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EDIR > Genito-urinary > Flashcards

Genito-urinary Flashcards

1
Q
  1. Regarding medullary sponge kidney, which of the following are correct?

(a) The cystic areas in the medulla do not communicate with the collecting ducts.

(b) The changes are unilateral in 25% of cases.

(c) It is a feature of Meckel-Gruber syndrome.

(d) Medullary nephrocalcinosis is visible radiographically in 10% of cases.

(e) There is an association with Ehlers-Danlos syndrome.

A

Answers:

(a) Not correct

(b) Correct

(c) Not correct

(d) Not correct

(e) Correct

Explanation:

Medullary sponge kidney is a common sporadic condition affecting young to middle aged adults. There is dysplastic cystic dilatation of papillary and medullary collecting ducts. Meckel- Gruber syndrome is an autosomal recessive syndrome comprising of multicystic dysplastic kidneys, occipital encephalocele and polydactyly. Medullary nephrocalcinosis is visible radiographically in 40% - 80%.

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2
Q
  1. Concerning renal papillary necrosis, which of the following are correct?

(a) Necrosis involves the overlying cortex in 10% of cases.

(b) It may result from aspirin use.

(c) A single papilla is affected in approximately 15% of cases.

(d) It is associated with a higher incidence of renal tract squamous cell carcinoma.

(e) Medullary sponge kidney is a cause.

A

Answers:

(a) Not correct

(b) Correct

(c) Correct

(d) Correct

(e) Not correct

Explanation:

Cortex is not involved in renal papillary necrosis. It involves pyramids and medullary papilla. Medullary sponge kidney causes renal papillary calculi not necrosis.

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3
Q
  1. Which of the following are correct regarding renal cell carcinoma?

(a) About 75% of tumours less than 3cm in size are hyperechoic on ultrasonography.

(b) Von Hippel-Lindau syndrome is risk factor.

(c) Calcification and cystic change occur in the minority of cases.

(d) About 30% of tumours are hypovascular on angiography.

(e) The lungs are the most common site for metastatic spread.

A

Answers:

(a) Correct

(b) Correct

(c) Correct

(d) Not correct

(e) Correct

Explanation:

5% of RCC are hypovascular on angiography. Tumours cause neovascularity. Renal vein or IVC extension of tumour is also seen on angiograph

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4
Q
  1. Concerning developmental abnormalities of the kidneys which of the following are correct:

(a) Accessory renal arteries normally enter the upper and mid poles.

(b) Duplication of the collecting system is seen in 10-12% of people.

(c) Horseshoe kidney is seen in 1 in 200 births.

(d) Horseshoe kidneys are more prone to trauma.

(e) Accessory renal arteries are less common in patients with horseshoe kidney.

A

Answers:

(a) Not correct

(b) Not correct

(c) Not correct

(d) Correct

(e) Not correct

Explanation:

Accessory renal arteries commonly enter the lower pole below the hilum and are more common in patients with horseshoe kidney. Incidence of horseshoe kidney is 1 in 700 births. Duplication of collecting system is seen in only 4% of people.

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5
Q
  1. Which of the following are correct regarding urinary tract stones:

(a) Craniocaudal size is underestimated on CT.

(b) Urinary tract obstruction cannot be diagnosed on unenhanced CT.

(c) Pure matrix stones are not visualized on unenhanced CT.

(d) Renal failure is a common clinical presentation.

(e) A plain abdominal X-Ray (KUB) has a sensitivity of 80%.

A

Answers:

(a) Not correct

(b) Not correct

(c) Correct

(d) Not correct

(e) Not correct

Explanation:

Partial voluming tends to overestimate the size of stone on CT.Unenhanced CT shows ureteric and collecting system dilatation, nephromegaly and perinephric and periureteric fat standing, which are all signs of obstruction. lain X-ray KUB has only 45% - 58% sensitivity. Renal failure is rare and is secondary to bilateral obstructing calculi.

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6
Q
  1. Which of the following are correct regarding contrast media nephrotoxicity (CMN):

(a) 0.45% saline infusion before and after contrast media injection reduces the risk of nephrotoxicity.

