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1
Q

Causes Dromedary hump

A

Spleen

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2
Q

Man with renal agenesis:

A

Ipsi absent epididymis, Vas,

Or

Ipsi seminal vesicle cyst

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3
Q

Horsehoe kidney gets hung up on:

A

IMA

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4
Q

AML vs Clear cell RCC?

A

Calcification

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5
Q

Clear cell looks like?

A/W

A

Enhancement equal to cortex, calcifications

VHL

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6
Q

Papillary RCC

MRI look

A

T2 Dark

Enhance less than clear cell (less than cortex)

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7
Q

Medullary RCC

A/W?

Presentation

A

Sickle cell

Large, metastasized, aggressive

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8
Q

Chromophobe RCC

A

Burt Hogge Dubbe

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9
Q

RCC Stage 1

A

<7cm

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10
Q

RCC stage 2

A

>7cm

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11
Q

RCC stage 3A

A

Renal Vein

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12
Q

RCC 3B

A

IVC below phragm

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13
Q

RCC 3C

A

above phragm

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14
Q

RCC stage 4

A

Beyond Gerota’s fascia

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15
Q

Nephrogenic phase =

A

80 seconds

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16
Q

Renal lymphoma MC appearance

A

BILATERAL enlarged kidneys with small low attenuation cortically based solid nodules

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17
Q

MC visceral organ involved in leukemia

A

Kidney

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18
Q

AML A/W

A

TS

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19
Q

AML with calcs =

A

a clear cell RCC (not an AML)

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20
Q

Lipid poor AML=

A

T2 dark

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21
Q

Oncocytoma vs. RCC?

A

Central scar

Spoke wheel vascular pattern US

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22
Q

Oncocytoma vs RCC PET

A

Onco HOT

RCC cold

-er than surrounding parenchyma

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23
Q

Bilateral Oncocytomas

A

Burt Hogge Dube

(DONT FORGET CHROMOPHOBE RCC TOO)

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24
Q

Multilocular cystic nephroma

A

Non-communicating fluid filled nodules with thick capsule

PROTRUDES INTO RENAL PELVIS
BIMODAL
4 year old boys and middle aged women

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25
Q

Boz 2f

A

Hyperdense >3cm

THIN calcs

<5% chance of cancer

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26
Q

Boz 3

A

Thick calcs

mural nodule

50% cancer

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27
Q

Boz 4

A

ANY enhancement

Cancer

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28
Q

ADPKD cysts where?

A

LIVER and SEMINAL VESICLES

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29
Q

HD kidney (Uremic cystic kidney disease)

A

3-6x risk of cancer

cysts regress after transplant

SMALL KIDNEYS

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30
Q

VHL Pancreas?

A

cysts

serous microcystic adenomas

islet cell tumors

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31
Q

VHL adrenal

A

PheoS

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32
Q

TS

kidney?

lung?

Cardiac?

A

AML (RCC at young age)

LAM

Rhabdomyosarcoma (septum)

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33
Q

Lithium kidney

A

Diabetes insipidus

innumeralble tiny cysts

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34
Q

Multicystic Dysplastic ?

A

PEDS

No functioning renal tissue

a/w contralateral tract abnormalities

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35
Q

T2 dark renal cyst

A

Lipid poor AML

Hemorrhagic cyst (T1 bright)

Papillary RCC (less enhancement than clear cell)

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36
Q

emphysematous pyelo

A

diabetics

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37
Q

emphysematous pyelitis

A

Gas localized to collecting system

diabetics, women, h/o obstruction

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38
Q

papillary necrosis causes

A

DM!

pyelo

sickle cell

TB

analgesics

cirrhosis

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39
Q

TB kidney

A

shrunken and calcified

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40
Q

HIV nephropathy

PCP kidney?

A

Big, echogenic

loss of renal sinus fat

PCP= punctate cortical calcs

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41
Q

CIN risk factors

A

DM

RF

CHF

Myeloma!

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42
Q

MC stones

A

Ca oxalate

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43
Q

Women and UTI stones

A

Struvite

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44
Q

Unseen on Xray

A

Uric acid

Also fat, diabetics

MAIN stones that can be treated MEDICALLY

Futz with pH

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45
Q

Only stones not seen on CT?

A

Indinavir

HIV patients!

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46
Q

Identifying Uric acid stones?

A

Lower attenuation <500

Little change between high and low energy on dual energy CT…

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47
Q

Cortical nephrocalcinosis

A

Usually sequela of hypoperfusion injury,

hypodense rim –> thin calcifications

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48
Q

medullary nephrocalcinosis

4 causes

A

hyperechoic papilla

hyperPTH or medullary sponge (usually asymmetric)

lasix in a kid

RTA type 1

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49
Q

Medullary sponge associations?

