Genitourinary, Adrenal, Obstetrics & Gynaecology and Breast - Warm Up

Question 1

@# 1. Regarding percutaneous nephrostomy:
a) It is best to target an upper pole calyx
b) A 5-French drain is adequate for an infected system
c) Ideally the guidewire should be passed into the ureter
d) The tract should be dilated to 2-French larger than that of the drainage catheter
e) A straight Amplatz wire should be used

Answer 1

1.
a) False - mid + lower pole calyces. This has lower risk of pneumothorax
b) False - 6-French uninfected, 8-French for infected
c) True
d) False - 1-French larger
e) False - J wire to avoid perforation of pelvis

Question 2

2. The following are branches of the internal iliac artery:
   a) Internal pudendal artery
   b) Superior gluteal artery
   c) Deep circumflex iliac artery
   d) Inferior vesical artery
   e) Inferior epigastric artery

Answer 2

2.
a) True
b) True
c) False - branch of external iliac artery
d) True
e) False - branch of external iliac artery

Question 3

3. The following are true of transabdominal ultrasound in early pregnancy:
   a) Gestational sac should be visible at 4 weeks
   b) Yolk sac is only visible from 7 weeks onwards
   c) The earliest ultrasound sign of pregnancy is fundal endometrial thickening
   d) Cardiac movement should be identifiable in the foetus at 6.5 weeks
   e) Biparietal diameter can be used to predict gestational age from 7 Weeks

Answer 3

3.
a) False - 5 weeks
b) False - from 6 weeks
c) True
d) True
e) False - 12-24 weeks

Question 4

@# 4. The following cause bladder wall calcification:
a) Transitional cell carcinoma
b) Cytotoxin cystitis
c) Sarcoidosis
d) Osteogenic sarcoma metastases
e) Scleroderma

Answer 4

4.
a) True
b) True
c) False
d) True
e) False

Question 5

5. Xanthogranulomatous pyelonephritis:
   a) Is more commonly diffuse than segmental
   b) May be caused by Proteus mirabilis infection
   c) Causes reduced size of the affected kidney
   d) Pyuria is associated in less than 50%
   e) Is not usually associated with calculi

Answer 5

5.
a) True
b) True
c) False - globally enlarged
d) False - it is seen in 95%
e) False - centrally obstructing staghorn calculus is seen in 75%

Question 6

6. Ovarian fibroma:
   a) Is bilateral in 40%
   b) Is usually well circumscribed
   c) Patients may have basal cell carcinoma
   d) Is usually hyperechoic on ultrasound
   e) Meigs’ syndrome is associated with 50%

Answer 6

a) False - less than 10%
b) True
c) True - it is associated with Gorlin’s syndrome
d) False - solid hypoechoic mass mostly
e) False - only 1 %. Ovarian fibroma with ascites and pleural effusion

Question 7

@# 7. The following renal calculi are radiopaque:
a) Cystine
b) Struvite
c) Calcium oxalate
d) Xanthine
e) Urate

Answer 7

7.
a) True - mildly radiopaque
b) True
c) True
d) False
e) False

Question 8

8. Regarding scintigraphy:
   a) Gallium-67 citrate is useful in gynaecological malignancies
   b) 99m technetium DTPA is cleared by tubular secretion
   c) 99m technetium DTPA is the best scintigraphic examination to detect renal cortical
   scarring
   d) 99m technetium DMSA is used for dynamic renal scintigraphy
   e) 99m technetium pertechnetate is used for micturating cystography

Answer 8

8.
a) False
b) False - glomerular filtration
c) False - 99m technetium DMSA as it is retained in the renal cortex
d) False - static renal scintigraphy
e) True

Question 9

@# 9. Phaeochromocytoma:
a) Is associated with tuberous sclerosis
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 gastric haemorrhage

Answer 9

a) True
b) True - in 1 % of cases
c) False - 10%
d) False-10%
e) True - Carney syndrome; triad of extradrenal phaeochromo- cytoma, gastric
leiomyosarcoma and pulmonary chondromas

Question 10

10. The following are true regarding renal anatomy:
    a) At the hilum the renal vein lies posterior to the renal artery
    b) 5% of people have accessory renal arteries
    c) The left renal vein is longer than the right
    d) The posterior leaf of the renal fascia is referred to as Gerota’s fascia
    e) The left renal vein receives the left inferior phrenic vein

Answer 10

10.
a) False - anterior
b) False -15-20%
c) True - it passes anterior to the aorta to reach the inferior vena cava
d) False - Zuckerkandl’s fascia. Gerota’s fascia is the anterior leaf
e) True