(b) Nephrotoxic effect of contrast media is dose dependent.

(c) Prophylactic haemodialysis prevents nephrotoxicity.

(d) Is usually benign and resolves within 1-2 weeks.

(e) Acetylcystein is a potent vasoconstrictor.

A

Answers:

(a) Correct

(b) Correct

(c) Not correct

(d) Correct

(e) Not correct

Explanation:

Hemodialysis can induce hypovolaemia which worsens renal ischemia. Acetylcystein is an antioxidant and scavenger of oxygen free radicals. It enhances the biological effect of the endogenous vasodilator nitric oxide.

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7
Q
  1. Which of the following are correct regarding angiomyolipoma (AML):

(a) Is the most common benign tumour of the kidney in adults.

(b) A high attenuation lesion on unenhanced CT excludes the diagnosis.

(c) The absence of fat-content on unenhanced CT excludes the diagnosis.

(d) Prolonged enhancement on delayed post-contrast CT favours a diagnosis of AML rather than renal cell carcinoma.

(e) Calcification is a common feature.

A

Answers:

(a) Correct

(b) Not correct

(c) Not correct

(d) Correct

(e) Not correct

Explanation:

AML with minimal fat content can have high attenuation on unenhanced CT. Fat content is characteristic of AML but 5% have predominance of blood vessels or immature fat. Calcification is a rare feature of AML.

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8
Q
  1. Which of the following are correct regarding genitourinary tuberculosis (TB):

(a) Is the most common manifestation of extrapulmonary TB.

(b) In renal TB: calyceal dilatation is usually accompanied by pelvic dilatation.

(c) The endometrium is affected in >70% of women with genital TB.

(d) Papillary necrosis is a recognized feature.

(e) A raised CA-125 level excludes tubo-ovarian TB.

A

Answers:

(a) Correct

(b) Not correct

(c) Correct

(d) Correct

(e) Not correct

Explanation:

In renal TB earliest IVU abnormality is a ‘moth eaten’ calyx due to erosion, followed by papillary necrosis. Dilatation of one or more calyces without pelvic dilatation typically occurs due to infundibular stenosis. Tubo-ovarian involvement is usually caused by hematogenous or lymphatic spread, mimicking ovarian cancer clinically and radiologically. Diagnosis is generally made post-operatively.

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9
Q
  1. Which of the following are correct regarding autosomal dominant polycystic kidney disease (ADPKD):

(a) 35-50% of patients develop end-stage renal failure.

(b) 2.5% of nephrons are affected by cystic change.

(c) Hepatic cysts are seen in 5-10% by 60 years of age.

(d) 2-10% of patients sustain subarachnoid haemorrhage.

(e) Cyst density >30 HU on post-intravenous contrast CT suggests malignant change.

A

Answers:

(a) Correct

(b) Correct

(c) Not correct

(d) Correct

(e) Not correct

Explanation:

Hepatic cysts are seen in 70%-75% by 60 yrs of age. The most common cause of increased density of cyst is haemorrhage (HU of 50-90). ADKPD patients on dialysis have an increased risk of cancer relative to population.

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10
Q
  1. Which of the following are correct regarding causes of cortical nephrocalcinosis:

(a) Chronic glomerulonephritis.

(b) Hyperparathyroidism.

(c) Chronic transplant rejection.

(d) Acute cortical necrosis.

(e) Hypervitaminosis D.

A

Answers:

(a) Correct

(b) Not correct

(c) Correct

(d) Correct

(e) Not correct

Explanation:

Medullary nephrocalcinosis is seen in hyperparathyroidism, hypervitaminosis D, renal tubular acidosis, medullary sponge kidney, renal papillary necrosis, hypercalciuria and primary hyperoxaluria

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11
Q
  1. Which of the following are correct regarding retroperitoneal fibrosis?

(a) When the ureters are involved, there is typically only mild pyelocalyectasis.

(b) The fibrotic plaque usually originates around the aortic bifurcation.

