Clinical Decision Making Flashcards
1
Q
- Pain associated with a stone in the ureter is the result of:
a. obstruction of urine flow with distention of the renal capsule.
b. irritation of the ureteral mucosa by the stone.
c. excessive ureteral peristalsis in response to the obstructing
stone.
d. irritation of the intramural ureter.
e. urinary extravasation from a ruptured calyceal fornix
A
- a. Obstruction of urine flow with distention of the renal capsule.
Pain is usually caused by acute distention of the renal capsule,
usually from inflammation or obstruction.
2
Q
- The most common cause of gross hematuria in a patient older than
50 years is:
a. renal calculi.
b. infection.
c. bladder cancer.
d. benign prostatic hyperplasia.
e. trauma.
A
- c. Bladder cancer.
3
Q
- The most common cause of pain associated with gross hematuria is:
a. simultaneous passage of a kidney stone.
b. ureteral obstruction due to blood clots.
c. urinary tract malignancy.
d. prostatic inflammation.
e. prostatic enlargement.
A
- b. Ureteral obstruction due to blood clots. Pain in association
with hematuria usually results from upper urinary tract hematuria
with obstruction of the ureters with clots.
4
Q
- All of the following are typical lower urinary tract symptoms
associated with benign prostatic hyperplasia EXCEPT:
a. urgency.
b. frequency.
c. nocturia.
d. dysuria.
e. weak urinary stream.
A
- d. Dysuria. Dysuria is painful urination that is usually caused by
inflammation.
5
Q
- The most likely cause of continuous incontinence (loss of urine at
all times and in all positions) is:
a. enterovesical fistula.
b. noncompliant bladder.
c. detrusor hyperreflexia.
d. vesicovaginal fistula.
e. sphincteric incompetence.
A
- d. Vesicovaginal fistula. Continuous incontinence is most
commonly due to a urinary tract fistula that bypasses the urethral
sphincter or an ectopic ureter.
6
Q
- All of the following are potential causes of anejaculation EXCEPT:
a. sympathetic denervation.
b. pharmacologic agents.
c. bladder neck and prostatic surgery.
d. androgen deficiency.
e. cerebrovascular accidents
A
- e. Cerebrovascular accidents. Anejaculation may result from
several causes: (1) androgen deficiency, (2) sympathetic
denervation, (3) pharmacologic agents, and (4) bladder neck and
prostatic surgery.
7
Q
- What percentage of patients with multiple sclerosis will present
with urinary symptoms as the first manifestation of the disease?
a. 1%
b. 5%
c. 10%
d. 15%
e. 20%
A
- b. 5%. In fact, 5% of patients with previously undiagnosed multiple
sclerosis present with urinary symptoms as the first manifestation
of the disease.
8
Q
- What important information is gained from pelvic bimanual
examination that cannot be obtained from radiologic evaluation?
a. Presence of bladder mass
b. Invasion of bladder cancer into perivesical fat
c. Presence of bladder calculi
d. Presence of associated pathologic lesion in female adnexal
structures
e. Mobility/fixation of pelvic organs
A
- e. Mobility/fixation of pelvic organs. In addition to defining areas
of induration, the bimanual examination allows the examiner to
assess the mobility of the bladder; such information cannot be
obtained by radiologic techniques such as computed tomography
(CT) and magnetic resonance imaging (MRI), which convey static
images.
9
Q
- With which of the following diseases is priapism most commonly
associated?
a. Peyronie disease
b. Sickle cell anemia
c. Parkinson disease
d. Organic depression
e. Leukemia
A
- b. Sickle cell anemia. Priapism occurs most commonly in
patients with sickle cell disease but can also occur in those with
advanced malignancy, coagulation disorders, and pulmonary
disease, as well as in many patients without an obvious cause.
10
Q
- What is the most common cause of cloudy urine?
a. Bacterial cystitis
b. Urine overgrowth with yeast
c. Phosphaturia
d. Alkaline urine
e. Significant proteinuria
A
- c. Phosphaturia. Cloudy urine is most commonly caused by
phosphates in the urine.