Question 11

@# 11. The following are causes of adrenal calcification:
a) Tuberculosis
b) Phaeochromocytoma
c) Adrenal myelolipoma
d) Histoplasmosis
e) Wolman’s disease

Answer 11

11.
a) True
b) True
c) True - calcification present in 20%
d) True
e) True - rare autosomal recessive lipid disorder associated with enlarged calcified adrenal
glands, hepatomegaly and splenomegaly

Question 12

12. Buscopan is contraindicated in the following:
    a) Pyloric stenosis
    b) Myasthenia gravis
    c) Angina pectoris
    d) Pregnancy
    e) Closed angle glaucoma

Answer 12

a) True
b) True
c) False
d) False
e) True

Question 13

13. The following cause a striated nephrogram:
    a) Medullary sponge kidney
    b) Amyloidosis
    c) Acute papillary necrosis
    d) Adult polycystic disease
    e) Acute pyelonephritis

Answer 13

13.
a) True - fan-shaped streaks radiating from the papilla to the periphery of the kidney
b) False - causes an increasingly dense nephrogram
c) False - causes an increasingly dense nephrogram
d) False - but seen in infantile polycystic disease due to contrast in dilated tubules
e) True

Question 14

@# 14. The following decrease noise in CT scanning:
a) Zoom enlargement of the display
b) Using a narrower window
c) Increasing slice thickness
d) Decreasing the pitch
e) Decreasing the scan time

Answer 14

14.
a) False - increases noise
b) False - increases noise as each grey level covers a smaller range of CT numbers
c) True
d) True
e) False

Question 15

15. Concerning anatomy of the lower urinary tract:
    a) Bladder rupture with fractures of the pelvis is usually extraperitoneal
    b) The point of tear in traumatic bladder rupture is usually at the anterior part of bladder
    c) The posterior urethra in the male comprises the prostatic and bulbous urethra
    d) In a duplex system the ureter draining the lower moiety is associated with ureterocoele
    e) The ureter lies anterior to the testicular artery

Answer 15

15.
a) True - intraperitoneal rupture may occur when the bladder is full
b) False - at the junction of the loose and fixed peritoneum at the posterior part of the bladder
c) False - prostatic and membranous urethra
d) False - the ureter draining the upper moiety
e) False - posterior

Question 16

@# 16. The following are true concerning testicular tumours:
a) 10% of germ cell tumours are bilateral
c) On ultrasound, seminoma is typically seen as a homogenous hyperechoic lesion
c) Embryonal cell carcinoma is normally homogenous on ultrasound
d) Pancreatic adenocarcinoma can metastasise to the testis
e) In 55-60% of cases, seminoma completely replaces the testicular tissue

Answer 16

16.
a) True
b) False - homogenous hypoechoic lesion sharply delineated from the normal testicular tissue
c) False - heterogenous. More aggressive than seminoma
d) True
e) False - not in the majority

Question 17

17. Leukoplakia:
    a) Is most commonly caused by chronic infection
    b) Most commonly affects the renal pelvis
    c) Is associated with calculi
    d) Produces passage of gritty flakes which is pathognomonic
    e) Causes filling defects in the ureters

Answer 17

1 7 .
a ) True
b) False - bladder
c) True - in 25-50%
d) True
e) True

Question 18

@# 18. Meta-iodo-benzyl-guanidine (MIBG) imaging is used to detect the following:
a) Colonic adenocarcinoma
b) Follicular thyroid carcinoma
c) Carcinoid tumour
d) Phaeochromocytoma
e) Neuroblastoma

Answer 18

18.
a) False
b) False - medullary thyroid carcinoma
c) True
d) True
e) True

Question 19

19. Concerning intravenous urograms:
    a) The paediatric dose of contrast is 2 ml per kilogram
    b) The use of laxatives has been shown to reduce bowel gas, thereby improving image quality
    c) The cephalic vein is the preferred injection site
    d) The injection should be given slowly so as to reduce risk of a contrast reaction
    e) Patients can eat and drink up to 2 hours before the procedure

Answer 19

19.
a) False - 1 ml per kilogram
b) False - not effective
c) False - flow is retarded in the cephalic vein as it pierces the clavipectoral fascia. The
median antecubital vein is preferred
d) False - injection should be rapid to maximise the density of the nephrogram
e) False - should have no food for 5 hours prior to examination

Question 20

@# 20. Concerning renal cell carcinoma:
a) It is bilateral in 10-15% of cases
b) Metastases are present at diagnosis in 40%
c) Stranding densities in the perirenal fat are consistent with tumour spread
d) The staging accuracy of MRI is much better than CT
e) Growth into the renal vein occurs in 5-10%

