GU

Question 1

name 2 nuclear tests performed for f/u reflux:

Answer 1

RCN

DMSA

Question 2

What is the Weigert–Meyer rule re duplex PC system

Answer 2

there is an increased risk of obstruction (in the upper pole moiety) and reflux (in the lower pole moiety)

Question 3

Where does the upper pole insert?

Answer 3

the upper pole ureter inserts ectopically (inferomedially) into the bladder and is prone to obstruction,

Question 4

Where does the lower pole insert?

Answer 4

The lower pole ureter inserts orthotopically (normally) but is prone to reflux.

Question 5

Ddx of Drooping lily sign on VCUG

Answer 5

1. Renal ptosis, which would be expected to show a normal number of calyces.
2. obstructed upper pole of the drooping lily has fewer calyces.

Seen in some patients with a duplicated collecting system. It refers to the inferolateral displacement of the opacified lower pole moiety due to an obstructed (and unopacified) upper pole moiety.

The similarity to a lily is further strengthened by the small number of calyces the lower pole moiety has

Question 6

Tx for PUJ obstruction

Answer 6

Pyeloplasty

Question 7

How to differentiate bwn PUJ obstruction and prominent extra renal pelvis

Answer 7

Whitaker test - Urodynamic study with integrate pyelogram

Question 8

Abrupt calibre change bwn dilated posterior urethra and normal calibre anterior urethra on VCUG

Answer 8

Posterior urethral valves

Question 9

MRI shows hydro in the kidney and a key hole in the bladder

Answer 9

Posterior urethral valves

Most Common cause of hydronephrosis in fetus is PUJ Obstruction

Question 10

BUZZWORD: Perirenal fluid collection

Answer 10

Posterior urethral valves

Non specific, can b seen in obstructive picture.

Question 11

main differential for posterior urethral valve

Answer 11

prune belly syndrome, which would show dilation of the ENTIRE ureter rather than only the prostatic portion

Question 12

Prune belly triad:

Answer 12

1. Crappy abdominal musculature. 2. Hydroureteronephrosis 3. Cryptorchidism- bladder distention interferes with descent of testes

Question 13

What is the diagnosis?

focal dilation of the distal ureter within the bladder wall, where the ureter infolds between the mucosal and muscular layers of the bladder wall.

Answer 13

Ureterocele

Question 14

Cobra head sign: contrast surrounded by a lucent rim protruding from the contrast filled bladder

Answer 14

Ureterocoele

Question 15

The ureterocoele is associated with….

Answer 15

Duplicated system- specially the upper pole

Question 16

MCDK

Answer 16

1. No functioning renal tissue
2. Contralateral renal tract abnormalities 50% of the time

Question 17

TS (4)

Answer 17

1. Renal cysts
2. Renal angiomyolipomas.
3. Cardiac rhabdomyoma.
4. CNS cortical hamartomas, subependymal nodules, and subependymal giant cell astrocytoma.

Question 18

VHL (5)

Answer 18

1. Renal cysts
2. Renal cell carcinoma (RCC): Up to 30% of VHL patients die from RCC.
3. Adrenal pheochromocytoma.
4. Pancreatic cysts, islet cell tumors, and serous cystadenomas.
5. Brain and spinal cord hemangioblastomas.

Question 19

BUZZWORD: Protrudes into renal pelvis

Answer 19

Multilocular cystic nephroma

Question 20

What is the diagnosis?

Bilateral enlarged and diffusely echogenic kidneys with loss of CM differentiation- No urine in the bladder in utero

Answer 20

ARPKD

Question 21

Liver findings in ARPKD

Answer 21

Abnormal bile ducts and fibrosis.

Question 22

RF for Wilm’s tumour (4)

Answer 22

1. Beckwith–Wiedemann syndrome (hemihypertrophy, macroglossia, omphalocele, neonatal hypoglycemia (due to insulin overproduction by pancreatic β-cells), and increased risk of childhood malignancies, including Wilms tumor and hepatoblastoma).
2. WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and mental retardation).
3. Horseshoe kidney: Approximately 2x incidence of Wilms tumor.
4. Trisomy 18.

Question 23

What is the diagnosis?

heterogeneous, solid renal mass. The claw sign indicates renal parenchyma origin. Tumor venous extension is seen in 5–10%.

