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Clinical Radiology 2A > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

What are the causes of papillary necrosis?

A

Diabetes (most common)

Pyelonephritis

TB

Sickle cell

Analgesics

Cirrhosis

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2
Q

What are the causes of medullary nephrocalcinosis?

A

Da: hyper vitamin D

C: calcaemic/calciuric state

RA: renal tubular acidosis (type 1)

M: medullary sponge kidney (usually unilateral)

P: hyperparathyroidism

S: sarcoid

T: hyper/hypothyroid

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3
Q

What are the causes of pyramidal nephrocalcinosis?

A

Da: drugs (furosemide)

H: hyperuricaemia

I: infection (TB)

P: papillary necrosis

S: sickle cell disease

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4
Q

What are the causes of cortical nephrocalcinosis?

A

P: chronic pyelonephritis

R: reflux

A: Alport syndrome

N: necrosis (renal cortical)

H: hypercalcaemia/hyperoxaluria

A: autosomal recessive polycystic kidney disease

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5
Q

What are the causes of cortical necrosis?

A

P: pregnancy
I: infarct
T: transplant rejection
H: Haemolytic uraemic syndrome (HUS)
E: Extracorporeal shock wave lithotripsy (ESWL)
A: arsenic
D: drugs
S: sepsis, snake bites

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6
Q

Patients had previous renal biopsy.

US shows tissue vibration artefact, high arterial velocity and pulsatile flow in the vein.

Diagnosis?

A

Arteriovenous fistula (AVF)

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7
Q

Patient who had renal transplant 2 weeks previously has an ultrasound.

The kidney appears swollen and there is reversal of diastolic flow in the renal artery.

What is the diagnosis?

A

Renal vein thrombosis

Reversal of diastolic flow = “reverse M sign”

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8
Q

What disorder is associated with medullary RCC?

A

Sickle cell trait

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9
Q

What syndrome is associated with chromophobe RCC?

A

Birt Hogg Dube

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10
Q

What disorder is associated with clear cell RCC?

A

von Hippel Lindau

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11
Q

What is the differential for a T2 dark renal cyst?

A

Lipid poor AML

Haemorrhagic cyst

Papillary subtype RCC

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12
Q

What are the only renal calculi not seen on CT and which group of patients get them?

A

Indinavir calculi

(Seen in HIV patients on indinavir)

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13
Q

Renal lesion with fat and no calcification.

A

Angiomyolipoma

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14
Q

What are some causes of a calcaemic/calciuric state?

A

Cushing’s

Bartters

Multiple myeloma

Bony metastases

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15
Q

What 3 conditions are associated with medullary sponge kidney?

A

Ehlers-Danlos syndrome

Carolis syndrome

Beckwith-Weidman syndrome

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16
Q

What are the causes of a delayed nephrogram?

i.e. failure of normal temporal progression of nephrographic contrast.

A

Obstructive uropathy (most common)

Renal vein thrombosis

Renal artery stenosis

Extrinsic compression (Page kidney)

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17
Q

What are the causes of a persistent nephrogram?

A

Hypotension/Shock

Acute tubular necrosis

Bilateral renal vein thrombosis

Bilateral renal artery stenosis

Bilateral obstructive uropathy

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18
Q

What is a normal resistive index in a transplant kidney?

A

Less than 0.7

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19
Q

What are the causes of post renal transplant fluid collections?

A

Haematoma (immediate)

Encapsulated urine collection: urinoma (1-2 weeks)

Abscess (3-4 weeks)

Lymphocele (2 months)

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20
Q

What percentage of the population have an early branching renal artery?

(Branches before the renal hilum)

A

10%

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21
Q

What percentage of the population have an accessory renal artery and which side is more common?

A

30%

left accessory renal artery is more common

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22
Q

Patient who had renal transplant 2 weeks previously, presents with decreases urine output. Ultrasound shows anechoic well defined perirenal mass with no septations.

What is the most likely diagnosis?

A

Urinoma

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23
Q

How would you distinguish acute tubular necrosis from acute rejection of renal transplant?