Answer 20

20.
a) False - 2%
b) True
c) False - usually attributable to oedema or fibrosis from previous inflammation
d) False - they are about equal
e) False - 30%

Question 21

21. The following are features of prune belly syndrome:
    a) Large bladder
    b) Medial deviation of the ureters
    c) Undescended testes
    d) Dilatation of the prostatic utricle
    e) Generally a good prognosis

Answer 21

21.
a) True
b) False - lateral deviation
c) True
d) True
e) False - there is high mortality

Question 22

@# 22. Raised alpha-fetoprotein is caused by the following:
a) Twins
b) Encephalocoele
c) Renal agenesis
d) Gastroschisis
e) Omphalocoele

Answer 22

22.
a) True
b) True
c) True
d) True
e) True

Question 23

23. Medullary sponge kidney:
    a) Is bilateral in 95% of cases
    b) Is usually first diagnosed in childhood
    c) Is an inherited disorder
    d) The kidneys are usually small in size
    e) Is associated with transient jaundice

Answer 23

23.
a) False - unilateral in 25%
b) False - young to middle-aged adulthood
c) False - sporadic
d) False - normal sized
e) True - Caroli’s disease; saccular cystic dilatation of major intrahepatic bile ducts

Question 24

24. Concerning the anatomy of the uterus:
    a) In children the uterus and cervix are of equal size
    b) The body of the uterus may drain to the inguinal lymph nodes
    c) The fundus drains to the para-aortic lymph nodes
    d) Just lateral to the cervix, the uterine artery passes below the ureter
    e) The subendometrial halo is hypoechoic on ultrasound

Answer 24

24.
a) False - equal size at puberty. The cervix is twice the size of the uterus in children
b) True - via the round ligament
c) True
d) False - passes above the ureter
e) True - analogous to the junctional zone on MRI

Question 25

@# 25. Krukenberg tumour is caused by:
a) Gastric adenocarcinoma
b) Colonic adenocarcinoma
c) Renal cell carcinoma
d) Pancreatic adenocarcinoma
e) Malignant melanoma

Answer 25

25.
a) True
b) True
c) False
d) True
e) False

Question 26

@# 26. The following may cause megaureter:
a) Posterior urethral valves
b) Retroperitoneal fibrosis
c) Beckwith-Wiedemann syndrome
d) Diabetes insipidus
e) Ectopic ureter

Answer 26

26.
a) True
b) True
c) False
d) True
e) True

Question 27

@# 27. Concerning congenital uterine anomalies:
a) 75% of women with congenital uterine anomalies have fertility problems
b) They are associated with urinary tract anomalies in 80-90%
c) In uterine didelphys there is duplication of the vagina
d) Bicornuate uterus is the commonest anomaly
e) Vaginal atresia may present with hydronephrosis

Answer 27

27.
a) False - 25%
b) False - 20-50%
c) True
d) False - septate uterus
e) True - due to a haematocolpos

Question 28

28. Adrenal metastases:
    a) Are present in a quarter of patients with malignant disease
    b) Commonly arise from a breast primary
    c) Are hyperintense to liver on T1 weighted images
    d) Are hyperintense to liver on T2 weighted images
    e) 75% of small adrenal masses in patients with known primary malignancy are metastases

Answer 28

28.
a) True
b) True
c) False - hypointense
d) True
e) False - 50% of small adrenal masses are benign adenomas in patients with known primary
malignancy

Question 29

29. Contents of the spermatic cord include:
    a) Testicular artery
    b) Genital branch of genitofemoral nerve
    c) Inferior epigastric artery
    d) Cremasteric artery
    e) Medial umbilical ligament

Answer 29

29.
a) True
b) True
c) False
d) True - a branch of the inferior epigastric artery
e) False

Question 30

30. Uterine fibroid embolisation:
    a) Can be used to treat intramural as well as pedunculated fibroids
    b) Can be performed immediately after cessation of medical treatment for fibroids
    c) Is performed using coils
    d) The internal iliac artery should be selectively catheterised using a Cobra catheter
    e) Premature menopause may occur

Answer 30

30.
a) False - should not be used if fibroid is pedunculated due to risk of intra-abdominal sepsis
b) False - delay for 3 months as gonadotrophin-releasing hormone analogues may shrink the
uterine arteries, making them extremely difficult to catheterise
c) False - polyvinyl alcohol particles
d) True
e) True - in 2%

