Imaging of Urinary Tract- McQuiston

Question 1

biggest question radiologist get when treating a patient

Answer 1

what to order when

Question 2

46 yr old female w/ L flank pain; no prior hx
UA shows RBCs TNTC
diagnosis of concern?

Answer 2

urolithiasis

Question 3

most appropriate imaging choice for 46 yr old female w/ L flank pain and no prior hx

Answer 3

non contrast CT abd/pel

Question 4

stone lodged where

Answer 4

ureterocystic junction

Question 5

yellow
blue

Answer 5

yellow: dilated renal pelvis
blue: fat stranding

Question 6

yellow
blue

Answer 6

yellow: dilated ureter
blue: vascular calcification

Question 7

Answer 7

Urolith

Question 8

stone anywhere in urinary tract

Answer 8

urolith

Question 9

stone in kidney

Answer 9

nephrolith

Question 10

stone in ureter

Answer 10

ureterolith

Question 11

stone in bladder

Answer 11

bladder stone

Question 12

size of urolith that will prompt surgical intervention (won’t pass on its own)

Answer 12

> 5 mm

Question 13

Answer 13

staghorn calculus

Question 14

99% of these are visible on CT

Answer 14

Urolithiasis

Question 15

are Indinavir and matrix stones visible on CT

Answer 15

no

Question 16

type of CT

Answer 16

dual energy

Question 17

dx stone on dual energy CT by

Answer 17

uric acid subtracting

Question 18

stones that MAY be visible on radiograph

Answer 18

calcium, struvite, cystine

Question 19

stone by US

Answer 19

echogenic foci
acoustic shadowing

Question 20

color doppler

Answer 20

twinkle artifact

Question 21

color doppler

Answer 21

comet tail artifact

Question 22

not used as primary imaging for urolithiasis

Answer 22

MRI

Question 23

Answer 23

Xanthogranulomatous pyelonephritis

Question 24

chronic pyelonephritis (XGP) most commonly associated with what bug

Answer 24

Proteus

Question 25

chronic urolithiasis 90% what type of stone

Answer 25

struvite

Question 26

26 yr old pregnant female w/ hx of kidney stones; UA shows microhematuria
next step?

Answer 26

US

Question 27

avoid CT’s in what patients

Answer 27

patients who are below 50 and have hx of kidney stones; pregnant pts

Question 28

another option besides US for pregnant patient with potential kidney stone

Answer 28

MRI w/out contrast

Question 29

dilated calyces and pelvis

Answer 29

hydronephrosis

Question 30

Answer 30

slow contrast movement through R kidney

Question 31

63 yr old male presents for outpatient CT, after presented to PCP w/ gross hematuria. denies pain, fever, dysuria
what CT protocol should be used?

Answer 31

CT w/out and then venous, arterial, and delayed phase contrast

Question 32

CT urography 5 phases

Answer 32

1. non contrast
2. cortical (arterial)
3. corticomedullary (venous)
4. medullary
5. excretory (delayed)

Question 33

Answer 33

RCC

Question 34

simple cyst (benign)
complicated cyst (benign, needs f/u)
cystic mass (could be malignant)
malignant mass (RCC until proven otherwise)

Answer 34

renal masses (Bosniak classification)

Question 35

no enhancement
no f/u

Answer 35

simple renal cyst

Question 36

benign calcifications
no enhancement
no f/u

Answer 36

Bosniak 2

Question 37

nodular calcification
minimal septal enhancement
no soft tissue enhancement
f/u

Answer 37

bosniak 2F

Question 38

multiloculated
thickened walls
enhancement
obtain tissue

Answer 38

bosniak 3

Question 39

solid
enhancement
tissue dx

Answer 39

RCC until proven otherwise (bosniak 4)

Question 40

when to do a tissue biopsy

Answer 40

when there is enhancement

Question 41

Answer 41

urothelial carcinoma (bladder tumor)

Question 42

21 yr old female w/ dysuria and fever; R flank pain; no prior hx; UA shows elevated leukocyte esterase, nitrites, WBCs
next step?

Answer 42

no imaging; give Ab’s (UTI)

Question 43

patient w/ previous UTI asymptomatic for over a yr; returned to ED w/ dysuria and R flank pain
next step?

Answer 43

CT w/ contrast

Question 44

what finding indicates R sided pyelonephritis

Answer 44

99% nephrolithiasis (R side no uniform like L)

Question 45

rare form of acute pyelonephritis; gas

Answer 45

emphysematous pyelonephritis

Question 46

abscess shown

Answer 46

acute pyelonephritis

Question 47

57 yr old male presents for CECT of abd/pelvis for staging of colon adenocarcinoma; creatinine is 2.7 mb/dL and serum cystatin C is 1.1 mg/dL; GFR 27
next step?

Answer 47

either hydrate or PET scan

Question 48

sudden deterioration in renal function w/in 48 hours after iodinated contrast medium was administered

Answer 48

contrast induced acute kidney injury (CI-AKI)

Question 49

absolute serum creatinine increase (>/0.3)
percentage increase in serum creatinine (>/= 50%)
urine output reduced to (</= 0.5)
diagnose?

Answer 49

contrast induced acute kidney injury

Question 50

to screen for CI-AKI

Answer 50

creatinine
GFR

Question 51

if GFR > 45 would you do contrast

Answer 51

yes

Question 52

for GFR < 30, would you do contrast

Answer 52

no

Question 53

management for CI-AKI

Answer 53

HYDRATION

Question 54

are people allergic to iodine

Answer 54

no (iodine is an element)

Question 55

if someone says allergic to iodine, what do you need to do

Answer 55

find out the source (fish, contrast media)

Question 56

predictable and dose related reaction

Answer 56

syncratic

Question 57

not predictable and not dose-related reaction

Answer 57

iodiosyncratic (allergic)

Question 58

risk for adverse reactions

Answer 58

prior reaction
allergies

Question 59

prophylaxis for patient allergic to contrast media

Answer 59

prednisone + diphenhydramine