A

MAG3: ATN has normal perfusion and rejection does not. Both have delayed excretion.

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24
Q

What are the criteria for renal artery stenosis in transplants?

A

Peak systolic velocity >200cm/s

2:1 PSV ratio between stenotic and pre-stenotic artery

Turbulent flow (spectral broadening)

Tardus-parvus waveform (measured at main renal artery hilum)

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25
Q

What are the two main causes of ureteral wall calcifications?

A

TB

Schistosomiasis

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26
Q

Numerous tiny subepithelial fluid-filled cysts with the wall of ureter which is typically seen in diabetics with recurrent UTI. What is the likely diagnosis?

A

Ureteritis cystica

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27
Q

Multiple small outpouchings of upper ⅔ of the ureter associated with chronic inflammation and an association with TCC. What is the likely diagnosis?

A

Ureteral pseudodiverticulosis.

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28
Q

In the renal tract, schistosomiasis predisposes to which cancer?

A

Squamous cell carcinoma.

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29
Q

Smooth oblong, mobile defect in the proximal ureter on urography.

A

Fibroepithelial polyp.

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30
Q

What are the causes of lateral deviation of the ureters?

A

Retroperitoneal adenopathy

Aortic aneurysm

Psoas hypertrophy (proximal ureter)

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31
Q

What are the causes of medial deviation of the ureters?

A

Retroperitoneal fibrosis

Retrocaval ureter (right side)

Pelvic lipomatosis

Psoas hypertrophy (distal ureter)

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32
Q

A urachal remnant may transform into what malignancy?

A

Adenocarcinoma

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33
Q

What is the most common bladder cancer in children <10 years?

A

Rhabdomyosarcoma

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34
Q

What is the site of injury in a bicycle crossbar injury of the urethra in a male?

A

Bulbous urethra

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35
Q

What is the difference in the urethral stricture caused by straddle injury vs gonococcal infection?

A

Straddle injury : short segment

Gonococcal : long irregular stricture

Both are bulbous urethra

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36
Q

What part of the prostate is commonly involved in BPH?

A

Transitional zone

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37
Q

What conditions are associated with a prostatic utricle cyst?

A

Hypospadias (most common)

Cryptorchidism

Unilateral renal agenesis

  • Prune belly syndrome*
  • Imperforate anus*
  • Down’s*
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38
Q

Which malignancy is associated with leukoplakia?

A

Squamous cell carcinoma

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39
Q

Conditions associated with a congenital seminal vesicle cyst?

A

Agenesis (renal/vas deferens)

Polycystic kidney disease

Ectopic ureter insertion

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40
Q

What are some of the common features of Turner syndrome?

(excluding MSK manifestations)

A

Coarctation of the aorta

Bicuspid aortic valve

Horseshoe kidney

Streaky ovaries/uterus

Pyloric stenosis

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41
Q

What are the common MSK manifestations of Turner syndrome?

A

Scoliosis

Short 4th metacarpal

Madelung deformity

Narrow scapholunate angle (+ve carpal sign)

Short stature

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42
Q

MEN type 2a is characterised by what?

A

Phaeochromocytomas

Parathyroid hyperplasia

Medullary thyroid cancer

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43
Q

MEN type 2b is characterised by what?

A

Phaeochromocytoma

Medullary thyroid cancer

Mucosal neuroma/ganglioneuromas

Marfanoid body habitus

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44
Q

MEN type 1 is an autosomal dominant syndrome characterised by what?

A

Pi: pituitary adenoma

Par: parathyroid proliferative disease

Panc: pancreatic endocrine tumours

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45
Q

1 month old with failure to thrive, diarrhoea and vomiting. CT shows hepatosplenomegaly and bilateral enlarged, calcified adrenal glands. What is the diagnosis?

A

Wolman disease

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46
Q

What is the Carney triad?

A

Extra-adrenal paraganglioma

GIST

Pulmonary chondroma (hamartoma)

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47
Q

What is the Carney complex?

A

Cardiac myxoma

Extra-cardiac myxoma

Skin pigmentation (blue naevia)

Testicular tumours (Sertoli most common)

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48
Q

What is Waterhouse-Friderichsen syndrome?

