Genitourinary, Adrenal, Obstetrics & Gynaecology and Breast - Practice papers Flashcards
- Concerning developmental abnormalities of the kidneys:
a) Duplication of the collecting system is seen in 10-12% of people
b) Accessory renal arteries normally enter the upper and mid poles
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
1.
a) False - 4%
b) False - lower pole below the hilum
c) False - 1 in 700 births
d) True - as they lie across the vertebral column
e) False - more common
- Glucagon is contraindicated in the following conditions:
a) Glucagonoma
b) Multiple myeloma
c) Sickle cell disease
d) Insulinoma
e) Phaeochromocytoma
2.
a) True
b) False
c) False
d) True
e) True
- The following are true of spiral (helical) CT scanning compared with sequential CT
scanning:
a) There is reduction in partial volume artefacts
b) Reformatting into other planes is improved
c) The heat loading of the tube is lower
d) Noise is lower
e) There is less slice-to-slice misregistration
3.
a) True
b) True
c) False - higher as there are no cooling periods between slices
d) False - higher
e) True
- Causes of renal papillary necrosis include:
a) Aspirin
b) Diabetes mellitus
c) Sickle cell disease
d) Systemic lupus erythematosus
e) Sarcoidosis
4.
a) True
b) True - accounts for 50% of cases
c) True
d) False
e) False
- The differential diagnosis of a pelvic fluid collection in a female on ultrasound includes:
a) Follicle rupture
b) Dermoid cyst
c) Ectopic pregnancy
d) Endometriosis
e) Pelvic inflammatory disease
5.
a) True
b) True
c) True
d) True
e) True
- Regarding ovarian cancer:
a) It is the commonest gynaecological malignancy
b) It is associated with colorectal cancer
c) CT only has a pre-operative staging accuracy of 50%
d) CA-125 is specific for ovarian cancer
e) Doppler ultrasound may help with differentiating benign from malignant disease
6.
a) False - second commonest after endometrial carcinoma
b) True - Lynch Type 2 cancer family syndrome
c) False - 70-90%
d) False - elevated in benign conditions, e.g. fibroids, endometriosis and pelvic inflammatory
disease
e) True
- Regarding gestational trophoblastic disease:
a) Young maternal age is a risk factor
b) It is associated with theca-lutein cysts
c) A predominantly echo-poor mass is seen on ultrasound
d) Raised human chorionic gonadotrophin is seen in up to 80% of cases
e) Invasive mole develops in approximately half of cases
7.
a) False - increased maternal age
b) True - in 20-50% of patients
c) False - echogenic mass
d) False - 100%
e) False - 12-15% of cases
- Causes of a thickened placenta on imaging include:
a) Diabetes
b) Infection
c) Rhesus incompatibility
d) Intra-uterine growth retardation
e) Gastroschisis
8.
a) True
b) True
c) True
d) False
e) False
- Regarding varicocoele embolisation:
a) The internal jugular vein may be punctured
b) The right spermatic vein joins the inferior vena cava just above the right renal vein
c) Should be limited to patients with large varicocoeles
d) Glyceryl-trinitrate may be needed
e) Embolisation is usually performed using polyvinyl alcohol particles
9.
a) True - although the common femoral vein is often used
b) False - it joins the anterior aspect of the inferior vena cava just below the right renal vein
c) False - symptomatic or subfertile patients
d) True - if the spermatic vein goes into spasm
e) False - using coils
- The following are true of ultrasound:
a) Resolution is improved by increasing frequency
b) M-mode imaging requires a high pulse rate frequency
c) In Doppler imaging the frequency of the approaching reflector decreases
d) Aliasing artefact is reduced by increasing frequency
e) Temperature rise of 1.5 degrees centigrade above normal produces no harmful effects
regardless of duration
10.
a) True
b) True - used in echocardiography
c) False - increases
d) False
e) True
- Angiomyolipoma:
a) Is a benign tumour
b) 50% are bilateral
c) CT demonstration of fat without calcification is diagnostic
d) Is characteristically hypoechoic on ultrasound
e) 20% of patients have tuberous sclerosis
11.
a) True - however, patients may die from massive haemorrhage
b) False - 80% are unilateral
c) True
d) False - characteristically hyperechoic
e) True
- The following cause bilateral large kidneys:
a) Acute glomerulonephritis
b) Amyloidosis
c) Uraemic medullary cystic disease
d) Diabetic glomerulosclerosis
e) Urate nephropathy
12.