Calcifications may be present.

Answer 23

Wilm’s tumour

Question 24

Ddx multilocular cystic nephroma.

Answer 24

cystic Wilm’s tumour

Question 25

Bilateral Wilm's tumour

Answer 25

They had nephroblastomatosus in 99%

Question 26

Hypodense rind , homogenous mass, with no necrosis

Answer 26

Nephroblastomatosis

Question 27

Beckwith Weidemann

Answer 27

Wilms Omphalocele Hepatoblastoma

Question 28

What is the diagnosis? Wilms Omphalocele Hepatoblastoma

Answer 28

Beckwith Weidemann

Question 29

Primary malignancies with potential metastases to kidneys(3)

Answer 29

1. Neuroblastoma 2. Leukaemia 3. Lymphoma

Question 30

Similar to Wilm's tumour in younger children \< 1 year old

Answer 30

Mesoblastic nephroma

Question 31

Multiple AMLs are associated with....

Answer 31

TS

Question 32

What is the lesion? suprarenal mass, with calcifications seen in ~50%.

Answer 32

adrenal neuroblastoma

Question 33

Neuroblastoma vs Wilm's tumour

Answer 33

Neuroblastoma tends to encase vessels, while Wilms tumor is known to displace vessels.

Question 34

MRI findings of neuroblastoma

Answer 34

On MRI, neuroblastoma often: 1. invades into neural foramina and the spinal canal. 2. Diffusion is often restricted, reflecting hypercellularity.

Question 35

NM test for adrenal neuroblastoma

Answer 35

I-123 MIBG scintigraphy same test used for phaeo, carcinoid

Question 36

A classic presentation of metastatic neuroblastoma

Answer 36

intracranial, subdural mass originating from the marrow

Question 37

Neuroblastoma vs ganglioneuroma

Answer 37

1. In contrast to neuroblastoma, ganglioneuroma affects slightly **_older children_** (most common age of a ganglioneuroma patient is 6 years old) 2. only 50% of ganglioneuromas are positive on I-123 MIBG scintigraphy. 3. MRI classically shows restricted diffusion of a neuroblastoma, but not in ganglioneuroma.

Question 38

What is the lesion? ultrasound: a hypoechoic, avascular, suprarenal mass. Hemorrhage may appear similar to neuroblastoma on initial ultrasound, but a follow-up scan would demonstrate involution.

Answer 38

Adrenal haemorrhage

Question 39

Name 2 conditions associated with adrenal cortical carcinoma

Answer 39

1. Beckwith–Wiedemann and 2. Li–Fraumeni syndromes

Question 40

Risk of which type of cancer with urachus remnant?

Answer 40

Adenocarcinoma

Question 41

What is the lesion? Imaging features a characteristic lobulated, bunch of grapes appearance.

Answer 41

Rhabdomyosarcoma

Question 42

What is the lesion? ........ is usually apparent on prenatal imaging. When detected after birth the characteristic clinical appearance is a skin-covered mass extending from the midline buttocks. It has a heterogeneous imaging appearance with cystic, solid, and fatty components.

Answer 42

Sacrococcygeal teratoma

Question 43

Horseshoe kidneys increase the risk of which malignancies?

Answer 43

1. TCC 2. Wilm's 3. Renal carcinoid

Question 44

Renal artery thrombosis secondary to .... What does is cause?

Answer 44

secondary to umbilical artery catheter. Does not cause enlargement but causes severe HTN.

Question 45

renal masses in neonates

Answer 45

1. Nephroblastomatosis 2. Mesoblastic nephroma- hamartoma (polyhydramnios)§

Question 46

patients is too young to have wilms tumour, what is the diagnosis?

Answer 46

Mesoblastic nephroma

Question 47

bilateral wilms

Answer 47

Nephroblastomatosis

Question 48

I say Beckwith Weidemann, you say....

Answer 48

1. Wilms 2. Omphalocele 3. Hepatoblastoma

Question 49

paratesticular mass with lung and bone metastases

Answer 49

rhabdomyosarcoma

Question 50

AFP is usually elevated in this testicular tumour

Answer 50

Yolk sac tumour (non seminoma)