A

Adrenal haemorrhage in the setting of fulminant meningitis

(from Neisseria Meningitidis)

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49
Q

Which conditions are associated with phaeochromocytoma?

A

Multiple endocrine neoplasia (MEN II)

von-Hippel-Lindau

Neurofibromatosis type 1

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50
Q

What is the main cause of congenital adrenal hypertrophy?

A

21-hydroxylase deficiency (90%)

11-beta-hydroxylase deficiency

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51
Q

A child presents with genital ambiguity, electrolyte imbalance and dehydration.

How can you differentiate normal neonatal adrenals from congenital adrenal hyperplasia?

A

Congenital adrenal hyperplasia will have:

Cerebriform pattern (characteristic)

Bilateral enlarged adrenal glands (limb width > 4mm, length > 20mm)

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52
Q

Patient presents with hypertension, persistent hypokalaemia and increased serum/urinary aldosterone. What are the most common causes of this syndrome?

A

Syndrome = Conn syndrome

Benign hyperfunctioning adrenal cortical adenoma 80%

Adrenal hyperplasia 20%

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53
Q

What are the causes of Cushing syndrome?

A

Adrenal hyperplasia - 70%

(90% pituitary microadenoma and 10% ectopic ACTH usually Ca)

Benign adrenal adenomas - 20%

Adrenal carcinoma - 10%

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54
Q

What is the absolute percentage washout of a benign adrenal nodule?

A

>60% at 15 minutes

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55
Q

What is the relative percentage washout of a benign adrenal nodule?

A

>40% at 15 minutes

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56
Q

How do you calculate the relative percentage washout of an adrenal nodule?

A

Portal venous - delayed x 100
Portal venous

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57
Q

How do you calculate absolute percentage washout of an adrenal nodule?

A

Portal venous - delayed x 100
Portal venous - unenhanced

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58
Q

Congenital bilateral absence of the vas deferens is seen in what condition?

A

Cystic fibrosis

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59
Q

Name 4 syndromes associated with male infertility.

A

Pituitary adenoma (makes prolactin)

Kallmans syndrome (can’t smell + infertile)

Klinefelters syndrome (tall, gynaecomastia and infertile)

Zinner syndrome (renal agenesis + ipsilateral seminal vesicle cyst)

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60
Q

What are the non-obstructive causes of male infertility?

A

Varicocele

Cryptorchidism

Anabolic steroid use

Erectile dysfunction

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61
Q

Cowden syndrome increases your risk of which cancers?

A

Breast cancer

Endometrial cancer

Follicular thyroid cancer

Lhermitte-Duclos (brain hamartoma)

62
Q

What are the MRI characteristics of a fibroadenoma?

A

T2 bright with non-enhancing septa and type 1 curve

63
Q

What is the MRI characteristics of extracapsular silicon?

A

T1 dark, T2 bright

64
Q

What is the imaging modality of choice to look for saline implant rupture?

A

Plain mammogram

65
Q

What type of breast implant rupture is associated with the “step ladder” appearance on US and “linguine sign” on MRI?

A

Intracapsular rupture of a silicone implant

(saline has no capsule so cannot have intracapsular rupture)

66
Q

What are the risk factors for male breast cancer?

A

BRCA mutation (normally BRCA 2)

Klinefelter syndrome

Cirrhosis

Chronic alcoholism

67
Q

When would you do a LMO view on a mammogram?

A

Kyphosis

Pectus excavatum

Avoid medial pacemaker/central line

68
Q

What are the causes of granulomatous prostatitis?

A

Intra-vesical BCG

Sarcoidosis

Tuberculous prostatitis

69
Q

Patient with hyperthyroidism has an MRI pelvis. This reveals a multilocular cystic mass with intensely enhancing solid component. Cystic component is very low signal on T2.

What is the diagnosis?

A

Struma ovarii

(ovarian teratoma)

70
Q

Triad of ascites, pleural effusion and benign ovarian tumour (most commonly fibroma) is referred to as what syndrome?