a) True
b) True
c) False - causes bilateral small kidneys
d) True
e) True
@#e 13. Regarding endometriosis:
a) Most commonly affects the fallopian tubes
b) 20% of infertile women are affected
c) Endometrioma is rarely anechoic on ultrasound
d) May present with pneumothorax
e) Cystic masses seen are typically hypointense on T1 weighted images
13.
a) False - 80% affects the ovaries
b) True
c) True - classically has diffuse low-level internal echoes
d) True
e) False - homogenously hyperintense on T1 weighted images
- The following statements regarding breast disease are true:
a) Sclerosing adenosis is a risk factor for breast cancer
b) 10-15% of fibroadenomas undergo malignant change
c) A history of trauma is elicited in 80-85% of women presenting with fat necrosis of the
breast
d) Gynaecomastia is bilateral in 15-20% of cases
e) Juvenile papillomatosis is associated with development of a metachronous tumour in 3-5%
14.
a) False
b) False - this is a benign tumour c) False - 40%
d) False - bilateral in 60-65%
e) True
- The following are features of angiosarcoma of the breast:
a) Highly malignant breast tumour
b) Usually presents in women 50-60 years of age
e) Painful
d) Appears hyperechoic on ultrasound
e) Treatment requires mastectomy and axillary lymph node dissection
15.
a) True
b) False - women 20-30 years of age
c) False - painless
d) False - it is a well defined multilobulated hypoechoic mass. If there is haemorrhage then it
can contain hyperechoic areas
e) False - haematogenous spread. There is no spread by lymphatics
- Features of cystosarcoma phylloides (phyllode tumour):
a) Slow growing mass
b) Commonly calcifies
c) Malignant degeneration occurs in 5-10%
d) Axillary metastases are rare
e) It usually presents in women under 20 years of age
16.
a) False - rapidly enlarging mass
b) False
c) True
d) True
e) False - usually presents in 5th-6th decade
- Regarding breast cancer imaging:
a) 1-2% of breast cancers are mammographically occult
b) Germ line mutations are associated with an increased lifetime risk of developing breast
cancer by 5-10%
c) BRCA 1 and 2 are the commonest germ line mutations associated with breast cancer
d) Breast cancer is most easily detected by mammography in women with dense breasts
e) Breast ultrasound uses a 10 MHz high frequency probe
17.
a) False - 10-12%
b) False - increased lifetime risk of developing breast cancer by 60-80%. More than 50% are
afflicted before 50 years of age
c) True
d) False - less likely to be detected in women with dense breasts and <50 years of age
e) True
- Regarding breast cancer metastases:
a) A long metastases-free interval is a good prognostic factor
b) Bony metastases have a better prognosis than lung metastases
c) Oestrogen receptor-positive metastases are more likely to occur in the liver
d) Peritoneal and retroperitoneal metastatic disease is more prevalent in lobular carcinomas of
the breast
e) The site of initial metastastic deposits is more commonly the brain in those patients who
have received adjuvant chemotherapy
18.
a) True
b) True
c) False - more likely to occur in bone
d) True - as are gastrointestinal and gynaecological
e) True - since the majority of chemotherapy agents used in the treatment of breast cancer do
not cross the blood-brain barrier
- Phaeochromocytoma:
a) When symptomatic tends to be larger at presentation
b) Is bilateral in 25%
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
19.
a) False - symptomatic tumours tend to be smaller at presentation
b) False - 10% bilateral, 10% malignant
c) True - as part of the Carney triad
d) False - they rarely contain sufficient fat for HU to be <10
e) True
- Regarding benign and malignant adrenal masses:
a) Lesions >4 cm tend to be malignant
b) Approximately one third of benign adenomas have HU of >10 on unenhanced CT
c) Adenomas tend to show delayed enhancement with IV contrast
f) Adenomas tend to show delayed clearance of IV contrast
g) Chemical shift MR utilises T1 weighted sequences
20.
a) True
b) True
c) False - adenomas enhance rapidly
d) False - adenomas show rapid washout of contrast media
e) True
- Concerning ovarian teratomas:
a) Mature teratomas are usually multi-loculated
b) Fat attenuation on CT is diagnostic for mature cystic teratoma
c) They are a known cause of peritonitis
d) Sebaceous fluid has low signal on T1 weighted MR
e) Calcification indicates a malignant teratoma
21.