Question 31

@# 31. The following are true concerning MRI artefacts:
a) Truncation artefact is avoided by decreasing the voxel size
b) Susceptibility artefacts are seen around metal implants
c) Susceptibility artefacts are reduced by using gradient-echo rather than spin-echo sequences
d) Aliasing is reduced by increasing the field of view
e) Aliasing is reduced by using a larger surface coil

Answer 31

31.
a) True
b) True
c) False - the opposite is true
d) True
e) False - smaller surface coil

Question 32

@# 32. Regarding pyeloureteritis cystica:
a) It is most commonly seen in young adults
b) The most common causative organism is Proteus mirabilis
c) Diabetics are predisposed
d) There is a good response to antibiotic therapy
e) There is a risk of malignancy

Answer 32

32.
a) False - 6th decade
b) False - Escherichia coli
c) True
d) False
e) True - increased incidence of transitional cell carcinoma of bladder

Question 33

33. Concerning MRI of the normal female reproductive organs:
    a) The endocervical canal is high signal on T2 weighted images
    b) The junctional zone is a layer of myometrial cells with a decreased nuclear cellular ratio
    c) The ovaries are well seen on T1 weighted images
    d) The uterosacral ligaments are best seen on T2 weighted images
    e) The outer myometrium is low signal on T2 weighted images

Answer 33

33.
a) True
b) False - increased nuclear cellular ratio making it low signal on T2 weighting
c) False - intermediate signal intensity with poor intrinsic contrast
d) False - T1 weighted imaging
e) False - intermediate signal intensity

Question 34

34. 34 The following cause polyhydramnios:
    a) Cystic adenomatoid malformation
    b) Posterior urethral valves
    c) Twin pregnancy
    d) Ventricular septal defect
    e) Post-maturity

Answer 34

34.
a) True
b) False - causes oligohydramnios
c) True
d) True
e) False - causes oligohydramnios

Question 35

@# 35. Gallium-67 citrate is taken up by the following:
a) Lymphoma
b) Bronchial carcinoma
c) Normal bone marrow
d) Haemangioma
e) Simple renal cysts

Answer 35

35.
a) True
b) True
c) True
d) False
e) False

Question 36

36. The following are seen in Beckwith-Wiedemann syndrome:
    a) Omphalocoele
    b) Gastrointestinal malrotation
    c) Polyhydramnios
    d) Microglossia
    e) Hepatoblastoma

Answer 36

36.
a) True
b) True
c) True - in half of cases
d) False - macroglossia
e) True - there is an increased risk of benign and malignant tumours

Question 37

37. 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) In the earliest stage, dilatation of the ureter is confined to the upper third
    e) Ureteral calculi are rarely seen

Answer 37

37.
a) True - it is very commonly seen in the bladder
b) False - only in advanced disease
c) True
d) False - lower third
e) False - commonly seen

Question 38

38. The following cause cortical nephrocalcinosis:
    a) Renal papillary necrosis
    b) Milk-alkali syndrome
    c) Chronic glomerulonephritis
    d) Chronic transplant rejection
    e) Sarcoidosis

Answer 38

38.
a) False - causes medullary nephrocalcinosis
b) False - causes medullary nephrocalcinosis
c) True - rarely
d) True
e) False - causes medullary nephrocalcinosis

Question 39

39. Concerning MRI of renal masses:
    a) The wall of a simple cyst is usually visible
    b) Renal cell carcinoma is usually hypointense on T2 weighted images
    c) Abscess is usually hyperintense on T2 weighted images
    d) Angiomyolipoma is hyperintense on T2 fast spin-echo weighted images
    e) Lymphoma is hypointense on T1 weighted images

Answer 39

39.
a) False - not visible
b) False - iso to hyperintense
c) True
d) True - due to fat. Also hyperintense on T1 weighted images
e) True - homogenously

Question 40

40. Ultrasound features of a breast carcinoma include:
    a) Poorly reflective mass
    b) Posterior wall enhancement
    c) Heterogenous internal echopattern
    d) III defined mass
    e) Posterior acoustic shadowing

Answer 40

40.
a) True
b) False - seen with a simple cyst
c) True
d) True
e) True

Question 41

41. Differential diagnoses for a single well defined soft tissue density opacity on
    mammography include:
    a) Cyst
    b) Lipoma
    c) Papilloma
    d) Intramammary lymph node
    e) Fibroadenoma

Answer 41

41.
a) True
b) False
c) True
d) True
e) True

Question 42

42. The following lesions of the breast have spiculated margins:
    a) Breast carcinoma
    b) Fat necrosis
    c) Radial scar
    d) Fibroadenoma
    e) Lymphoma