A

Meigs syndrome

71
Q

Rarely a dermoid can undergo malignant transformation. What cancer does it tend to transform into?

A

Squamous cell cancer

72
Q

An endometrioma can rarely undergo malignant degeneration to what?

A

Clear cell carcinoma

73
Q

What are the imaging features of polycystic ovarian syndrome (PCOS)?

A

≥ 10 peripheral simple cysts

“string of pearls” appearance

Enlarged ovaries ≥ 10 ml

74
Q

How do you differentiate an endometrioma from haemorrhagic cyst?

A

Follow up US in 6-12 weeks

Haemorrhagic cyst will resolve

75
Q

What are the classical MRI appearances of an endometrioma?

A

T1 bright (blood)

No fat suppression

T2 dark with “shading”

76
Q

What is the classic ultrasound appearance of an endometrioma?

A

Rounded mass with homogeneous low level internal echoes and increased through transmission (posterior acoustic enhancement)

77
Q

What are the radiological features of ovarian hyperstimulation syndrome?

A

Enlarged ovaries with theca lutein cysts

Ascites

Pleural effusions

May have pericardial effusion

78
Q

Patient has an ultrasound which shows multilocular cystic ovary with “spokewheel” appearance.
It is diagnosed as theca lutein cyst.
What are the associations with this?

A

Gestational trophoblastic disease

Multifetal pregnancy

Ovarian hyperstimulation syndrome

PCOS

Diabetes

Clomiphene

79
Q

What is normal endometrial thickness for post-menopausal woman on tamoxifen and not on tamoxifen?

A

No tamoxifen ≤ 4 mm

Tamoxifen ≤ 8 mm

80
Q

Hereditary non-polyposis colon cancer (HNPCC) is associated with which gynaecological malignancy?

A

Endometrial cancer

81
Q

What is the differential for endometrial thickening?

A

Pregnancy (early/ectopic/retained products)

Endometrial cancer

Endometrial hyperplasia

Endometritis

HRT/taxoxifen

Oestrogen secreting ovarian tumours (granulosa cell, endometroid carcinoma)

82
Q

Patient with post-menopausal bleeding and endometrium > 5 mm.
What is the next step?

A

Biopsy

83
Q

What is the MR appearance of hyaline degeneration of leiomyomas?

A

T2 dark. Does not enhance.

84
Q

What is the most classic features of adenomyosis?

A

Thickening of the junctional zone to > 12 mm (normal is < 5 mm)

85
Q

What is the classic MR appearance in red (carneous) degeneration of a leiomyoma?

A

Peripheral rim of T1 high signal

86
Q

What are the contraindications to a hysterosalpingogram?

A

Infection (PID)

Active bleeding

Pregnancy

Contrast allergy

87
Q

Which uterine abnormality results in infertility issues and why?

A

Septate uterus

Fibrous or muscular septum has poor blood supply so implantation on the septum fails

88
Q

When are hysterosalpingograms performed?

A

Day 7-10 menstural cycle

89
Q

What is uterine didelphys?

A

Complete uterine duplication with two cervices, two uteri and two upper ⅓ vagina with a transverse vaginal septum 75% of the time (associated with hydrometrocolpos)

90
Q

Name 2 associations with Mullerian agenesis

A

Renal anomalies 30-40%

Vertebral anomalies 10%

91
Q

Mayer-Rokitansky-Kuster-Hauser syndrome (Mullerian agenesis) has what three features?

A

Vaginal atresia

Absent or rudimentary uterus

Normal ovaries

(Atypical form can have associated ovarian abnormalities)

92
Q

What are the features of a Bosniak type II cyst?

A

Thin curvilinear calcification

Hyperdense cyst < 3cm

93
Q

What are the features of a Bosniak type IIF cyst?

A

Thin septa

Mural or septal enhancement (visible but not measurable)

Nodular calcification

Hyperdense cyst > 3cm

94
Q

What are the features of a Bosniak type III cyst?

A

Thick septa

Mural enhancement (measurable)

Coarse calcification

Irregular margin

Smooth mural thickening

95
Q

What are the features of a Bosniak type IV cyst?

