GU Residents' Exam 2022 Flashcards
Primary muscle of passive urinary continence? (Dunnick, 5)
Circular smooth muscle internal urethral sphincter lies around the bladder neck
Next, if injured: INTRINSIC
Shortest male urethral segment (Dunnick, 4)
Membranous urethra
This stage consists of a series of uriniferous tubules, each of which is associated with a group of blood vessels to form primitive glomeruli. (Dunnick, 10)
Mesonephros
In Weigert-Meyer rule of duplex collecting system, upper pole moiety corresponds to? (Dunnick,21)
Ectopic ureter inserts to the bladder inferiorly and medially, which may obstruct
U EIMO
Most common congenital bladder anomaly (Dunnick, 28)
Urinary bladder herniation through an underdeveloped abdominal wall muscle defect.
Exstrophy
Congenital disorders in which the incidence of horseshoe kidneys is increased? EXCEPT (Pollack, 739)
a. Trisomy 18
b. Down syndrome
c. Turner syndrome
d. Fanconi’s anemia
e. Thalidomide embryopathy
b. Down syndrome
Horseshoe kidney is the mort common renal anomaly, occuning in approximately 1:400 births. There is a 2:1 male predominance. The abnormality occurs when the kidneys are connected by an ISTHMUS. The anomaly is thought to occur because an abnormal position of the umbilical artery results in disturbance of the normal pattern of cephalic migration. As a result, there is contact between the developing metanephric blastema on each side that leads to partial fusion.
BAND: anterior to IVC and aorta, posterior to IMA
Most common anomalies associated with horseshoe kidney? (Pollack, 739)
Ureteropelvic junction obstruction
Imaging findings in patients with a horseshoe kidney include
(1) An abnormal axis for each kidney with the lower poles more medially located than the upper poles
(2) The kidneys lie in a more caudad position
(3) A bilateral malrotation with the renal pelves in an anterior position so that the lower calyces are projected in a more medial position than the proximal ureter
Congenital disorder in the bladder, in which a thick transverse band of muscle, incompletely divides the bladder into two unequal segments. (Pollack, 836)
Hour glass bladder
Which is correct blood supply of adrenal gland (Dunnick, 1)
a. Superior adrenal artery branch from aorta
b. Superior adrenal artery branch from the ipsilateral renal artery
c. Middle adrenal artery branch from phrenic artery
d. Middle adrenal artery branch from ipsilateral renal artery
e. Inferior adrenal artery branch from ipsilateral renal artery
e. Inferior adrenal artery branch from ipsilateral renal artery
Superior adrenal artery from inferior phrenic artery
Middle adrenal artery from aorta
Inferior adrenal artery from renal artery
Size discrepancies in kidneys may suggest a pathology if? (Dunnick, 40)
Right kidney is 1.5 longer than left
R > L by 1.5 cm
L > R by 2.0 cm
Most common type of posterior urethral valve (Dunnick, 31)
a. Leaflets from distal veromontanum to urethral wall
b. Leaflets from proximal veromontanum to urethra wall
c. Leaflets from proximal prostatic urethra
d. Leaflets from distal prostatic urethra
e. Leaflets from proximal prostatic urethra representing redundant mucosal folds
a. Leaflets from distal veromontanum to urethral wall
Which of the following is a risk factor for adverse reactions to contrast media? (Dunnick Textbook of Uroradiology, 5th ed, p. 64)
a. Anxiety
b. Cardiac disease
c. History of asthma or allergy
d. Medications such as beta-blockers & interleukin
e. All of the above
e. AOTA
In a randomized prospective study designed to identify which risk factors were important predictors of an increased risk of a contrastreaction, it was concluded that a history of prior contrast medium reaction, asthma, and a history of allergy to food or drugs were the only independent risk factors associated with a statistically important increased risk of reaction.
A history of a SEVERE reaction to contrast media is considered a contraindication to reexamination in all but the most urgent cases.
