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Generalist Exam Questions > Kidneys > Flashcards

Kidneys Flashcards

1
Q

What is the layer of fibrous tissue that surrounds the kidney and adrenal gland?

A

Gerota’s fascia

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2
Q

What vessel is more anterior, Renal veins or renal arteries?

A

LRV followed by LRA then ureter is posterior

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3
Q

What abnormality is cause when the LRV is squished between the Ao and SMA?

A

Nutcracker phenomenon

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4
Q

Cortical extensions between renal pyramids are known as?

A

Columns or bertin

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5
Q

What is the fat containing area of the kidney?

A

Sinus

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6
Q

What is a normal kidney size?

A

10-12cm

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7
Q

Cortical thickness should be what measurement?

A

Greater than 1cm

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8
Q

What is known as a lateral cortical bulge of kidney tissue of the same echogenicity as the rest of the tissue?

A

Dromedary hump

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9
Q

What kidney variant = remnant due to incomplete fusion of the upper and lower poles?

A

Junctional defect - is triangular / wedge shaped and typically HYPERECHOIC

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10
Q

What is known as fatty infiltration of the kidney in the 6-7th decade in Obese patients?

A) Nephrocalcinosis
B) Medullary sponge kidney
C) Renal sinus lipomatosis
D) Nephrolithiasis

A

Renal sinus lipomatosis

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11
Q

If you suspect an extra renal pelvis, what steps should you take to prove vs dilated ureter?

A
  1. Image in SAG and TRV and measure
  2. Show with color
  3. Elongate to show it DOES NOT extend into the kidney
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12
Q

Where should you search for an ectopic kidney?

A

Pelvis

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13
Q

In horseshoe kidney, do the ureters pass anterior or posterior to the fused renal parenchyma?

A

Anterior

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14
Q

What are S/S of horseshoe kidney?

A

Palpable pulsatile abdominal mass

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15
Q

Hydro in pregnancy is quite common, in what kidney does this typically occur?

A

Rt side

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16
Q

If you see hydro in the kidney, what additional structure do you need to include in the exam?

A

Bladder and jets (rule out obstruction) - get patient to go pee and re-check kidneys to see if its due to hydration or not

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17
Q

Explain different grades of hydro:

A

Grade 1 (mild) - minimal separation of sinus echoes
Grade 2 (mild) - dilation of renal pelvis with some but not all calyces/medulla dilation
Grade 3 (moderate) - complete pelvocaliectasis
Grade 4 (severe) - Gross dilation of pelvis with cortical thinning <1cm

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18
Q

Symptoms of pyonephritis?

A

Hematuria and renal insufficiency

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19
Q

What type of Lithiasis is associated with UTI’s?

A) Calcium oxalate
B) Staghorn
C) Magnesium ammonium
D) Uric acid

A

Staghorn calculus - look for DENSE shadow posteriorly

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20
Q

Symptoms of nephrolithiasis?

A

Renal colic
N/V
Fever
Chills
Hematuria

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21
Q

How to look for kidney stones?

A

Take off cross beam
Look for posterior shadow
Use twinkle on CD

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22
Q

On ultrasound, you see many small echogenic foci in bilateral kidney throughout cortex with no shadowing. What is the most plausible diagnosis?

A

Cortical nephrocalcinosis - excess calcium deposits in cortex

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23
Q

What population are kidney stones most common?

A

Men aged 20-50

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24
Q

What pathology is described as echogenic renal pyramids with shadowing?

A)Kidney stones
B) Urolithiasis
C) Medullay nephrocalcinosis
D) Cortical nephrocalcinosis

A

Medullary nephrocalcinosis - associated with medullary sponge kidney

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25
Q

How to decipher parapelvic cyst VS hydro?

A
  1. Parapelvic cyst is well defined and round
  2. It does NOT extend into the renal pelvis when you turn on it
  3. It does not extend outside of the kidney
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26
Q

In a septated kidney cyst, what are clues of malignancy?

A

Septations >1cm WITH vascularity
Calcified walls
Papillary projections

27
Q

What kind of cysts “originate from renal parenchyma and protrude into the sinus”?

A

Parapelvic cysts - no communication with collecting system - typically solitary and large

28
Q

Symptoms of ADPKD?

A

Presents in 40’s - hematuria, abdominal discomfort, kidney failure

29
Q

What pathology is described as “multiple cystic dilatations of collecting ducts in the medulla” ?

A

Medullary Sponge Kidney

30
Q

What is medullary sponge kidney associated with?

A

Caroli’s disease

31
Q

What is tuberous sclerosis associated with (2) ?

A

Renal cysts and BILATERAL AML’s

32
Q

What kidney disease is associated with the following symptoms: mental retardation, seizures, and cutaneous lesions?