11
Q
- Conditions that decrease urine specific gravity include all of the
following EXCEPT:
a. increased fluid intake.
b. use of diuretics.
c. decreased renal concentrating ability.
d. dehydration.
e. diabetes insipidus.
A
- d. Dehydration. Conditions that decrease specific gravity include
(1) increased fluid intake, (2) diuretics, (3) decreased renal
concentrating ability, and (4) diabetes insipidus.
12
Q
- Urine osmolality usually varies between:
a. 10 and 200 mOsm/L.
b. 50 and 500 mOsm/L.
c. 50 and 1200 mOsm/L.
d. 100 and 1000 mOsm/L.
e. 100 and 1500 mOsm/L.
A
- c. 50 and 1200 mOsm/L. Osmolality is a measure of the amount of
solutes dissolved in the urine and usually varies between 50 and
1200 mOsm/L.
13
Q
- Elevated ascorbic acid levels in the urine may lead to false-negative
results on a urine dipstick test for:
a. glucose.
b. hemoglobin.
c. myoglobin.
d. red blood cells.
e. leukocytes.
A
- a. Glucose. False-negative results for glucose and bilirubin may be
seen in the presence of elevated ascorbic acid concentrations in the
urine.
14
Q
- Hematuria is distinguished from hemoglobinuria or myoglobinuria
by:
a. dipstick testing.
b. the simultaneous presence of significant leukocytes.
c. microscopic presence of erythrocytes.
d. examination of serum.
e. evaluation of hematocrit.
A
- c. Microscopic presence of erythrocytes. Hematuria can be
distinguished from hemoglobinuria and myoglobinuria by
microscopic examination of the centrifuged urine; the presence of a
large number of erythrocytes establishes the diagnosis of
hematuria.
15
Q
- The presence of one positive dipstick reading for hematuria is
associated with significant urologic pathologic findings on
subsequent testing in what percentage of patients?
a. 2%
b. 10%
c. 25%
d. 50%
e. 75%
A
- c. 25%. Investigators at the University of Wisconsin found that
26% of adults who had at least one positive dipstick reading for
hematuria were subsequently found to have significant urologic
pathologic findings.
16
Q
- The most common cause of glomerular hematuria is:
a. transitional cell carcinoma.
b. nephritic syndrome.
c. Berger disease (immunoglobulin A nephropathy).
d. poststreptococcal glomerulonephritis.
e. Goodpasture syndrome.
A
- c. Berger disease (immunoglobulin A nephropathy). IgA
nephropathy, or Berger disease, is the most common cause of
glomerular hematuria, accounting for about 30% of cases.
17
Q
- The most common cause of proteinuria is:
a. Fanconi syndrome.
b. excessive glomerular permeability due to primary glomerular
disease.
c. failure of adequate tubular reabsorption.
d. overflow proteinuria due to increased plasma concentration of
immunoglobulins.
e. diabetes.
A
- b. Excessive glomerular permeability due to primary
glomerular disease. Glomerular proteinuria is the most common
type of proteinuria and results from increased glomerular capillary
permeability to protein, especially albumin. Glomerular proteinuria
occurs in any of the primary glomerular diseases such as IgA
nephropathy or in glomerulopathy associated with systemic illness
such as diabetes mellitus.
18
Q
- Transient proteinuria may be due to all of the following EXCEPT:
a. exercise.
b. fever.
c. emotional stress.
d. congestive heart failure (CHF).
e. ureteroscopy.
A
- e. Ureteroscopy. Transient proteinuria occurs commonly,
especially in the pediatric population, and usually resolves
spontaneously within a few days. It may result from fever, exercise,
or emotional stress. In older patients, transient proteinuria may be
due to CHF.
19
Q
- Glucose will be detected in the urine when the serum level is
above:
a. 75 mg/dL.
b. 100 mg/dL.
c. 150 mg/dL.
d. 180 mg/dL.
e. 225 mg/dL.
A
- d. 180 mg/dL. This so-called renal threshold corresponds to a
serum glucose level of about 180 mg/dL; above this level, glucose
will be detected in the urine
20
Q
- The specificity of dipstick nitrite testing for bacteriuria is:
a. 20%.
b. 40%.
c. 60%.
d. 80%.
e. >90%.