Most contrast reactions occur within the first 10 minutes after injection of the contrast medium
This systemic disorder occurs almost exclusively in patients with renal failure and is associated with the administration of with gadolinium-based contrast material for MR examinations. (Dunnick Textbook of Uroradiology, 5th ed, p. 69)
Nephrogenic systemic fibrosis
Lactic acidosis is a possible complication associated with the continued use of this drug in patients who undergo examinations
requiring contrast administration. Which among the following drugs fits is this? (Dunnick Textbook of Uroradiology, 5th ed, p. 68)
Metformin
Retrocrural lymph nodes are considered enlarged if they measure greater than: (Dunnick Textbook of Uroradiology, 5th ed, p. 79)
6 mm
What is the most common malignant tumor to arise in the retroperitoneum? (Dunnick Textbook of Uroradiology, 5th ed, p. 80)
Lymphoma
What is the most common primary retroperitoneal malignancy? (Dunnick Textbook of Uroradiology, 5th ed, p. 82)
Liposarcoma
What is the most common cause of spontaneous retroperitoneal hemorrhage? (Dunnick Textbook of Uroradiology, 5th ed, p. 74)
Rupture of an abdominal aortic aneurysm
Which of the following is the ideal modality for detecting retroperitoneal hemorrhages or abscesses and defining their extent?
(Dunnick Textbook of Uroradiology, 5th ed, p. 75-76)
CT
Which of the following can be a cause of retroperitoneal fibrosis? (Dunnick Textbook of Uroradiology, 5th ed, p. 77)
a. Retroperitoneal bleeding
b. Malignancy
c. Radiation therapy
d. All of the above
d. AOTa
What is the stage of a neuroblastoma with contiguous extension beyond the midline with possible bilateral involvement of the regional
nodes? (Dunnick Textbook of Uroradiology, 5th ed, p. 91)
Stage III
The most common location of neuroblastoma is the ADRENAL GLAND. It is also the most common extracranial malignant tumor in childhood
Adrenal masses with a percentage enhancement washout of > 60% or a relative enhancement washout of > 40% can be confidently diagnosed
as ____. (Dunnick Textbook of Uroradiology, 5th ed, p. 99)
Adenoma
Low signal on both T1, T2
Loss of signal going from in-phase images to out-of-phase images is a more reliable method to identify an adenoma.
AW = (Enhanced - Delayed) / Enhanced - Plain
RW = (Enhanced - Delayed) / Enhanced
Bosniak classification of renal cortical cysts with few, thin septations with minimal enhancement (Dunnick Textbook of Uroradiology, 5th ed,
p109)
IIF
I: Simple cyst
II: Non-enhancing thin septa, rim calcifications, exophytic hyperdense cyst
IIF: Perceived enhancing thin septa or minimal wall/septal thickening, large hyperdense cyst (>3 cm)
III: Measurable enhancement, one or more thick. or irregular septationa, some thickened walls. or large, nonborder-forming calcifications
IV: Large cyst with enhancing nodular component apart from the wall
True or False: For patients with infantile polycystic disease, when the disease presents in older children, the hepatic component is mild, where
as the renal manifestation is more severe (Dunnick Textbook of
Uroradiology, 5th ed, p112)
False
Patients with severe fonns of IPCD have renal failure at birth and most die within the first few days of life.
There seems to be an inverse relationship between the renal and the hepatic manifestations of the disease; when the renal disease is present at birth, the hepatic manifestations are mild.
When the disease present in older children, the hepatic component dominates; whereas the renal manifestations are less severe
In summary:
At birth: renal > hepatic
Older: hepatic > renal
It consists of a collection of irregularly sized cysts and fibrous tissue but no functioning renal parenchyma. The cysts do not communicate, the renal collecting system is small or absent, and there are atretic ipsilateral renal vessels. (Dunnick Textbook of Uroradiology, 5th ed, p114)
Multicystic dysplastic kidney
MCDK is the second most common cause of an abdominal mass in the neonate, trailing only hydronephrosis in frequency.
Renal cysts and cancers are not present in this type of Von Hippel-Lindau disease (Dunnick Textbook of Uroradiology, 5th ed, p117)
IIA
Type of renal cell carcinoma with the best overall prognosis (Dunnick Textbook of Uroradiology, 5th ed, p127)
Chromophobe
This syndrome comprises of macroglossia, omphalocele, adrenal cytomegaly, and visceromegaly, which includes Wilms tumor (Dunnick Textbook of Uroradiology, 5th ed, p144)
Beckwith-Wiedemann
This tumor is usually present at birth and has been described as a congenital Wilms tumor or fetal mesenchymal hamartoma (Dunnick
Textbook of Uroradiology, 5th ed, p146)
Mesoblastic nephroma
Most common manifestation of renal lymphoma (Dunnick Textbook *0/1 of Uroradiology, 5th ed, p151)
Multiple cortical nodules
Hallmark of renal tuberculosis (Dunnick Textbook of Uroradiology, 5th ed, p170)
Infundibular stenosis
The following are features of a renal inflammatory disease characterized by the presence of lipid-laden macrophages, except:
(Dunnick Textbook of Uroradiology, 5th ed, p167)
a. Male predominance
b. Obstructing pelvocalyceal stone
c. Poorly defined mass
d. Nonfunctioning kidney
e. NOTA
a. Male predominance
The classically described triad of findings includes: (1) a staghom calculus. (2) absent or diminished excretion of contrast medium, and (3) a poorly defined renal mass.
