Opening Round Flashcards
(143 cards)
1
Q
Case 1
Is there an increased risk of Renal Cell in ADPKD
A
No
2
Q
Case 1
How does ADPKD tend to present clinically?
A
Hematuria
Hypertension
Renal Insufficiency
3
Q
Case 1
Name two Complications of Autosomal Dominant Polycystic Kidney Disease
A
Renal failure
- Nearly all patients
Intracranial aneurysms
- 15% of patients
4
Q
Case 2
Define the four classes of Renal Trauma
A
Class I
- Contusion or Capsular hematoma
Class II
- Major Laceration
Class III
- Multifocal laceration or renal vessel injury
Class IV
- UPJ disruption
5
Q
Case 2
How do you manage renal injury based on class
A
Class I
- Conservative
Class II/III
- Depends on patient stability
Class IV
- Surgery
6
Q
Case 3
What is the normal path of renal migration during development?
A
Ureteral bud
- Develops at the S1 level
- Migrates cranially to the L2 level
7
Q
Case 3
What is the most common complication of a pelvic kidney?
A
UPJ Obstruction
Followed by
- Reflux
- Stone formation
8
Q
Case 4
What single imaging feature is diagnostic of multilocular cystic nephroma?
A
Herniation in to the renal pelvis
- Very specific
- Not very sensitive
9
Q
Case 3
What causes pelvic ectopia of a kidney?
A
Arrest of cranial migration of the ureteral bud as it tries to join the metanephric bud
10
Q
Case 4
DDX of a renal mass with septations and thickened margins
A
- Renal cell carcinoma
- Multilocular cystic nephroma
- Complicated renal cyst
- Infection
- Hemorrhage
11
Q
Case 5
Causes of unilateral papillary necrosis?
A
Pyelonephritis
Ureteral Obstruction
Tuberculosis
Renal Vein Thrombosis
12
Q
Case 4 What Bosniak class cystic masses require surgery?
A
III and IV
13
Q
Case 5
Name causes of Papillary Necrosis
A
POSTCARD
Pyelonephritis Obstruction Sickle Cell Disease TB Cirrhosis / Pancreatitis Analgesic Abuse Renal Vein Thrombosis Diabetes
14
Q
Case 6
T/F
Hydronephrosis in the setting of pyeolonephritis may be nonobstructive
A
True
- Bacterial Endotoxin
- Smooth muscle paralysis
- Non-obstructive hydronephrosis
15
Q
Case 6
What is the mechanism by which Pyelonephritis occurs
A
Infection ascending from the bladder via reflux
16
Q
Case 5
Are filling defects in Papillary Necrosis in the renal calyx or the medulla
A
Medulla
17
Q
Case 6
What else can look like pyeolonephritis?
A
Renal contusion
18
Q
Case 6
What is the cause of decreased enhancement in pyelonephritis?
A
Papillary necrosis
19
Q
Case 7
What is the likelihood that a calcified renal mass is a renal cell?
A
60%
–> All calcified renal masses should be further evaluated
20
Q
Case 7
Is rim calcification a benign or malignant feature
A
80% Benign
- Cysts complicated by
- Infection
- Hemorrhage
20 % malignant!
(the q may be asked in reverse)
21
Q
Case 8
What stage is an RCC with renal vein tumor thrombosis?
A
III
22
Q
Case 8
How often do you see synchronous RCC lesions?
A
2%
23
Q
Case 9
Is RCC more common in men or women?
A
Men
- x 2
- Age 50-70
24
Q
Case 10
How often do you see synchronous TCC lesions?
A
40%
vs RCC
- 2%
25
Case 10
| What percentage of TCC's develop in the bladder
90%
26
Case 10
| DDX of a non-calcified filling defect on a urogram
Radiolucent stone
TCC
Air bubble
Infectious debris
27
Case 11
T/F
Uric acid stones are radiolucent on CT.
False
| - virtually all calculi are radiodense on CT
28
Case 10
| Risk factors for urinary bladder cancer?