(c) On CT, the aorta is typically enveloped and anteriorly displaced by a fibrotic mass.

(d) An increase in signal intensity on T2 weighted imaging indicates a good response to steroid treatment.

(e) It is associated with primary sclerosing cholangitis.

A

Answers:

(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct

Explanation:

On CT, the aorta is engulfed by the fibrotic mass but not displaced. Displacement is seen in malignancy.
Steroid treatment causes a decrease in signal intensity on T2WI indicating a good response.

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12
Q
  1. Which of the following are correct regarding schistosomiasis:

(a) Calcification is the most important single imaging feature.

(b) The bladder usually has a reduced capacity in the early stages.

(c) Is endemic in parts of the Eastern Mediterranean.
(d) Ureteral calculi are rarely seen.

(e) In the earliest stage, dilatation of the ureter is confined to the upper third.

A

Answers:

(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct

Explanation:

Schistosomiasis is commonly associated with ureteric calculi, dilatation of lower ureter in early stage and
reduced bladder capacity in advanced stages

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13
Q

(GIT) 41. Which of the following are correct regarding bladder cancers?

(a) Urachal abnormalities are most frequently associated with squamous cell carcinomas.

(b) MRI can identify muscle invasion.

(c) The presence of low signal within the seminal vesicles on T2 weighted MRI is specific for tumour involvement.

(d) Tumour extension to the cervix is common.

(e) Bladder cancer enhances early following intravenous gadolinium- diethylenetriaminepentaacetic acid
(DTPA).

A

Answers:

(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct

Explanation:

About 90% of the bladder cancers are transitional cell tumour. Squamous cell carcinoma is associated with
chronic infection and leukoplakia. Transitional cell tumour may extend to the perivesicle fat, seminal vesicles
and prostate in Males but extension to the uterus and cervix is uncommon in females The seminal vesicles are
high signal on T2-weighted images. Low signal changes may be seen with atrophy, tumour extension and fibrosis.

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14
Q
  1. Regarding testicular ultrasound, which of the following are correct?

(a) Absent testicular blood flow on colour Doppler imaging is pathognomonic of testicular torsion.

(b) There is an association between testicular microlithiasis and Klinefelter’s syndrome.

(c) Testicular cysts are seen in upto 10% of testicular ultrasound studies.

(d) The epididymis is typically enlarged, hypervascular and hyperechoic when inflamed.

(e) The normal epididymis is slightly hypoechoic to the normal testis.

A

Answers:

(a) Not correct

(b) Correct

(c) Correct

(d) Not correct.

(e) Not correct

Explanation:

In paediatric patients, intratesticular flow can be difficult to demonstrate on colour Doppler. Power Doppler
may be helpful in such cases.
When inflamed epididymis is typically enlarged, hypervascular and hypoechoic. Orchitis is seen in 20% cases
and shows similar appearance.
The normal epididymis is isoechoic to slightly hyperechoic to normal testis.

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15
Q

(Ped) 21. Which of the following are correct regarding imaging of the testis:

(a) An appendix is present in over 90 % of males

(b) Examination of the contralateral testis is mandatory in possible torsion

(c) A hydrocele may cause false positive diagnosis of torsion on scintigraphic evaluation

(d) Torsion is most common in the neonatal age group

(e) A torted testis is usually of high echogenicity on ultrasound

A

Answers:

(a) Correct

(b) Correct

(c) Correct

(d) Not correct

(e) Not correct

Explanation:

Torsion of testis is rare in neonates. A torted testis is usually hypoechoic on ultrasound due to congestion,
infarction and edema.

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16
Q
  1. Which of the following are correct regarding imaging of prostate cancer:

(a) Can be reliably detected by transrectal ultrasound.

(b) Intravenous contrast is used routinely in MRI.

(c) Normal zonal anatomy of the prostate gland is best seen on T1 weighted MRI.

(d) Usually appears as a high signal intensity lesion on T2 weighted MRI.

(e) Is usually hypoechoic on TRUS.

A

Answers:

(a) Not correct.