Renal ultrasound findings in patient with acute pyelonephritis may show normal findings (Dunnick Textbook of Uroradiology, 5th ed, p157)
True
Utz findings in acute uncomplicated pyelonephritis may be normal or shows diffuse or focal renal enlargement with regions of increased or decreased echogenicity of the renal parenchyma
(Fig. 9.3). The normal cortioomedullary di1ferentiation may be lost
RENAL nephrometry score of an endophytic solid renal tumor, which measures 4.0 cm, seen in the ventral region, 5mm from the collecting
system, and crosses the polar line
8
Which of the following is false about circumcaval ureters? (Dunnick 5th ed., p 179):
a. Secondary to persistence of the right subcardinal vein, trapping the ureter behind the IVC
b. More common in men than in women
c. The most common complication is obstruction
d. None of the above
d. None of the above
Identify the collagen vascular disease affecting small arteries and veins presenting with glomerulitis and necrotizing granulomas of the respiratory tract (Dunnick 5th ed., p 180)
a. Polyarteritis nodosa
b. Wegener granulomatosis
c. Systemic lupus erythematosus
d. Scleroderma
b. Wegener granulomatosis
Segmental hypoplasia of the kidney has been recognized as a cause of severe hypertension. The affected kidney is small, has few pyramids,
and has a deep cortical scar or groove overlying an abnormal calyx. The
calyx underlying the cortical scar is dilated and clubbed. This disease is termed? (Dunnic 5th ed., p 190)
Ask-Upmark kidney
Most common cause of renal artery stenosis: (Dunnick 5th ed., p 191)
a. Trauma
b. Fibromuscular dysplasia
c. Takayasu aortitis
d. None of the above
d. NOTA
The most common etiology of renovascular hypertension among children is? (Dunnick 5th ed., 197)
Fibromuscular dysplasia
Bilateralnephromegalywithdiminishedopacificationofthecollecting system on excretory urography is most characteristic of? (Dunnick 5th
ed., p. 205)
Acute interstitial nephritis
Most common malignant cause of bilateral nephromegaly in children? (Dunnick 5th ed., p. 206)
Leukemia
The association of chronic hereditary renal disease, deafness, and ocular abnormalities is known as: (Dunnick 5th ed., p. 208)
Alport syndrome
Complication of renal transplantation occuring 1-4 weeks after surgery characterized by renal swelling, altered echogenicity of the renal pyramids and cortex, edema of the renal sinus fat and collecting system
walls (Dunnick 5th ed., p. 215).
Acute rejection
Most common peritransplant fluid collection after renal transplant: (Dunnick 5th ed., p. 226)
Lymphocele
True or false: Torsion of a transplanted kidney is more likely to occur when the transplant kidney is placed in the peritoneal cavity (Dunnick 5th
ed., p. 222).
True
Which of the following arteries can serve as collateral pathway when the main renal artery is compromised? (Dunnick 5th ed., p. 176)
Lumbar arteries
Among the causes of medullary nephrocalcinosis which usually present bilaterally, medullary sponge kidney is an exception since it may
occur unilaterally or segmentally. This is because: (Dunnick: Textbook of Uroradiology, 5th ed., p 231)
It is an anatomic rather than a metabolic defect.