```
Smoking
Benze exposure
Analgesic abuse
Balkan nephropathy
Some oncologic chemoRx
```
29
Case 12
| What modalities can help to differentiate hydronephrosis versus peripelvic cysts seen on Ultrasound
Postcontrast CT
Postconstrast MRI
IVP
30
Case 11
| What is soft tissue rim sign?
Collar of ST around a ureteral stone on CT
31
Case 13
| Two causes of immobile, off-midline stone in the bladder
```
Stone in
- Bladder Diverticulum
- Ureterocele
Displacement of a stone by
- Mass
- Enlarged prostate
```
32
Case 13
| Define a Ureterocele
Focal dilation of the distal end of the ureter
| - Typically smooth regular wall
33
Case 13
| Define a Pseudoureterocele
Dilation of the intramural ureter
- 2o to contiguous bladder dz
- Irregular thick, nodular wall
34
Case 13
| What are the most common complications of an intravesical ureterocele?
- Obstruction
- Stones
- Milk of Ca+
- Recurrent UTIs
- Hydronephrosis
35
Case 14
| What makes up most radiolucent urinary tract stones?
Uric acid
36
Case 14
| DDx for filling defect in collecting system?
```
Radiolucent stone
TCC
Blood Clot
Infectious debris
Sloughed papillae
Ari bubble
```
38
Case 15
| Is UPJ obstruction functional or anatomic?
Functional
- Ureteral smooth muscle
- Deficiency
- Derangement
- > Failure of normal peristalsis
39
Case 15
| What is congenital UPJ obstruction associated with?
```
Horseshoe kidney
Contralateral multicystic dysplastic kidney
Contralateral renal agenesis
Ureteral duplication
Vesicoureteral reflux
```
40
Case 15
How often is congenital UPJ obstruction bilateral?
How is it treated?
20%
Surgically
- Endopyelotomy
- Open Pyeloplasty
41
Case 16
| When does the portal venous phase of contrast enhancement occur?
70-90 seconds
42
Case 16
| When does the pyelographic phase of contrast enhancement occur?
120-180 seconds
43
Case 16
| What are three most common primary renal tumors in adults?
Renal cell carcinoma
Transitional cell carcinoma
Squamous cell carcinoma
44
Case 17
| Causes of hematuria
```
Stones
UTI
Malignancy
Glomoerulonephritis
Prostatic hypertrophy
```
45
Case 19
| Is TCC more common in men or women?
Men
- 3 x
- 50-60 yo
46
Case 15
| Most common cause of abdominal masses in neonates?
UPJ Obstruction
47
Case 18
| Name four causes of bladder stones
```
Urinary stasis
Foreign body
Stones from kidneys
1o endemic stone dz
- PESD
```
48
Case 19
| What are two reasons to get a postvoid film on an IVP
Evaluate bladder
- Mucosa
- Function
49
Case 17
| DDX of an adherent and irregular bladder mass
```
Bladder carcinoma
Benign bladder tumor
Fungal infection
Cystitis
Fibrosis
Adherent blood products
```
50
Case 20
| What is the most important feature of bladder cancer to determine therapy and prognosis?
Extension through the muscular bladder wall
51
Case 20
| What stage is a bladder tumor that breaches the muscular layer of the bladder wall?
T3a
52
Case 20
What is the most common histologic subtype of bladder CA?
What histologic subtype is associated with urachal remnants?
TCC - 85%
AdenoCA
53
Case 21
| What are two risk factors for emphysematous cystitis
Diabetes
| Bladder outlet obstruction
54
Case 21
Is emphysematous cystitis an emergency?
How is it treated?
No, it's not an emergency
Antibiotics
Bladder drainage (foley or suprapubic)
Treat the hyperglycemia in diabetics
55
Case 21
| What common bacterial organisms cause emphysematous cystitis?
Most common
- E. coli
- Enterobacter
Followed by
- Clostredium perfringes
- Nocardia
- Candida
56
Case 22
| What are the features of an intraperitoneal bladder rupture?