A

Ehlers Danlos

Carolis

Beckwith Wideman

Review, hyperechoic shadowing pyramids

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50
Q

Persistent nephrogram

A

Shock/ATN

Bilateral

enhancement at 2-3 hours

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51
Q

Renal vein thrombosis US

A

Reversed arterial diastolic flow

absent venous flow

big kid with delayed nephrogram

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52
Q

Post transplant complication

First two weeks

A

Urinoma

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53
Q

Renal transplant immediate collection

A

hematoma

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54
Q

1-2 months after transplant

A

lymphocele

MC fluid collection to cause hydro

compress ipsi femoral vein –> leg swelling

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55
Q

Acute rejection/ATN

A

Both in first week

prominent pyramids, increased size

elevated RI’s

56
Q

ATN vs Acute rejection

A

MAG 3

ATN - normal perfusion

Acute rejection Decrased

BOTH delayed excrn

57
Q

1 year post transplant

A

Chronic rej

non-specific

elevated RI’s

may enlarge

may lose CM differentiation

58
Q

Vascular complication first week

A

vein thrombosis

reversed diasolic arterial

kinking

hypercoag

hyperacute rej

delayed thrombosis 2/2 stenosis

59
Q

vascular complx weeks to months

A

artery stenosis

MC vascular complx

at anastamosis

60
Q

Transplant artery stenosis criteria

A

PSV>200

PSV ratio > 3.0 (with ext iliac)

tardus parvus

jetting

61
Q

pseudoaneurysm vs avf

A

pseudoan = yinyang, doppler with biphasic flow at neck

avf = vibration artifact (perivascular mosaic color assignment)

62
Q

RCC in transplant patient

100x risk

location?

A

native kidney

63
Q

PTLD

A

First year, multiple organs

tx = back off immunosupp

BCELL proliferation

64
Q

Cyclophosphamide risk?

A

Urothelial cancer

65
Q

week 1 transplant complx?

A

Vein thrombosis

Urinoma

hematoma

66
Q

week 1-4 complx

A

Artery thrombosis

Lymphocele

67
Q

transplant complx Months 1-6

A

Artery STENOSIS

Lymphocele

biopsy injury (avf/pseudoan)

Drug tox

68
Q

After 6 months

A

Chronic rejection

RCC

Lymphoma

PTLD

69
Q

Obstruction vs. adynamic primary megaureter?

A

Collecting system dilatation = actual obstruction

70
Q

primary megaureter

Side, location

A

Most lower third

Left more common, usually unilateral

71
Q

Retrocaval ureter

A

developmental anomaly of IVC

72
Q

weigart meyer

A

upper inserts inferior and medial, ureterocele, obstructs

73
Q

MC GU congenital anomaly

A

UPJ obstruction

74
Q

UPJ obstrx a/w

A

crossing vessels

Multi-cystic dysplastic on other side**

75
Q

Extrarenal pelvis vs congenital UPJ obstrx?

A

Whitaker test

urodynamics study with antegrade pyelogram

76
Q

Ureteral wall calcs (2)

A

TB

Schistosomiasis

77
Q

Ureteritis cystica

A

tindy subepithelial cysts within wall

2/2 chronic inflamm (stones, infx)

diabetics with recurrent UTI

Maybe increased cancer risk

78
Q

Ureteral pseudodiverticulosis

A

Like ureteritis cystica but small outpouchings not cysts

favors upper and middle thirds

a/w cancer

79
Q

bladder/Ureter leukoplakia

A

squamous cell

more common in bladder

80
Q

malakoplakia?

A

Chronic UTI’s (e coli)

female immunocomp**

plaque like, nodular lesions

More common in bladder

Can cause obstrx

NOT PREMALIG

81
Q

Leuko vs Malako

A

Leuko premalig

MALAKO NOT

82
Q

retroperitoneal fibrosis

A

80% idiopathic

Radiation

‘erg’s and methyldopa

panc, pyelonephritis

inflamm aneurysm

lymphoma, desmoplastic rxn

Active will be GALLIUM AND PET HOT

83
Q

Thickenend upper tract wall in an anticoagulated patient

A

Subepithelial renal pelvis hematoma

ANTICOAGULATED

Hyperdense on PRE contrast

84
Q

Least common site for TCC

A

URETER

(75% of ureter TCC affect bottom 1/3)

Renal pelvis 2-3x more common

Bladder 100x more common

85
Q

Upper/ lower TCC

A

IF you have upper, 40% chance of developing lower

If you have bladder, 4% chance of developing upper tract

86
Q

Balkan nephropathy

A

High rate of upper tract TCC’s

2/2 aristolochic acid

87
Q

Squamous

A

MUCH less common

2/2 Schistosomiasis

88
Q

smooth, oblong mobile defect on urography

A

Fibroepithelial polyp

benign

89
Q

Eagle Barrett (3)

A

Deficient abdominal muscles

hydroureteronephrosis

cryptorchidism (big belly keeps testes from dropping)

90
Q

Acquired bladder tics

A

Big prostate

91
Q

Syndrome bladder tic

A

Elhlers Danlos

92
Q

Hutch Diverticula

A

a/w ipsi reflux

at UVJ

Not a/w posterior valves

93
Q

urachal remnant cancer?

A

ADENO!

MIDLINE!