(b) Not correct

(c) Not correct

(d) Not correct

(e) Correct

Explanation:

Only cancer located in the peripheral zone can be reliably detected on TRUS, with 60%-70 % appearing
hypoechoic, 40% are isoechoic and 1% - 5% are hyperechoic.
Intravenous contrast in not used routinely in MRI as it has no superiority of T2WI. T2WI best demonstrates
zonal anatomy with cancer appearing as lesion of low signal within the high signal of peripheral zone.
All the zones have intermediate signal on T1WI on MRI.

17
Q
  1. Which of the following are correct regarding testicular microlithiasis:

(a) Extratesticular scrotal calcification is usually benign.

(b) Acoustic shadowing is observed in most cases.

(c) Is associated with infertility.

(d) Is usually unilateral.

(e) May be associated with neurofibromatosis.

A

Answers:

(a) Correct

(b) Not correct

(c) Not correct

(d) Not correct

(e) Correct

Explanation:

Acoustic shadowing is not seen due to small size of calcification. Infertility is not associated with microlithiasis
(association is 1% same as general population).
Unilaterality is seen only in 2.7% to 27%.

18
Q
  1. Which of the following are correct regarding testicular epidermoid cysts:

(a) Are usually multiple and bilateral.

(b) The majority occur in the elderly.

(c) Concentric layers of calcification are characteristic on ultrasound.

(d) A bull’s eye pattern is a recognized appearance on MRI.

(e) Are typically treated by orchidectomy.

A

Answers:

(a) Not correct

(b) Not correct

(c) Correct

(d) Correct

(e) Not correct

Explanation:

1% of intratesticular tumours are epidermoid and most commonly seen between 20-40 yrs.
They are usually solitary and unilateral, but cases of multiplicity and bilaterality have been recognized

19
Q

(GIT) 31. In the imaging of acute testicular torsion, which of the following are correct:

(a) On sonography, a reactive hydrocoele is seen after 6 hours.

(b) Surgery is successful in 20% of patients who present between 12 and 24 hours after onset of symptoms.

(c) Colour Doppler ultrasound may show increased blood flow in the depididymis.

(d) Hyperperfusion of the testicle on colour Doppler ultrasonography makes testicular torsion unlikely.

(e) Tc-99m pertechnetate scintigraphy typically shows a halo of hyperactivity in the acute phase (first 6 hours).

A

Answers:

(a) Correct

(b) Correct

(c) Correct

(d) Not correct

(e) Not correct

Explanation:

Spontaneous detorsion of testis may occur leading to unilateral testicle hypoperfusion. Surgery is still indicated
in these cases. Scintigraphy is highly sensitive and specific when performed only. In the acute phase, there is
reduced perfusion in the testis with decreased activity. In the subacute phase, there is a peritesticular reactive
hyperaemia with a hilar or increased tracer activity. Later, there is marked absence of tracer activity.

20
Q
  1. Which of the following are correct regarding pheochromocytoma: (T/F)

(a) Is associated with gastric haemorrhage.

(b) Affects the bladder.

(c) Is bilateral in 20-40% of cases.

(d) Is extra-adrenal in 20-30% of cases.

(e) Is associated with tuberous sclerosis.

A

Answers:

(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct

Explanation:

The pheochromocytoma follows 10% rule. It is bilateral in 10% cases, 10% cases are extra adrenal, 10% are
malignant, 10% are in children, 10% are familial, 10% are not associated with hypertension and 10% show
calcification

21
Q
  1. Which of the following are correct regarding pheochromocytoma: (T/F)

(a) Is bilateral in 25%

(b) When symptomatic tends to be large at presentation.

(c) Is associated with pulmonary hamartomas.

(d) Usually has CT attenuation values of <10 Hounsfield units (HU) on unenhanced scans.

(e) Is of high signal intensity on T2 weighted MR.

A

Answers:

(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct

Explanation:

Pheochromocytoma are bilateral in 10% cases, and symptomatic lesions tend to be smaller in size.
They rarely contain enough fat to reduce the attenuation value <10 HU units.

