Genitourinary, Adrenal, Obstetrics & Gynaecology and Breast - Practice papers

Question 1

1. 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

Answer 1

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

Question 2

2. Glucagon is contraindicated in the following conditions:
   a) Glucagonoma
   b) Multiple myeloma
   c) Sickle cell disease
   d) Insulinoma
   e) Phaeochromocytoma

Answer 2

2.
a) True
b) False
c) False
d) True
e) True

Question 3

3. 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

Answer 3

3.
a) True
b) True
c) False - higher as there are no cooling periods between slices
d) False - higher
e) True

Question 4

4. Causes of renal papillary necrosis include:
   a) Aspirin
   b) Diabetes mellitus
   c) Sickle cell disease
   d) Systemic lupus erythematosus
   e) Sarcoidosis

Answer 4

4.
a) True
b) True - accounts for 50% of cases
c) True
d) False
e) False

Question 5

5. 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

Answer 5

5.
a) True
b) True
c) True
d) True
e) True

Question 6

6. 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

Answer 6

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

Question 7

7. 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

Answer 7

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

Question 8

8. Causes of a thickened placenta on imaging include:
   a) Diabetes
   b) Infection
   c) Rhesus incompatibility
   d) Intra-uterine growth retardation
   e) Gastroschisis

Answer 8

8.
a) True
b) True
c) True
d) False
e) False

Question 9

9. 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

Answer 9

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

Question 10

10. 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

Answer 10

10.
a) True
b) True - used in echocardiography
c) False - increases
d) False
e) True

Question 11

11. 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

Answer 11

11.
a) True - however, patients may die from massive haemorrhage
b) False - 80% are unilateral
c) True
d) False - characteristically hyperechoic
e) True

Question 12

12. The following cause bilateral large kidneys:
    a) Acute glomerulonephritis
    b) Amyloidosis
    c) Uraemic medullary cystic disease
    d) Diabetic glomerulosclerosis
    e) Urate nephropathy

Answer 12

12.
a) True
b) True
c) False - causes bilateral small kidneys
d) True
e) True

Question 13

@#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

Answer 13

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

Question 14

14. 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%

Answer 14

14.
a) False
b) False - this is a benign tumour c) False - 40%
d) False - bilateral in 60-65%
e) True

Question 15

15. 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

Answer 15

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

Question 16

16. 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

Answer 16

16.
a) False - rapidly enlarging mass
b) False
c) True
d) True
e) False - usually presents in 5th-6th decade

Question 17

17. 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

Answer 17

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

Question 18

18. 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

Answer 18

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

Question 19

19. 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

Answer 19

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

Question 20

20. 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

Answer 20

20.
a) True
b) True
c) False - adenomas enhance rapidly
d) False - adenomas show rapid washout of contrast media
e) True

Question 21

21. 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

Answer 21

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

Question 22

22. 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

Answer 22

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

Question 23

23. 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

Answer 23

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

Question 24

24. 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

Answer 24

24.
a) True
b) False - covered by peritoneum and amnion
c) False - other anomalies in over 80% of cases
d) False
e) True

Question 25

25. 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

Answer 25

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

Question 26

26. 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

Answer 26

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

Question 27

27. Medial deviation of the ureters is caused by:
    a) Iliopsoas hypertrophy
    b) Retrocaval ureter
    c) Aortic aneurysm
    d) Retroperitoneal fibrosis
    e) Pelvic lipomatosis

Answer 27

27.
a) True
b) True - right side only
c) False - lateral deviation
d) True
e) True

Question 28

28. 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

Answer 28

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

Question 29

29. 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

Answer 29

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

Question 30

30. 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

Answer 30

30.
a) True
b) True
c) False - low signal intensity
d) True - as may prostatitis, hyperplastic nodules and radiation therapy
e) True