A
- e. >90%. The specificity of the nitrite dipstick test for detecting
bacteriuria is greater than 90%.
21
Q
- All of the following are microscopic features of squamous
epithelial cells EXCEPT:
a. large size.
b. small central nucleus.
c. irregular cytoplasm.
d. presence in clumps.
e. fine granularity in the cytoplasm.
A
- d. Presence in clumps. Squamous epithelial cells are large, have a
central small nucleus about the size of an erythrocyte, and have an
irregular cytoplasm with fine granularity.
22
Q
- The number of bacteria per high-power microscopic field that
corresponds to colony counts of 100,000/mL is:
a. 1.
b. 3.
c. 5.
d. 10.
e. 20.
A
- c. 5. Therefore five bacteria per high-power field in a spun
specimen reflect colony counts of about 100,000/mL.
23
Q
- Pain in the flaccid penis is usually due to:
a. Peyronie disease.
b. bladder or urethral inflammation.
c. priapism.
d. calculi impacted in the distal ureter.
e. hydrocele.
A
- b. Bladder or urethral inflammation. Pain in the flaccid penis is
usually secondary to inflammation in the bladder or urethra, with
referred pain that is experienced maximally at the urethral meatus.
24
Q
- Chronic scrotal pain is most often due to:
a. testicular torsion.
b. trauma.
c. cryptorchidism.
d. hydrocele.
e. orchitis.
A
- d. Hydrocele. Chronic scrotal pain is usually related to
noninflammatory conditions such as a hydrocele or varicocele, and
the pain is usually characterized as a dull, heavy sensation that does
not radiate
25
Q
- Terminal hematuria (at the end of the urinary stream) is usually due
to:
a. bladder neck or prostatic inflammation.
b. bladder cancer.
c. kidney stones.
d. bladder calculi.
e. urethral stricture disease.
A
- a. Bladder neck or prostatic inflammation. Terminal hematuria
occurs at the end of micturition and is usually secondary to
inflammation in the area of the bladder neck or prostatic urethra.
26
Q
- Enuresis is present in what percentage of children at age 5 years?
a. 5%
b. 15%
c. 25%
d. 50%
e. 75%
A
- b. 15%. Enuresis refers to urinary incontinence that occurs during
sleep. It occurs normally in children as old as 3 years but persists in
about 15% of children at age 5 and about 1% of children at age 15.
27
Q
- All of the following in the medical history suggest that erectile
dysfunction is more likely due to organic rather than psychogenic
causes EXCEPT:
a. sudden onset.
b. peripheral vascular disease.
c. absence of nocturnal erections.
d. diabetes mellitus.
e. inability to achieve adequate erections in a variety of
circumstances.
A
- a. Sudden onset. A careful history will often determine whether
the problem is primarily psychogenic or organic. In men with
psychogenic impotence, the condition frequently develops rather
quickly, secondary to a precipitating event such as marital stress or
change or loss of a sexual partner.
28
Q
- All of the following should be routinely performed in men with
hematospermia EXCEPT:
a. cystoscopy.
b. digital rectal examination.
c. serum prostate-specific antigen (PSA) level.
d. genital examination.
e. urinalysis.
A
- a. Cystoscopy. A genital and rectal examination should be done to
exclude the presence of tuberculosis, a PSA assessment and digital
rectal examination should be done to exclude prostatic carcinoma,
and a urinary cytologic assessment should be done to exclude the
possibility of transitional cell carcinoma of the prostate.
29
Q
- Pneumaturia may be due to all of the following EXCEPT:
a. diverticulitis.
b. colon cancer.
c. recent urinary tract instrumentation.
d. inflammatory bowel disease.
e. ectopic ureter
A
- e. Ectopic ureter. Pneumaturia is the passage of gas in the urine. In
patients who have not recently had urinary tract instrumentation or
a urethral catheter placed, this is almost always due to a fistula
between the intestine and bladder. Common causes include
diverticulitis, carcinoma of the sigmoid colon, and regional
enteritis (Crohn disease).