22
Q
  1. Which of the following are correct regarding benign and malignant adrenal masses: (T/F)

(a) Chemical shift MR utilises T1 weighted sequences.

(b) Approximately one third of benign adenomas have HU of >10 on unenhanced CT.

(c) Adenomas tend to show delayed enhancement with IV contrast.

(d) Adenomas tend to show delayed clearance of IV contrast.

(e) Lesions >4cm tend to be malignant.

A

Answers:

(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct

Explanation:

Adenomas (benign) show rapid enhancement and rapid washout of contrast media on post contrast study.

23
Q
  1. Which of the following statements are correct? (T/F)

(a) Vesico-ureteric reflux usually occurs into the lower pole moiety of a complete ureteral duplication

(b) Ectopic ureterocoeles in duplex kidneys are more common in boy than girls.

(c) An ectopic ureteral insertion may present with daytime incontinence in a girl.

(d) Horseshoe kidneys are associated with a higher incidence of duplicated kidneys.

(e) Ectopic ureteral insertion in boys in always supra-sphincteric.

A

Answers:

(a) Correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct

Explanation:

Ureterocoeles which are related to the upper pole moiety of a duplex kidney occur 8 times more frequently in
girls than boys. Ureterocoeles related to non-duplicated system show an equal gender incidence.

24
Q

(GU) 19. Which of the following statements are correct? (T/F)

(a) Haematocolpos refers to a uterine cavity distended with blood.

(b) After puberty, the most common cause of haematocolpos is vaginal atresia.

(c) A fluid collection within the endometrial cavity of a neonate is abnormal.

(d) Congenital haematometrocolpos is usually associated with other anomalies.

(e) Haematometra is a cause of ureteric obstruction.

A

Answers:

(a) Not correct.
(b) Not correct
(c) Not correct
(d) Correct
(e) Correct

Explanation:

Hematocolpos refers to vagina distended with blood and hematometra refers to uterine cavity distended with blood. An imperforate hymen is the most common cause of hematocolpos. Approximately 25% of neonates have
a fluid collection within the endometrial cavity, thus a normal finding.

25
Q
  1. The following features favour a diagnosis of Wilm’s tumor rather than neuroblastoma: (T/F)

(a) Presentation before 1 year of age.

(b) Calcification

(c) Lung metastases

(d) Claw sign

(e) The tumor displaces rather than engulfs the major vessels

A

Answers:

(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct

Explanation:

Peak age of Wilm’s tumor is 3 years and neuroblastoma is most common in children below 2 years. Stippled type
of calcification is seen in 85% of cases of neuroblastoma. Calcification is uncommon in Wilm’s and is seen as
curvilinear or amorphous type in 15% cases.

26
Q
  1. Which of the following are correct regarding renal masses in neonates: (T/F)

(a) Wilm’s tumor is the most common cause of an abdominal mass in neonates.

(b) Mesoblastic nephroma is the most common fetal renal reoplasm.

(c) Mesoblastic nephroma is easily distinguished from Wilm’s tumor on cross-sectional imaging

(d) Extension into the renal vein is a feature of mesoblastic nephroma.

(e) Mesoblastic nephroma is associated with oligohydramnios.

A

Answers:

(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct

Explanation:

Hydronephrotic kidney is the most common abdominal mass in neonates. Mesoblastic nephroma is associated
with polyhydramnios and thus premature labor. It cannot be distinguished from Wilm’s tumor on cross-sectional
imaging. It is benign and does not invade venous structures, hence differentiating it from Wilm’s tumor.

27
Q

(GU) 34. Which of the following are correct regarding multicystic dysplastic kidney: (T/F)

(a) Is the second commonest cause of a neonatal abdominal mass.

(b) Is associated with PUJ obstruction.

(c) Is usually unilateral.

(d) The renal cysts communicate.

(e) Intervening normal renal parenchyma is present.

A

Answers:

(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct

Explanation:

Multicystic dysplastic kidney shows non-communicating cysts with no normal renal parenchyma.

EDIR (9 decks)

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