A

Large cystic/ necrotic area

Irregular mural thickening

Solid enhancing structures

96
Q

What percentage of Bosniak I and II cysts are malignant?

A

0%

97
Q

Which percentage of Bosniak type IIF cysts are malignant?

A

5%

98
Q

Which percentage of Bosniak type III cysts are malignant?

A

50%

99
Q

Which percentage of Bosniak type IV cysts are malignant?

A

>90%

100
Q

“Shrinking breast” can be used to describe which cancer?

A

Invasive lobular breast cancer

101
Q

Where would you find a Rotter node?

A

between pectoralis major and minor

102
Q

Describe the location of level 1 axillary nodes.

A

lateral to pectoralis minor

103
Q

Describe the location of level 2 axillary nodes.

A

deep to pectoralis minor

104
Q

Describe the location of level 3 axillary nodes.

A

medial to pectoralis minor

105
Q

What are the causes of increased breast density?

A

Pregnancy

Hormone replacement therapy

Pituitary prolactinoma

Medication (anti-psychotics)

Malignancy

106
Q

Sub-areolar lesion with a fat-fluid level following cessation of lactation. Diagnosis?

A

Galactocele

107
Q

True lateral view on mammogram is useful for localising things seen on only one view. If the abnormality is only in the CC view when would you do ML lateral over LM lateral?

A

if the abnormality is lateral an ML lateral should be performed (if medial, LM lateral)

108
Q

If an abnormality is only seen in the MLO view (not the CC). What view would you do next?

A

true lateral view ML

(most cancers are lateral)

109
Q

A lesion that is medial on the CC film will move in which direction on the MLO?

A

Will become more superior (and more superior on the ML)

Lead sinks, muffins rise

110
Q

A lesion that is lateral on the CC film will move in which direction on the MLO?

A

inferior

“lead sinks, muffins rise”

111
Q

If a breast lesion is only seen on the CC view, how do we know if it is superior or inferior in the breast?

A

If you roll the breast medial a superior tumour will move medial, a inferior lesion will move lateral

112
Q

Milk of calcium/ tea-cupping is seen in what?

A

fibrocystic change

113
Q

What is the name for a thrombosed vein in the breast with that presents as a tender palpable cord?

A

Mondor disease

(treatment is warm compress and NSAIDS)

114
Q

Which benign lesion of the breast is described as a “breast within a breast”?

A

Hamartoma

115
Q

Malignant phyllodes tumours can metastasise to where?

A

lungs and bone

116
Q

Rapidly growing mass in a middle aged lady which looks like a fibroadenoma. Diagnosis?

A

Phyllodes

117
Q

What are the imaging features of a fibroadenoma?

A

Oval circumscribed mass

homogenous hypoechoic echotexture with a central hyperechoic band

Popcorn calcifications in older patients

T2 bright with progressive (type 1) enhancement

118
Q

What is the most common invasive breast cancer?

A

invasive ductal carcinoma

119
Q

Which subtype of invasive ductal carcinoma is associated with a radial scar?

A

Tubular

120
Q

What is the difference between multifocal and multicentric breast cancer?

A

multifocal = same quadrant

multicentric = different quadrants

121
Q

What is the most common cause of bloody nipple discharge?

A

Papilloma

(most common intraductal mass lesion)

122
Q

What are the contraindications to galactography?

A

active infection

inability to express discharge

contrast allergy

prior surgery to the nipple areola complex

123
Q

Can you see intracapsular rupture of a silicone implant on mammogram?

A

Yes

124
Q

What are the MRI features of fat necrosis?

A

T1/ T2 bright with fat saturation

125
Q

What are the mammographic appearances post radiotherapy?

A

skin thickening

trabecular thickening

should improve on subsequent mammograms

126
Q

What is the most common primary to metastasise to the breast?

A

melanoma

127
Q

What are the criteria for a T4 breast lesion?

A

chest wall fixation

skin involvement

inflammatory breast cancer

128
Q

When should you do a breast MRI?