30
Q
- Which of the following disorders may commonly lead to irritative
voiding symptoms?
a. Parkinson disease
b. Renal cell carcinoma
c. Bladder diverticula
d. Prostate cancer
e. Testicular torsion
A
- a. Parkinson disease. The second important example of
nonspecific lower urinary tract symptoms that may occur
secondary to a variety of neurologic conditions is irritative
symptoms resulting from neurologic disease such as
cerebrovascular accident, diabetes mellitus, or Parkinson disease
31
Q
- All of following is true of uroflowmetry EXCEPT:
a. Qmax >20 mL/s is not consistent with obstruction.
b. Qmax, mean flow rate, and voided volume are parameters
obtained from this study.
c. 80 mL voided volume is adequate for uroflowmetry.
d. the study can be performed in sitting and standing positions.
e. uroflowmetry cannot diagnose the location of obstruction.
A
- c. 80 mL voided volume is adequate for uroflowmetry. The
minimum voided volume that is accepted as a requirement for
considering an adequate assessment is at least 100 mL.
32
Q
- The following should be given to uncomplicated patients
undergoing simple flexible diagnostic cystourethroscopy:
a. single-dose oral antibiotic following procedure
b. 3 days of oral antibiotics following procedure
c. 3 days of oral antibiotics starting the day prior to procedure
d. nothing
e. single intramuscular injection of ceftriaxone following
procedure
A
- d. Nothing. For patients undergoing simple diagnostic flexible
cystoscopy no antibiotic prophylaxis is recommended unless there
are extenuating risk factors for infection or recent orthopedic
implantation of artificial joints. Refer to American Urological
Association (AUA) recommendations on antibiotic prophylaxis for
urological procedures
33
Q
- What is the most appropriate initial workup for asymptomatic
microscopic hematuria (AMH)?
a. Flexible cystoscopy, urinary cytology, CT urogram, and
UroVysion FISH
b. Flexible cystoscopy and CT urogram
c. CT urogram and NMP22
d. Flexible cystoscopy, urinary cytology, and CT urogram
e. Flexible cystoscopy, renal ultrasound, and urinary cytology
A
- b. Flexible cystoscopy and CT urogram. For the initial work-up
of AMH, routine urine cytology is not necessary. Cytology is
generally utilized in patients with a history of bladder cancer
undergoing surveillance or the index of suspicion of a high-grade
lesion is present.
34
Q
- The measure of the potential adverse health effects of ionizing
radiation in sieverts (Sv) is known as:
a. radiation exposure.
b. absorbed dose.
c. equivalent dose.
d. effective dose.
e. relative radiation levels.
A
- d. Effective dose. The distribution of energy absorption in the
human body will be different based on the body part being imaged
and a variety of other factors. The most important risk of radiation
exposure from diagnostic imaging is the development of cancer.
The effective dose is a quantity used to denote the radiation risk
(expressed in sieverts) to a population of patients from an
imaging study.
35
Q
- The relative radiation level associated with abdominal computed
tomography (CT) without and with contrast is:
a. none.
b. minimal, less than 0.1 mSv.
c. low, 0.1 to 1.0 mSv.
d. moderate, 1 to 10 mSv.
e. high, 10 to 100 mSv
A
- e. High, 10 to 100 mSv. The average person living in the United
States is exposed to 6.2 mSv of radiation per year from ambient
sources, such as radon, cosmic rays, and medical procedures, which
account for 36% of the annual radiation exposure (NCRP, 2012).
The recommended occupational exposure limit to medical
personnel is 50 mSv per year (NCRP, 2012). The effective dose
from a three-phase CT of the abdomen and pelvis without and with
contrast may be as high as 25 to 40 mSv.
36
Q
- Bladder filling may precipitate autonomic dysreflexia in patients
with a spinal cord injury above:
a. S2.
b. L4.
c. T10.
d. T12.
e. T6.
A
- e. T6. Autonomic dysreflexia, also known as hyperreflexia, means
an overactivity of the autonomic nervous system that can result in
an abrupt onset of excessively high blood pressure. Persons at risk
for this problem generally have spinal cord injury level above T6.