Staghorn calculi are composed of: (Dunnick: Textbook of Uroradiology, 5th ed., p 233)
Triple phosphate + uric acid + cystine
The following findings help differentiate a ureteral stone from phleboliths on CT except? (Dunnick: Textbook of Uroradiology, 5th ed., p 237)
a. Perinephric stranding
b. Periureteral edema
c. Always lateral to the gonadal vein
d. Hydronephrosis
c. Always lateral to the gonadal vein
What is the most common radiolucent stone? (Dunnick: Textbook of Uroradiology, 5th ed., p 233)
Uric acid
Most common site of ureteral obstruction: (Dunnick: Textbook of Uroradiology, 5th ed., p 234)
Ureterovesical junction
True or False: Retrocaval ureter can only occur on the right side. (Dunnick: Textbook of Uroradiology, 5th ed., p 252)
True
A voiding cystourethrogram, was requested for a 1-year-old female with urinary tract infection. During the examination, you noted reflux into
the mildly dilated collecting system on the right, with minimal blunting of
the fornices. Based on the International Classification of Vesicoureteral Reflux, what is the grade of reflux? (Dunnick: Textbook of Uroradiology, 5th
ed., p 262)
III
This type of backflow observed during retrograde pyelogram is seen as streaks of contrast extending from the calyces into the parenchyma of
the kidney. (Dunnick: Textbook of Uroradiology, 5th ed., p 263)
Pyelotubular
A 52-year-old female underwent KUB intravenous pyelography for recurrent urinary tract infection. Radiographs show multiple, small (2-3
mm), radiolucent filling defects along the nondilated ureters, bilaterally.
What will be your impression? (Dunnick: Textbook of Uroradiology, 5th ed.,
p 271)
Findings are suggestive of ureteritis cystica
Which of the following may cause urinary bladder wall calcifications? (Dunnick: Textbook of Uroradiology, 5th ed., p 282)
a. Schistosomiasis
b. Radiation cystitis
c. Tuberculosis
d. A and B only
e. All of the above
e. AOTA
57.Itisthemostcommonsecondarytumorfoundintheurinarybladder? (Dunnick: Textbook of Uroradiology, 5th ed., p 303)
Melanoma
A 30-year-old male is for work-up of neurogenic bladder with no perception of bladder filling or emptying. You noted a Christmas tree
bladder on voiding cystourethrogram. Where is the probable lesion
causing the neurogenic bladder which will be the focus of further
imaging? (Dunnick: Textbook of Uroradiology, 5th ed., p 315)
Suprasacral but below the pons
Which of the following are CT findings suggestive of bladder outlet obstruction? (Dunnick 319)
a. Bladder wall thickening
b. Indentation of the bladder base
c. Poor emptying of the bladder on post-void imaging
d. All of the above
c. AOTA
The modality used for the most accurate staging of localized prostate malignancy is? (Dunnick 325)
MRI
In prostate malignancy, osseous metastasis typically appear as what kind of lesions? (Dunnick 329)
Blastic
In prostate malignancy, osseous metastasis can be differentiated from sclerotic bone islands using what modality? (Dunnick 329)
Scintigraphy
Which is a pathognomonic finding in prostatitis? (Dunnick 332)
a. Prostate hyperenhancement
b. Prostate hypoenhancement
c. Prostate enlargement
d. None of the above
d. NOTA
Non-specific prostate calcifications tend to appear in which zone of the prostate gland? (Dunnick 333)
Peripheral Zone
Which of the following is described as an ovoid filling defect in the prostatic urethra? (Dunnick 336)
Verumontanum
Urethral strictures from gonorrhea infection are most common in which segment? (Dunnick 338)
Bulbar
TRUE or FALSE: The male urethra is fixed along two locations: the penoscrotal junction and the membranous urethra. (Dunnick 341)
True
Themostcommonhistopathologyofmalignanttumorsoftheurethra is? (Dunnick 343)
Squamous cell carcinoma
The mainstay modality for diagnosis of pelvic inflammatory disease is? (Dunnick 354)
Ultrasound
TRUE or FALSE: Hysterosalpingography has a role in evaluation of ACUTE pelvic inflammatory disease? (Dunnick 356)
False
Which of the following is true? (Dunnick, 376)
a. MRI is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids
b. CT is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids
c. Necrotic or degenerated fibroids are avidly enhancing
d. Calcified regions have high signal intensity on all sequences
a. MRI is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids
Most common type of testicular tumor? (Dunnick, 389)
Seminoma
Which of the following is correct about staging of testicular tumors? (Dunnick 391)
a. Stage III disease – tumor confined to the scrotum
b. Stage IV disease – metastasis to extra-abdominal lymph nodes
c. Stage I lesion – extranodal disease
d. Stage II disease – involves lymph nodes inferior to the diaphragm
d. Stage II disease – involves lymph nodes inferior to the diaphragm
True of testicular torsion? (Dunnick, 396)