A) TB
B) Lupus
C) Tuberous sclerosis
D) Acute tubular necrosis

A

Tuberous sclerosis

33
Q

What kidney pathology may be seen in Von hippel Lindau?

A

Renal cysts, possibly RCC.
Pheochromocytoma in adrenal gland

34
Q

What is the m/c benign renal tumor?

A

Adenoma- hyperechoic lesion <3cm

35
Q

SF and presentation of renal adenoma?

A

Round, hyperechoic, 1-3cm
Presents in 60-70’s and more male dominant
Can be associated with RCC/adenocarcinoma

36
Q

SF and presentation of AML’s?

A

Round, hyperechoic, vascular, cortical
Presents in 40-60’s and more female dominant
More commonly affects Rt side

37
Q

What kind of tumor secretes renin?

A

Juxtaglomerular Tumor/reninoma

38
Q

If you see a possible malignancy, what other structures should you pay more attention to? Hint: vessels

A

IVC and renal vein and the rest of the abdomen for potential METS

Renal vein waveform: continuous with mild pulsatility
IVC waveform: Pulsatility due to how close the right atrium is of the heart

39
Q

What are the other names for RCC?

A

Adenocarcinoma and hypernephroma

40
Q

What is the most common symptom of RCC?

A

Gross hematuria

41
Q

SF of RCC?

A

Hyperechoic but may be iso or hypoechoic
Very vascular and potential calcifications
Assess IVC and RV for tumor extension

42
Q

What is the most common urothelial carcinoma?

A

TCC

43
Q

If there is a TCC, where will the tumor in the kidney be located?

A

Solid mass seen in renal SINUS

44
Q

What are lymphomas in the kidney typically caused by?

A

METS from the blood system

45
Q

METS in kidney typically come from where?

A

Lung, breast, or contralateral kidney

46
Q

What may be seen in the kidney when a patient presents with decreased hematocrit?

A) Hematoma
B) Lipoma
C) Tubular necrosis
D) Infarction

A

Renal hematoma - always avascular

47
Q

What pathology is known as the “loss of blood supply due to the obstruction of blood by occlusion or
stenosis”?

A

Renal infarction - wedge shaped area in cortex

48
Q

What pathology is “acute suppurative bacterial inflammation of renal tubulointerstitial tissues”?

A

Acute pyelonephritis - associated with ascending UTI - most common in women aged 15-35

49
Q

What is acute pyelonephritis usually caused by?

A

E coli

50
Q

Difference between acute pyelonephritis and emphysematous?

A

Emphysematous is a medical emergency due to gas within the body, appears as echogenic foci with dirty shadowing or ring-down due to gas within kidney, need to send to ER

51
Q

Xanthogranulomatous pyelonephritis occurs when macrophages take over parenchyma. What SF will you NOT see with this pathology?

A) Staghorn calculi typically
B) Renal enlargement >12cm
C) Decreased renal function
D) Renal atrophy

A

Renal atrophy

52
Q

Whats are the classic kidney features of a patient with TB?

A

Putty kidney - small, calcified, non-functioning kidney, increased echogenicity due to calcification

53
Q

“Putty kidney” is associated with what abnormality?

A

TB

54
Q

What types of patients typically present with Lupus?

A

Females ages 20-40

55
Q

Patients present with increased BUN and creatinine. What might this imply?

A) Liver failure
B) Dehydration
C) Muscle dystrophy
D) AKI

A

Acute kidney injury

56
Q

What is the most common renal disease to develop into acute kidney injury?

A) Tuberous sclerosis
B) Acute tubular necrosis
C) Papillary necrosis
D) Lupus

A

Acute Tubular necrosis

57
Q

SF of ATN?

A

Echogenic kidneys with bilateral enlargement

58
Q

Patient presents with hypertension and decreased GFR. On ultrasound you see an atrophied echogenic kidney. Whats the most likely diagnosis?

A) AKI
B) Chronic kidney disease
C) ATN
D) Tuberous sclerosis

A

Chronic kidney disease

59
Q

What week GA do the kidneys begin to function?

A

8 weeks

60
Q

Which of the following pathologies does NOT have an increased risk of RCC?

A) medullary sponge kidney
B) Von hippel-lindau
C) Tuberous sclerosis
D) ADPKD

A

Medullary sponge kidney is NOT associated with RCC

61
Q

What portion of the renal arteries course alongside the renal pyramids?

A) Interlobar
B) Interlobular
C) Arcuate
D) Segmental

A

A

62
Q

What portion of the renal arteries course on top of the renal pyramids?

A) Interlobar
B) Interlobular
C) Arcuate
D) Segmental

A

C

63
Q

During ultrasound evaluation of the kidney, you detect a muscle posteromedial in relation to the kidney. What structure is being imaged?

A) Quadratus lumborum
B) Rectus sheath
C) Psoas
D) Iliacus
E) Piriformis

A

A

Generalist Exam Questions (21 decks)

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