Autonomic dysreflexia can develop suddenly, is potentially life
threatening, and is considered a medical emergency. If not treated
promptly and correctly, it may lead to seizures, stroke, and even
death.
37
Q
- Radiation exposure diminishes as the square of the distance from
the radiation source. An exposure of 9 mSv at 1 foot from the
source would be how much at 3 feet from the source?
a. 0.09 mSv
b. 1 mSv
c. 3 mSv
d. 9 mSv
e. 27 mSv
A
- b. 1 mSv. Maintaining the maximum practical distance from an
active radiation source significantly decreases exposure to medical
personnel.
38
Q
- Type 2 diabetics on oral metformin biguanide hyperglycemic
therapy are at risk for biguanide lactic acidosis after exposure to
intravascular radiologic contrast media if they:
a. discontinue metformin 48 hours before the study.
b. have severe renal insufficiency and take metformin the day of
the study.
c. are given a saline injection while taking metformin.
d. have normal kidney function and fail to stop metformin 48
hours before the study.
e. decrease metformin dose and increase other antihyperglycemic
agents on the day of the study.
A
- b. Have severe renal insufficiency and take metformin the day
of the study. Patients with type 2 diabetes mellitus on metformin
may have an accumulation of the drug after administering
intravascular radiologic contrast medium (IRCM), resulting in
biguanide lactic acidosis presenting with vomiting, diarrhea, and
somnolence. This condition is fatal in approximately 50% of cases
(Wiholm, 1993). a Biguanide lactic acidosis is rare in patients
with normal renal function. Consequently in patients with
normal renal function and no known comorbidities, there is no
need to discontinue metformin before IRCM use, nor is there a
need to check creatinine following the imaging study.
39
Q
- All of the following are true EXCEPT:
a. Patients with a history of asthma are at greater risk of having
an adverse reaction to contrast media.
b. Severe allergic reactions are not dose dependent.
c. Hyperosmolar contrast media are more likely to cause contrast
reactions than are iso-osmolar agents.
d. The mechanism of action associated with severe idiosyncratic
anaphylactoid (IA) reactions is an immunoglobulin E (IgE)
antibody reaction to the contrast media.
e. Severe cardiac disease is a risk factor for an adverse reaction
to contrast media.
A
- d. The mechanism of action associated with severe idiosyncratic
anaphylactoid (IA) reactions is an immunoglobulin E (IgE)
antibody reaction to the contrast media. The IA reactions are
most concerning because they are potentially fatal and can occur
without any predictable or predisposing factors. Approximately
85% of IA reactions occur during or immediately after
injection of IRCM and are more common in patients with a
prior adverse drug reaction to contrast media; patients with
asthma, diabetes, impaired renal function, or diminished
cardiac function; and patients on beta-adrenergic blockers
(Spring et al., 1997).
40
Q
- After rapidly assessing airway, breathing, and circulation, the
medical treatment of choice for a severe, life-threatening adverse
drug reaction following exposure to contrast media is:
a. subcutaneous injection of epinephrine 0.5 mg of 1:10,000
epinephrine.
b. intravenous injection of 100 mg of methylprednisone.
c. 0.01 mg/kg of epinephrine (1:10,000 concentration), given
intramuscularly in the lateral thigh.
d. intravenous diphenhydramine, 50 mg.
e. 0.01 mg/kg of epinephrine (1:1000 concentration), given
intramuscularly in the lateral thigh.
A
- e. 0.01 mg/kg of epinephrine (1:1000 concentration), given
intramuscularly in the lateral thigh. Rapid administration of
epinephrine is the treatment of choice for severe contrast reactions.
Epinephrine can be administered intravenously (IV) 0.01 mg/kg
body weight of 1: 10,000 dilution or 0.1 mL/kg slowly into a
running IV infusion of saline and can be repeated every 5 to 15
minutes as needed. If no IV access is available, the recommended
intramuscular dose of epinephrine is 0.01 mg/kg of 1:1000 dilution
(or 0.01 mL/kg to a maximum of 0.15 mg of 1:1000 if body weight
is <30 kg; 0.3 mg if weight is >30 kg) injected intramuscularly in
the lateral thigh.
