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GU Radiology > GU Residents' Exam 2022 > Flashcards

GU Residents' Exam 2022 Flashcards

1
Q

Primary muscle of passive urinary continence? (Dunnick, 5)

A

Circular smooth muscle internal urethral sphincter lies around the bladder neck

Next, if injured: INTRINSIC

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2
Q

Shortest male urethral segment (Dunnick, 4)

A

Membranous urethra

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3
Q

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)

A

Mesonephros

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4
Q

In Weigert-Meyer rule of duplex collecting system, upper pole moiety corresponds to? (Dunnick,21)

A

Ectopic ureter inserts to the bladder inferiorly and medially, which may obstruct

U EIMO

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5
Q

Most common congenital bladder anomaly (Dunnick, 28)

A

Urinary bladder herniation through an underdeveloped abdominal wall muscle defect.

Exstrophy

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6
Q

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

A

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

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7
Q

Most common anomalies associated with horseshoe kidney? (Pollack, 739)

A

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

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8
Q

Congenital disorder in the bladder, in which a thick transverse band of muscle, incompletely divides the bladder into two unequal segments. (Pollack, 836)

A

Hour glass bladder

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9
Q

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

A

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

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10
Q

Size discrepancies in kidneys may suggest a pathology if? (Dunnick, 40)

A

Right kidney is 1.5 longer than left

R > L by 1.5 cm
L > R by 2.0 cm

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11
Q

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

a. Leaflets from distal veromontanum to urethral wall

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12
Q

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

A

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

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13
Q

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)

A

Nephrogenic systemic fibrosis

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14
Q

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)

A

Metformin

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15
Q

Retrocrural lymph nodes are considered enlarged if they measure greater than: (Dunnick Textbook of Uroradiology, 5th ed, p. 79)

A

6 mm

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16
Q

What is the most common malignant tumor to arise in the retroperitoneum? (Dunnick Textbook of Uroradiology, 5th ed, p. 80)

A

Lymphoma

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17
Q

What is the most common primary retroperitoneal malignancy? (Dunnick Textbook of Uroradiology, 5th ed, p. 82)

A

Liposarcoma

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18
Q

What is the most common cause of spontaneous retroperitoneal hemorrhage? (Dunnick Textbook of Uroradiology, 5th ed, p. 74)

A

Rupture of an abdominal aortic aneurysm

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19
Q

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)

A

CT

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20
Q

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

A

d. AOTa

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21
Q

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)

A

Stage III

The most common location of neuroblastoma is the ADRENAL GLAND. It is also the most common extracranial malignant tumor in childhood

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22
Q

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)

A

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

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23
Q

Bosniak classification of renal cortical cysts with few, thin septations with minimal enhancement (Dunnick Textbook of Uroradiology, 5th ed,
p109)

A

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

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24
Q

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)

A

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

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25
Q

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)

A

Multicystic dysplastic kidney

MCDK is the second most common cause of an abdominal mass in the neonate, trailing only hydronephrosis in frequency.

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26
Q

Renal cysts and cancers are not present in this type of Von Hippel-Lindau disease (Dunnick Textbook of Uroradiology, 5th ed, p117)

A

IIA

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27
Q

Type of renal cell carcinoma with the best overall prognosis (Dunnick Textbook of Uroradiology, 5th ed, p127)

A

Chromophobe

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28
Q

This syndrome comprises of macroglossia, omphalocele, adrenal cytomegaly, and visceromegaly, which includes Wilms tumor (Dunnick Textbook of Uroradiology, 5th ed, p144)

A

Beckwith-Wiedemann

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29
Q

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)

A

Mesoblastic nephroma

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30
Q

Most common manifestation of renal lymphoma (Dunnick Textbook *0/1 of Uroradiology, 5th ed, p151)

A

Multiple cortical nodules

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31
Q

Hallmark of renal tuberculosis (Dunnick Textbook of Uroradiology, 5th ed, p170)

A

Infundibular stenosis

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32
Q

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

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.

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33
Q

Renal ultrasound findings in patient with acute pyelonephritis may show normal findings (Dunnick Textbook of Uroradiology, 5th ed, p157)

A

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

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34
Q

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

A

8

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35
Q

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

A

d. None of the above

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36
Q

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

A

b. Wegener granulomatosis

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37
Q

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)

A

Ask-Upmark kidney

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38
Q

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

A

d. NOTA

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39
Q

The most common etiology of renovascular hypertension among children is? (Dunnick 5th ed., 197)

A

Fibromuscular dysplasia

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40
Q

Bilateralnephromegalywithdiminishedopacificationofthecollecting system on excretory urography is most characteristic of? (Dunnick 5th
ed., p. 205)

A

Acute interstitial nephritis

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41
Q

Most common malignant cause of bilateral nephromegaly in children? (Dunnick 5th ed., p. 206)

A

Leukemia

42
Q

The association of chronic hereditary renal disease, deafness, and ocular abnormalities is known as: (Dunnick 5th ed., p. 208)

A

Alport syndrome

43
Q

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).

A

Acute rejection

44
Q

Most common peritransplant fluid collection after renal transplant: (Dunnick 5th ed., p. 226)

A

Lymphocele

45
Q

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).

A

True

46
Q

Which of the following arteries can serve as collateral pathway when the main renal artery is compromised? (Dunnick 5th ed., p. 176)

A

Lumbar arteries

47
Q

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)

A

It is an anatomic rather than a metabolic defect.

