: Lithotomy
Lithotomy position provides optimal perineal and urethral access required for all transurethral endoscopic procedures.
Question 2: Which irrigation fluid is used during monopolar TURP to avoid conducting electrical current?
- Normal saline (0.9% NaCl)
- Glycine 1.5% (Correct answer)
- Lactated Ringer's solution
- Sterile water
Correct answer: Glycine 1.5%
Glycine 1.5% is a non-electrolyte, non-hemolytic solution used in monopolar TURP because normal saline conducts electricity and would disperse monopolar current.
Question 3: What is the hallmark presentation of transurethral resection (TUR) syndrome?
- Hypertension and bradycardia only
- Hyponatremia with neurological symptoms (Correct answer)
- Hyperkalemia and cardiac arrhythmias
- Hypercalcemia and confusion
Correct answer: Hyponatremia with neurological symptoms
TUR syndrome results from systemic absorption of hypotonic irrigant, causing dilutional hyponatremia that manifests as neurological symptoms including confusion, seizures, and cardiovascular instability.
Question 4: Before ureteroscopy, which pre-operative assessment finding most warrants procedure postponement?
- Serum creatinine 1.3 mg/dL
- Positive urine culture (Correct answer)
- INR of 1.1
- Mild hypertension
Correct answer: Positive urine culture
A positive urine culture must be treated before ureteroscopy to prevent urosepsis from instrumenting an infected, closed urinary system under pressure.
Question 5: Per current ASA guidelines, what is the recommended NPO duration for solid foods before elective urologic surgery?
- 2 hours
- 4 hours
- 6 hours (Correct answer)
- 12 hours
Correct answer: 6 hours
Current ASA guidelines require 6 hours NPO for light meals and 8 hours for fatty meals, with the standard recommendation for solid foods being 6 hours before elective surgery.
Question 6: According to AUA guidelines, which antibiotic class is recommended for prophylaxis before cystoscopy in high-risk patients?
- Macrolides
- Fluoroquinolones or trimethoprim-sulfamethoxazole (Correct answer)
- First-generation cephalosporins
- Aminoglycosides
Correct answer: Fluoroquinolones or trimethoprim-sulfamethoxazole
AUA Best Practice Statement recommends fluoroquinolones or trimethoprim-sulfamethoxazole for antimicrobial prophylaxis before lower urinary tract endoscopic procedures in at-risk patients.
Question 7: Which post-operative complication occurs most frequently after percutaneous nephrolithotomy (PCNL)?
- Pneumothorax
- Renal arteriovenous fistula
- Fever and urinary tract infection (Correct answer)
- Colonic injury
Correct answer: Fever and urinary tract infection
Fever and urinary tract infection are the most common complications after PCNL, occurring in up to 35% of patients due to bacteremia from stone manipulation in the renal collecting system.
CUA Surgical Procedures & Perioperative Care 1
What is the standard patient positioning for transurethral resection of the prostate (TURP)?