41
Q
- Which of the following is NOT a risk factor for developing
contrast-induced nephropathy (CIN)?
a. Type 2 diabetes mellitus
b. Dehydration
c. Hypertension
d. Ventricular ejection fraction less than 50%
e. Chronic kidney disease (CKD) (glomerular filtration rate
[GFR] < 60 mL/min)
A
- d. Ventricular ejection fraction less than 50%. The most common
patient-related risk factors for CIN are CKD (creatinine clearance
<60 mL/min), diabetes mellitus, dehydration, diuretic use,
advanced age, congestive heart failure, age, hypertension, low
hematocrit, and ventricular ejection fraction less than 40%. The
patients at highest risk for developing CIN are those with both
diabetes and preexisting renal insufficiency.
42
Q
- Nephrogenic systemic fibrosis (NSF) is:
a. a rare genetic condition exacerbated by the use of gadolinium-
based contrast medium (GBCM).
b. immediately evident after exposure to gadolinium in 10% of
exposed patients.
c. fibrosis of the skin, subcutaneous tissue, and skeletal muscle
seen in patients with chronic hypertension exposed to
gadolinium contrast medium.
d. not seen in patients with GFR greater than 60 mL/min/1.73
m2.
e. mainly seen in dialysis patients exposed to gadolinium contrast
medium.
A
- d. Not seen in patients with GFR greater than 60 mL/min/1.73
m 2 . Patients with CKD but GRF greater than 30 mL/min/1.73 m2
are considered to be at extremely low or no risk for developing
NSF if a dose of GBCM of 0.1 mmol/kg or less is used. Patients
with GFR greater than 60 mL/min/1.73 m2 do not appear to be at
increased risk of developing NSF, and the current consensus is that
all GBCM can be administered safely to these patients.
43
Q
- During a diuretic renal scintigraphy:
a. the diuretic is administered approximately 2 minutes after
peak activity is seen in the collecting system.
b. a T½ of greater than 14 minutes is consistent with obstruction.
c. 99mTc-DMSA is the most sensitive for obstruction and
determination of GFR.
d. intestinal or gallbladder activity should never be seen with
99mTc-MAG3.
e. a T½ of less than 10 minutes is consistent with a nonobstructed
system.
A
- e. a T ½ of less than 10 minutes is consistent with a
nonobstructed system. Transit time throughout the collecting
system in less than 10 minutes is consistent with a normal,
nonobstructed collecting system. A T½ of 10 to 20 minutes shows
mild to moderate delay and may be a mechanical obstruction. The
patient’s perception of pain after diuretic administration can be
helpful for the treating urologist to consider when planning surgery
in the patient with middle to moderate obstruction. A T ½ of
greater than 20 minutes is consistent with a high-grade
obstruction.
44
Q
- Positron emission tomography (PET):
a. has a higher diagnostic accuracy than CT for seminoma and
nonseminoma testis cancer following chemotherapy.
b. is sensitive and specific for detection of postchemotherapy
teratoma.
c. can be used with high positive predictive value within 2 weeks
of completion of chemotherapy for bulky lymph adenopathy.
d. has greater predictive value of primary disease in metastatic
urothelial carcinoma than magnetic resonance imaging (MRI).
e. is able to detect local or systemic recurrence of prostate cancer
in 74% of patients with prostate-specific antigen recurrence.
A
- a. Has a higher diagnostic accuracy than CT for seminoma and
nonseminoma testis cancer following chemotherapy. There are
data on the use of PET/CT in testis cancer, where PET/CT was
found to have a higher diagnostic accuracy than CT for staging and
restaging in the assessment of a CT-visualized residual mass
following chemotherapy for seminoma and nonseminomatous germ
cell tumors (Hain et al., 2000; Albers et al., 1999).