48
Q

Staghorn calculi are composed of: (Dunnick: Textbook of Uroradiology, 5th ed., p 233)

A

Triple phosphate + uric acid + cystine

49
Q

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

A

c. Always lateral to the gonadal vein

50
Q

What is the most common radiolucent stone? (Dunnick: Textbook of Uroradiology, 5th ed., p 233)

A

Uric acid

51
Q

Most common site of ureteral obstruction: (Dunnick: Textbook of Uroradiology, 5th ed., p 234)

A

Ureterovesical junction

52
Q

True or False: Retrocaval ureter can only occur on the right side. (Dunnick: Textbook of Uroradiology, 5th ed., p 252)

A

True

53
Q

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)

A

III

54
Q

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)

A

Pyelotubular

55
Q

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)

A

Findings are suggestive of ureteritis cystica

56
Q

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

A

e. AOTA

57
Q

57.Itisthemostcommonsecondarytumorfoundintheurinarybladder? (Dunnick: Textbook of Uroradiology, 5th ed., p 303)

A

Melanoma

58
Q

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)

A

Suprasacral but below the pons

59
Q

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

A

c. AOTA

60
Q

The modality used for the most accurate staging of localized prostate malignancy is? (Dunnick 325)

A

MRI

61
Q

In prostate malignancy, osseous metastasis typically appear as what kind of lesions? (Dunnick 329)

A

Blastic

62
Q

In prostate malignancy, osseous metastasis can be differentiated from sclerotic bone islands using what modality? (Dunnick 329)

A

Scintigraphy

63
Q

Which is a pathognomonic finding in prostatitis? (Dunnick 332)
a. Prostate hyperenhancement
b. Prostate hypoenhancement
c. Prostate enlargement
d. None of the above

A

d. NOTA

64
Q

Non-specific prostate calcifications tend to appear in which zone of the prostate gland? (Dunnick 333)

A

Peripheral Zone

65
Q

Which of the following is described as an ovoid filling defect in the prostatic urethra? (Dunnick 336)

A

Verumontanum

66
Q

Urethral strictures from gonorrhea infection are most common in which segment? (Dunnick 338)

A

Bulbar

67
Q

TRUE or FALSE: The male urethra is fixed along two locations: the penoscrotal junction and the membranous urethra. (Dunnick 341)

A

True

68
Q

Themostcommonhistopathologyofmalignanttumorsoftheurethra is? (Dunnick 343)

A

Squamous cell carcinoma

69
Q

The mainstay modality for diagnosis of pelvic inflammatory disease is? (Dunnick 354)

A

Ultrasound

70
Q

TRUE or FALSE: Hysterosalpingography has a role in evaluation of ACUTE pelvic inflammatory disease? (Dunnick 356)

A

False

71
Q

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

a. MRI is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids

72
Q

Most common type of testicular tumor? (Dunnick, 389)

A

Seminoma

73
Q

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

A

d. Stage II disease – involves lymph nodes inferior to the diaphragm

74
Q

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

a. Markedly diminished or absent intratesticular flow

75
Q

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

A

c. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration

76
Q

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

A

e. Type II Intraperitoneal rupture

77
Q

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

A

d. Type IV: Extraperitoneal rupture

78
Q

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

A

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

79
Q

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

A

c. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete

80
Q

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

A

d. Pure anterior urethral injury-partial or complete

81
Q

Identify

A

VERUMONTANUM

82
Q

Identify the specific anomaly

A

HORSESHOE KIDNEY

83
Q
A

MEDIASTINUM TESTIS

84
Q

50 year old male with ill-defined back pain, s/p ureteral stenting. Diagnosis?

A

RETROPERITONEAL FIBROSIS

85
Q

Axial T1 in-phase and T1 out-of-phase images. Diagnosis?

A

ADRENAL ADENOMA

86
Q

Bosniak category

A

BOSNIAK IIF

87
Q

Diagnosis

A

Oncocytoma

88
Q

Diagnosis

A

EMPHYSEMATOUS PYELONEPHRITIS

89
Q

Identify the vascular anomaly

A

RETROAORTIC LEFT RENAL VEIN

90
Q

Diagnosis

A

CIRCUMCAVAL URETER

91
Q

This is a renal infarct because of the presence of which radiologic sign?

A

Cortical rim sign

92
Q

What radiologic sign

A

CHAMPAGNE GLASS SIGN

Transitional cell carcinoma of the ureter: most common

93
Q

Diagnosis

A

PAPILLARY NECROSIS

94
Q

Diagnosis

A

MEDULLARY NEPHROCALCINOSIS

95
Q

Intravenous pyelogram; elderly male with obstructive urinary symptoms. Likely diagnosis?

A

BENIGN PROSTATIC HYPERTROPHY

96
Q

Identify the surgery with changes pointed by the arrow

A

TRANSURETHRAL RESECTION OF THE PROSTATE

97
Q

True or False: The mass effects seen in the image below are more likely to be caused by lymphadenopathy fibrosis rather than retroperitoneal fibrosis.

A

True

98
Q

Type of bladder injury?

A

INTRAPERITONEAL BLADDER RUPTURE

99
Q

Pathology seen in the left kidney?

A

RENAL INFARCT

100
Q

Type of urethral injury?

A

Type II

GU Radiology (7 decks)

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