94
Q

MC bladder ca <10yo

A

Rhabdomyosarcoma

buncha grapes = botyroid

met to lungs, nodes, bones

95
Q

MC TCC subtype bladder

A

superficial papillary

96
Q

schisto squamous look

A

heavily calcified bladder and distal ureters

97
Q

MC mesenchymal bladder tumor

A

leiomyoma

MC at trigone

98
Q

Diversions

conduits

reservoirs

MC early comp

A

Adynamic ileus

25% of cases

3% SBO

adhesive disease near enteroenteric anastamosis

99
Q

stricture with diversion

A

left side higher risk than right (angulation under mesentery)

101
Q

Psoas hitch

A

long segment distal ureter resected, bladder pulled up and sewn to psoas as a hitch

102
Q

Emphysematous cystitis

A

E coli

diabetes

103
Q

Bladder TB

A

affects upper tract more (shrunken, calcified putty kids)

can secondarily involve the bladder (thick, contracted +/- calcs)

104
Q

Schisto bladder

A

entirely calcified

105
Q

colovesicular fistula

A

Diverticular disease

106
Q

ileovesicular fistula

107
Q

Rectovesical fistula

A

trauma or cancer

108
Q

neurogenic bladder

A

small, contracted

atonic, large

stasis–>cancer, stones, infections

109
Q

Extraperitoneal bladder rupture

A

More common (80-90%)

a/w pelvic fracture

managed MEDICALLY

110
Q

extraperitoneal bladder rupture sign

A

molar tooth, contrast in prevesicle space of Rezius

111
Q

Intraperitoneal rupture

A

full bladder dome pops under pressure

SURGERY

112
Q

Urethral injury

Type I

A

STRETCHED

PERIURETERAL HEMATOMA

PROBLY NORMAL RUG

113
Q

Type II urethral injury

A

Rupture above UG diaphragm

extraperitoneal contrast

114
Q

Type III urethral injury

A

BELOW UG diaphragm

extraperitoneal and perineal contrast

115
Q

Type IV urethral injury

A

Injury invovles bladder extending to urethra

116
Q

Type V urethral injury

A

Injury to anterior urethra

117
Q

urethral stricture

Traumatic

A

Bulbar

short segment

118
Q

urethral stricture

infectious

A

long segment

irregular

bulbar also

gonococcal

119
Q

urethral diverticula

A

almost always 2/2 long term foley placement

CANCER, ALMOST ALWAYS ADENO!

120
Q

urethral diverticula in females

A

way more common

2/2 repeated UTI

saddle bag appearance

ADENO CA RISK

121
Q

Urethral cancer

In a tic?

bulbar/penile?

prostatic?

A

tic ADENO

bulbar/penile SQUAMOUS

prostatic TRANSITIONAL CELL

122
Q

Fluoro sign of bladder Ca muscle wall invasion?

A

Wall retraction

necesitates radical cystectomy over TUBRT

123
Q

Renal cancer staging

T3a

T3b

T3c

T4

A

T3a = Renal vein or perinephric space

T3b = IVC Below diaphragm

T3c = IVC above diaphragm

T4 = ‘Surrounding structures’

124
Q

Renal lymphoma

uni or bilateral?

A

90% BILATERAL

125
Q

Ureteral displacement

MEDIAL?

LATERAL ?

A

MEDIAL = RETROPERITONEAL FIBROSIS

LATERAL = LAD, Retroperitoneal mass, AAA

126
Q

Upper tract TCC.

% chance of contra ureteral ca?

Bladder?

A

3-5% contra ureter

bladder cancer in 30-50%

127
Q

Retroperitoneal liposarc

tx = ?

Calcs = ?

A

Large fatty tumor in the retroperitoneum, not arising from kidney and without vessels = retroperitoneal liposarc UPO

tx = debulking surgery

Calcs mean higher grade

128
Q

Mechanism of reflux in lower moiety ureter

A

Shorter intramural course

129
Q

Bladder Ca T4 staging

a vs b

A

T4a bladder ca invades pelvic viscera

T4b invades pelvic or abdominal wall

130
Q

location of urachus ?

fascia wise?

A

Space of Retzius?

Between fascia transversalis and parietal peritoneum

Urachal cancer invades abd wall early

131
Q

Neurogenic bladde on ivp

A

deformed with lots of tics

132
Q

Types of neurogenic bladder (lesion location)

A

Above T12 > christmas tree bladder

spastic detrusor with sphincter dyssenergy

Sacral and peripheral neuropathy > atonic/distended

Above pons > spastic bladder with normal sphincters

133
Q

Bladder mycetoma

A/W

A

Lamellated air in a fibrous appearing bladder mass

DM

134
Q

Timing for CT urogram

A

6-10 minute delay to evaluate collecting system/ureters

135
Q

AAST

renal injury grades 1-4

A

1 non expanding subcapsular hematoma

2 superficial lac < 1cm

3 superficial lac >1cm

4 collecting system or main vessels with contained hemorrhage

136
Q

RPF vs Lymphoma

A

Both PET hot

Lymphoma lifts aorta, tends to be larger

RPF - ureteral obstruction, ureters MEDIALLY deviated

137
Q

Common appearance of DM nephropathy

A

bilateral nephromegaly

GU (1 decks)

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