45
Q
- What is the minimum estimated GFR for use of gadolinium-based
contrast agents?
a. Less than 30 mL/min/1.73 m2
b. Greater than 50 mL/min/1.73 m2
c. Greater than 35 mL/min/1.73 m2
d. Greater than 30 mL/min/1.73 m2
e. There are no restrictions for patients with renal insufficiency.
A
- d. Greater than 30 mL/min/1.73 m2. NSF occurs in patients
with acute or chronic renal insufficiency with a GFR less than
30 mL/min/1.73 m2.
46
Q
- In magnetic resonance (MR) images using T2-weighted sequences,
fluid appears as:
a. dark.
b. bright.
c. low signal.
d. signal void.
e. indeterminate
A
- b. Bright. High signal on T2-weighted images. Fluid exhibits a low
signal on T1-weighted images.
47
Q
- What lesions may have a high signal (bright) on T2-weighted MRI
of the adrenal gland?
a. Pheochromocytoma
b. Metastasis
c. Adrenal cortical carcinoma (ACC)
d. None of the above
e. All of the above
A
- e. All of the above. Traditional teaching reported the lightbulb sign
to be consistent with pheochromocytoma. However, metastasis and
ACC also have a high signal on T2-weighted images. Furthermore,
Varghese and colleagues reported that 35% of
pheochromocytomas demonstrated low T2 signal, contrary to
conventional teaching. Therefore the conventional teaching of the
“lightbulb sign” is incorrect.
48
Q
- MR chemical shift imaging (CSI) for adrenal adenoma takes
advantage of which of the following phenomena to aid in the
diagnosis?
a. Water and fat within the same voxel signals are canceled out
in opposed-phase imaging.
b. Opposed-phase imaging will exhibit a high signal (bright).
c. Intracellular lipid content within an adenoma is low.
d. Intravenous contrast is required.
e. All of the above.
A
- a. Water and fat within the same voxel signals are canceled out
in opposed-phase imaging. MR CSI is performed on T1-weighted
images. Opposed-phase imaging will demonstrate a low signal
(dark) if fat and water occupy the same voxel. Adrenal adenomas
have high intracytoplasmic fat. CSI is performed without the use of
intravenous contrast.
49
Q
- Oncocytoma typically has been characterized by a central scar.
Which other renal lesion may also exhibit a central scar on T2-
weighted images?
a. Clear cell carcinoma
b. Angiomyolipoma
c. Chromophobe carcinoma
d. Transitional cell carcinoma
e. No other renal masses exhibit a central scar.
A
- c. Chromophobe carcinoma. Chromophobe carcinoma exhibits a
high signal on T2-weighted images.
50
Q
- Which renal mass exhibits signal drop on opposed phase imaging?
a. Papillary renal cell
b. Chromophobe carcinoma
c. Angiomyolipoma
d. Clear cell carcinoma
e. Transitional cell carcinoma
A
- d. Clear cell carcinoma. Microscopic intracytoplasmic lipids have
been found in 59% of clear cell carcinomas, which allows it to be
differentiated from other renal cell carcinoma cell types.
51
Q
- What signal characteristics do kidney stones exhibit on MR
urography?
a. High signal on T2-weighted images
b. Low signal on T2-weighted images
c. Signal void
d. High signal on T1-weighted images
e. Low signal on T1-weighted images
A
- c. Signal void. Nephrolithiasis/calcification on MR imaging has no
signal characteristics; therefore it appears as a void on imaging.
52
Q
- Multiparametric imaging of the prostate consists of anatomic and
functional sequences. Match the correct pair.
a. Anatomic: Diffusion-weighted imaging
b. Functional: T1- and T2-weighted images
c. Anatomic: Dynamic contrast enhanced sequences
d. Functional: Apparent diffusion coefficient maps
e. All of the above
A
- d. Functional: Apparent diffusion coefficient maps.
Multiparametric MRI refers to the use of anatomic sequences (T1-
weighted images, T2 triplanar [axial, sagittal, and coronal] images)
and functional sequences (diffusion-weighted imaging/apparent
diffusion coefficient maps, dynamic contrast-enhanced MRI,
spectroscopy). The combined approach has reported negative and
positive predictive values to be greater than 90% in detecting
prostate cancer.