a. Markedly diminished or absent intratesticular flow
b. Complete testicular ischemia lasting longer than 24 hours causes reversible infarction
c. Bell-clapper deformity reduces the chance of testicular torsion Radionuclide scanning is the ideal initial examination
a. Markedly diminished or absent intratesticular flow
Grade 1 Renal Injury? (Renal Injury Scale of the American Association of Surgeons in Trauma) (Dunnick, 407)
a. Nonexpanding perirenal hematoma confined to the retroperitoneum; superficial lacerations (<1 em depth) in the renal cortex
b. Lacerations extending through the renal cortex, medulla, and collecting system; injuries to the main renal artery or vein with contained hemorrhage; thrombosis of a segmental renal artery without parenchymal laceration
c. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration
d. Lacerations that completely shatter the kidney; injuries to the renal hilum with devascularization of the kidney; traumatic renal arterial occlusion
c. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration
Type that accounts for approximately one-third of bladder injuries? (Dunnick, 415)
a. Type IV: Extraperitoneal rupture
b. Type V: Combined bladder injury
c. Type I: Bladder contusion
d. Type III: Interstitial bladder injury
e. Type II Intraperitoneal rupture
e. Type II Intraperitoneal rupture
Type of bladder injury associated with one or more fractures of the pubic rami or diastasis of the symphysis pubis? Dunnick 415
a. Type I: Bladder contusion
b. Type II Intraperitoneal rupture
c. Type III: Interstitial bladder injury
d. Type IV: Extraperitoneal rupture
e. Type V: Combined bladder injury
d. Type IV: Extraperitoneal rupture
Grade 4 Renal Injury? (Renal Injury Scale of the American Association of Surgeons in Trauma) (Dunnick, 407)
a. Nonexpanding perirenal hematoma confined to the retroperitoneum; superficial lacerations (<1 em depth) in the renal cortex
b. Lacerations extending through the renal cortex, medulla, and collecting system; injuries to the main renal artery or vein with contained hemorrhage; thrombosis of a segmental renal artery without parenchymal laceration
c. Lacerations that completely shatter the kidney; injuries to the renal hilum with devascularization of the kidney; traumatic renal arterial occlusion
d. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration
b. Lacerations extending through the renal cortex, medulla, and collecting system; injuries to the main renal artery or vein with contained hemorrhage; thrombosis of a segmental renal artery without parenchymal laceration
Type III urethral injury (unified classification of blunt posterior and anterior urethral injuries proposed by Goldman et al.)? Dunnick 418
a. Pure posterior injury with tear of membranous urethra above the UGD-partial or complete
b. Bladder neck injury with extension into the urethra
c. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete
d. Posterior urethra intact, but stretched
e. Pure anterior urethral injury-partial or complete
c. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete
Type V urethral injury (unified classification of blunt posterior and anterior urethral injuries proposed by Goldman et al.)? Dunnick 418
a. Bladder neck injury with extension into the urethra
b. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete
c. Posterior urethra intact, but stretched
d. Pure anterior urethral injury-partial or complete
e. Pure posterior injury with tear of membranous urethra above the UGD-partial or complete
d. Pure anterior urethral injury-partial or complete
Identify
VERUMONTANUM
Identify the specific anomaly
HORSESHOE KIDNEY
MEDIASTINUM TESTIS
50 year old male with ill-defined back pain, s/p ureteral stenting. Diagnosis?
RETROPERITONEAL FIBROSIS
Axial T1 in-phase and T1 out-of-phase images. Diagnosis?
ADRENAL ADENOMA
Bosniak category
BOSNIAK IIF
Diagnosis
Oncocytoma
Diagnosis
EMPHYSEMATOUS PYELONEPHRITIS
Identify the vascular anomaly
RETROAORTIC LEFT RENAL VEIN
Diagnosis
CIRCUMCAVAL URETER
This is a renal infarct because of the presence of which radiologic sign?
Cortical rim sign
What radiologic sign
CHAMPAGNE GLASS SIGN
Transitional cell carcinoma of the ureter: most common
Diagnosis
PAPILLARY NECROSIS
Diagnosis
MEDULLARY NEPHROCALCINOSIS
Intravenous pyelogram; elderly male with obstructive urinary symptoms. Likely diagnosis?
BENIGN PROSTATIC HYPERTROPHY
Identify the surgery with changes pointed by the arrow
TRANSURETHRAL RESECTION OF THE PROSTATE
True or False: The mass effects seen in the image below are more likely to be caused by lymphadenopathy fibrosis rather than retroperitoneal fibrosis.
True
Type of bladder injury?
INTRAPERITONEAL BLADDER RUPTURE
Pathology seen in the left kidney?
RENAL INFARCT
Type of urethral injury?
Type II