a) False - unilocular
b) True
c) True - following rupture or torsion
d) False - high T1 signal intensity
e) False - calcification outside the mural nodule is suspicious of malignancy
- Regarding contrast media nephrotoxicity:
a) Old age is an independent risk factor
b) Development of nephrotoxicity is independent of dose given
c) Baseline creatinine must rise by 50% for the diagnosis to be made
d) Oral acetylcysteine is protective
e) Non-ionic dimmers are less nephrotoxic than low osmolar contrast media
22.
a) True - as are diabetic nephropathy, dehydration, heart failure and NSAIDS
b) False - nephrotoxicity is dose-dependent
c) False - 25% above baseline levels
d) True
e) True
- Regarding ureteric stent placement:
a) Irritative bladder symptoms occur in over 75%
b) Encrustation is common when a stent is left for >6 weeks
c) Haematuria is a rare complication
d) Antibiotic prophylaxis is required even in the presence of a sterile urinary tract
e) Vesico-ureteric reflux is a common post-stent complication
23.
a) True
b) True - 47% at 6-12 weeks
c) False - microscopic haematuria is seen following most stents
d) True
e) True - 80% of cases
- Omphalocoele:
a) Is a midline abdominal wall defect
b) Has no covering over the herniated contents
c) Is usually an isolated abnormality
d) Is associated with a normal umbilical cord insertion
e) Is associated with Beckwith-Wiedemann syndrome
24.
a) True
b) False - covered by peritoneum and amnion
c) False - other anomalies in over 80% of cases
d) False
e) True
- Regarding renal lymphoma:
a) Primary renal lymphoma is rare
b) It is more common in non-Hodgkin’s lymphoma
c) It is hypoechoic at ultrasound
d) Multiple masses are more common than isolated lesions
e) Post-contrast, there is decreased enhancement compared to the surrounding normal renal
parenchyma
25.
a) True
b) True
c) True
d) True
e) True
- Multicystic dysplastic kidney:
a) Is the second commonest cause of a neonatal abdominal mass b) Is usually unilateral
c) Is associated with PUJ obstruction
d) The renal cysts communicate
e) Intervening normal renal parenchyma is present
26.
a) True - hydronephrosis is the most common cause
b) True
c) True - in 10 - 20% of cases
d) False - no communication is seen
e) False - no normal renal parenchyma is seen
- Medial deviation of the ureters is caused by:
a) Iliopsoas hypertrophy
b) Retrocaval ureter
c) Aortic aneurysm
d) Retroperitoneal fibrosis
e) Pelvic lipomatosis
27.
a) True
b) True - right side only
c) False - lateral deviation
d) True
e) True
- Regarding emphysematous infections of the renal tract:
a) Diabetes is present in almost half the cases of pyelonephritis
b) Escherichia coli is the most common pathogen
c) Infection does not spread beyond the renal capsule
d) Ultrasound reliably demonstrates the depth of involvement
e) Perirenal fluid collections are a poor prognostic sign
28.
a) False - in over 90%
b) True
c) False - gas may extend into the perirenal space
d) False - CT is more effective
e) False - perirenal fluid collections imply a favourable immune response
- Regarding paratesticular masses:
a) Epididymal cysts are anechoic at ultrasound
b) Spermatocoeles may be distinguished from epididymal cysts by ultrasound
c) Papillary cystadenomas are associated with cerebellar haemangiomas
d) Pampiniform plexus vessel diameter of 4 mm is normal
e) Lipomas are the most common paratesticular tumour
29.
a) True
b) False - both are well defined, anechoic structures
c) True - as part of von Hippel-Lindau disease
d) False - >3 mm is abnormal
e) True
- Regarding prostatic carcinoma:
a) Zonal anatomy is best depicted on T2 weighted MR
b) The prostatic capsule is of low signal intensity on T2 weighted MR
c) Carcinoma is usually intermediate to high signal on T2 weighted MR
d) Haemorrhage may mimic carcinoma
e) The vas deferens and seminal vesicles are of high T2 signal intensity
30.
a) True
b) True
c) False - low signal intensity
d) True - as may prostatitis, hyperplastic nodules and radiation therapy
e) True