A

day 7-14 of menstrual cycle

129
Q

Which breast cancers can be bright on T2?

A

colloid cancer

mucinous cancer

130
Q

What is the single most predictive feature of breast malignancy?

A

spiculated margins

131
Q

What are the MRI features of an ovarian fibroma?

A

Low on T1/ T2

Does not enhance/ heterogenous enhancement (unlike fibroids)

132
Q

What are the typical MRI features of prostate cancer?

A

Low on T1 and T2

Type 3 contrast curve (early enhancement, early washout)

133
Q

Where is the most common location for a prostate tumour?

A

Peripheral zone (70%)

134
Q

What cysts are found on the cervix as a result of plugging of the mucous glands?

A

Nabothian cysts

135
Q

Where is the classic location of a Gartner duct cyst?

A

Anterior lateral wall of the upper vagina

136
Q

Where is the classic location of a Bartholin cyst?

A

Posterolateral inferior third of the vagina

Below the pubic symphysis

137
Q

What cyst is found laterally to the external urethral meatus and inferior to the pubic symphysis?

A

Skene gland cyst

(paraurethral cyst)

138
Q

What is the likely diagnosis for a midline, infra-umbilical soft tissue mass with calcification?

A

Urachal adenocarcinoma

139
Q

Which uterine anomaly has two uterine canals separated by a deep myometrial cleft?

A

Bicornuate uterus

(can be differentiated from septate by the presence of a fundal cleft)

140
Q

What are the associations with testicular microlithiasis?

A

Cryptorchidism

Infertility

Klinefelters

Downs syndrome

Alveolar microlithiasis

Testicular carcinoma

141
Q

What are the diagnostic criteria for contrast induced nephropathy?

A

Exposure to a contrast agent

Increased serum creatinine of 0.5mg/dL OR 25% increase from baseline

Increase in serum creatinine 48-72 hours after administration of contrast which persists 2-5 days

Alternate injuries rules out

142
Q

What are the features of a prostatic utricle cyst?

A

Occur in the 1st and 2nd decades of life

Arise in the midline at the level of the verumontanum

Communicate with the urethra

Do not extend above the prostate gland

143
Q

What are the features of a mullerian duct cyst?

A

Occur in the 3rd and 4th decades of life

Anywhere along the path of mullerian duct regression from scrotum to prostatic utricle

Do not communicate with the urethra

Often extend superior to the prostate

144
Q

In regards to bladder cancer, what are T1 and T2 sequences used for?

A

T1: assess peri-vesicle extension

T2: assess muscle invasion

145
Q

Squamous metaplasia secondary to chronic irritations. Imaging shows mural filling defects in the bladder and ureter. What is the most likely diagnosis?

A

Leukoplakia

146
Q

What is malacoplakia?

A

Chronic granulomatous disease in immunocompromised females secondary to recurrent UTIs (E.coli) in which you get mucosal mass involving the bladder

147
Q

What is the histological finding in malacoplakia?

A

Von Hansemann cells which contain calcific Michaelis-Gutmann bodies

148
Q

What is the cause of primary congenital bladder diverticula?

A

Hutch diverticula

Occurs at the UVJ and is associated with ipsilateral reflux

149
Q

What are the secondary causes of bladder diverticula?

A

Ehlers Danlos

Chronic outlet obstruction

Menkes (kinky hair syndrome)

Prune belly syndrome

Williams syndrome

150
Q

What are the 5 types of urethral injury?

A

Type 1: stretched (has peri-urethral haematoma)

Type 2: rupture above urogenital diaphragm (extraperitoneal contrast)

Type 3: rupture below the urogenital diaphragm (extraperitonal and perineal contrast)

Type 4: Injury involves the bladder extending to the urethra

Type 5: Injury to the anterior urethra

151
Q

Clear cell carcinoma of the vagina is associated with what?

A

DES (synthetic estrogen)

Think about this if patient also described as having “T-shaped” uterus

152
Q

What ovarian lesion has intense peripheral blood flow?

A

Corpus luteum

Clinical Radiology 2A (8 decks)

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