Answer 42

42.
a) True
b) True
c) True
d) False
e) False

Question 43

@# 43. Regarding anatomy of the breast:
a) The internal mammary artery contributes 50-60% of the blood supply to the breast
b) Lymph flows bi-directionally via superficial and deep lymphatics of the breast
c) Level 3 axillary lymph nodes lie lateral to the medial border of pectoralis minor
d) The breast is entirely invested by the fascia of the chest wall
e) Cooper’s ligaments are normally of high signal on T2 weighted MRI

Answer 43

43.
a) True - the lateral thoracic artery contributes 30% of the blood supply and some also
supplied by the perforating branches of the intercostals arteries
b) False - lymph flows uni-directionally superficial to deep
c) False - level 1 axillary lymph nodes lie lateral to the lateral border of pectoralis minor,
level 2 lie behind pectoralis minor and level 3 nodes lie medial to the medial border of
pectoralis minor
d) True
e) False - low signal on T2 weighted MRI images

Question 44

@# 44. Regarding carcinoma of the male breast:
a) 3-5% occur in men with Klinefelter’s syndrome
b) Gynaecomastia is the most significant risk factor
c) Tumour is more commonly found in the right breast
d) 40-60% have enlarged lymph nodes at the time of presentation
e) There is an association with males with increased testosterone levels

Answer 44

44.
a) True
b) False - risk factors include Klinefelter’s syndrome, testicular atrophy, lung disease
c) False - left breast
d) True
e) False - association with males with increased oestrogen levels

Question 45

@# 45. Renal vein thrombosis:
a) Is more common on the right
b) Is most commonly due to membranous glomerulonephritis
c) Causes a striated nephrogram
d) Causes renal enlargement
e) May be secondary to ovarian vein thrombosis

Answer 45

a) False - left side is more common
b) True
c) True
d) True
e) True - the left ovarian vein drains into the left renal vein

Question 46

46. Regarding the investigation of renal artery stenosis:
    a) Radionuclide scintigraphy may provide the diagnosis
    b) Intrarenal Doppler waveforms may show pulsus tardus
    c) Renal - aortic peak systolic ratio is >2.5
    d) MR angiography underestimates the degree of stenosis
    e) Maximum intensity projections are sufficient to interpret stenotic lesions

Answer 46

46.
a) True - ACE inhibitor scintigraphy
b) True - dampened waveforms are seen with significant stenoses
c) False - >3.5
d) False - MR overestimates stenoses
e) False - source images should be analysed

Question 47

@# 47. 47 Features of von Hippel-Lindau disease include:
a) Renal cysts are present in over 50%
b) Renal impairment is common
c) Renal angiomas may be distinguished from renal cell carcinoma by imaging
d) Renal cell carcinomas are usually solitary
e) A cyst with an enhancing nodule is suspicious for malignancy

Answer 47

47.
a) True - 50-70%
b) False
c) False
d) False - renal cell carcinomas tend to be multicentric and bilateral
e) True

Question 48

@# 48. Regarding CT of renal trauma:
a) Renal contusions are hypoattenuating during the nephrographic phase of contrast
enhancement
b) Grade 2 lacerations are confined to the renal cortex
c) Evidence of acute arterial bleeding indicates a Grade 3 renal injury
d) The cortical rim sign is usually absent with avulsion of the renal artery
e) Absence of perinephric haematoma is typical of renal artery occlusion

Answer 48

48.
a) True
b) False - cortex, medulla +/- collecting system
c) True
d) False
e) True

Question 49

49. Concerning imaging of cervical disorders:
    a) Cervical tumours tend to be hyperintense on T2 weighted MR sequences
    b) Nabothian cysts are low signal on T1 weighted MR
    c) Adenoma malignum is associated with Peutz-Jehgers syndrome
    d) Cervical tumour invading the rectal mucosa represents stage 3 disease
    e) The vaginal wall is hypointense on T2 weighted MR

Answer 49

49.
a) True
b) False - intermediate to high signal on T1, and high T2 signal
c) True
d) False - stage 4 disease
e) True

Question 50

@# 50. In renal tract tuberculosis:
a) 25% of patients with pulmonary tuberculosis will develop significant renal tuberculosis
b) Renal calcification is uncommon
c) Papillary irregularity on IVU is a late sign
d) A large, distended bladder is seen
e) Ureteral involvement is due to haematogenous spread

Answer 50

50.
a) False - 4-8%
a) False - common (24-44% of cases)
b) False - an early sign
c) False - reduced bladder capacity
d) False - passage of infected urine