```
Cloud-like
Collect in
- Rectouterine
- Rectovesical pouch
Outline small bowel loops
Extends to paracolic gutters
```
57
Case 20
| DDx for multiple polypoid bladder masses
Multifocal bladder CA
Fungal infection
Focal proliferative cystitis
58
Case 23
| How are extraperitoneal ruptures treated?
Foley Decompression
| - Allows for spontaneous healing
59
Case 23
| Which type of bladder rupture is considered a surgical emergency?
Intraperitoneal
60
Case 23
| At least how much contrast is needed in the bladder to adequately evaluate for bladder rupture?
300 cc
| Infused by low-pressure gravity infusion
61
Case 22
| What are the features of an extraperitoneal bladder rupture?
```
Flame-shaped
Collect in extra peritoneal spaces
- Perivesical
- Anterior prevesical (Retzius)
- Retrorectal space
```
64
Case 24
T/F
Glands of Littre visualization is always a sign of pathology.
False
- Commonly seen in urethritis
- Can also be seen as normal variant
65
Case 24
| In a RUG, what gives a slightly irregular contour along the dorsal aspect of the anterior male urethra?
Glands of Littre
66
Case 26
| What are the two segments of the posterior male urethra?
Membranous
| Prostatic
67
Case 26
| What causes anterior urethral injury?
Straddle injury
| - Bulbous urethera
68
Case 26
| What causes posterior urethral injury?
MVA
- w/ pelvic fractures
- Esp anterior arch
69
Case 27
| DDX for a spiral appearing fallopian tube
Salpingitis isthmica nodosa
Tuberculosis
Tubal adenomyosis
70
Case 27
| What are the two complications associated with Salpingitis isthmica nodosa?
Infertility
| Ectopic pregnancy
71
Case 27
| What are contraindications to performing an HSG
Pregnancy
Active menstruation
PID
Recent D and C
72
Case 24
| What is the duct that is seen arising posterolateral to the membranous urethra?
Cowper's duct
| - Imbedded in the urogenital diaphragm
73
Case 25
| Iatrogenic strictures affect what part of the male urethra most commonly?
Membranous urethra
| - penoscrotal junction
74
Case 28
| What are the features of a Septate Uterus on ULTRASOUND?
Intercornual
- Distance less than 4 cm
- Angle less than 75 deg
Fundus
- Convex
- Flat
- Minimally concave
75
Case 29
| Corpus luteum cysts are expected to resolve by when during pregnancy?
16 weeks
76
Case 29
Cysts of what size MUST be removed during pregnancy and at what point is it best to remove them?
What size cysts in pregnancy may be managed conservatively?
10cm (Controversy regarding cysts that are 5-10cm)
2nd trimester
5 cm
77
Case 30
| What colonic wall thickness is considered abnormal and a sign of radiation colitis? When does it occur after radiation?
4 mm
Approx 2 yrs
78
Case 30
| Is radiation colitis more common in cervical or endometrial cancer? Why?
Cervical
| Higher radiation dose
79
Case 28
| The mullerian or parasmesonephric ducts form what female structures?
Upper vagina
Uterus
Fallopian tubes
80
Case 25
| What are causes of a urethral stricture?
```
Iatrogenic
- most common cause in kids
Infection
Trauma
Noninfectious urethritis
- chemical irritation
Neoplasm
- long irregular strictures
```
81
Case 26
| The membranous urethra is contained within what structure?
Urogenital diaphragm
82
Case 31
| What complications occur with Dermoid cysts?
```
Torsion (most common)
Infection
Trauma
Rupture w slow leak
Malignant transformation (2% -> Squamous cell CA)
```
83
Case 31
T/F
Malignant transformation of dermoids most commonly occurs in postmenopausal women.
True
84
Case 32
| Hydronephrosis indicates what T stage of cervical cancer?
T3a
85
Case 32
| Is CT or MRI better for primary staging of cervical cancer?
MRI
- High spacial contrast
- Allows ID of dz beyond cervical stroma
- Best to evaluate for parametrial extension
- Must be used for any cervical mass > 1.5cm
CT
- Essential for advanced disease
- Best modality to look for distant mets
86
Case 32
| In cervical CA, what stage allows for surgical cure?
T2A
| - No parametrial invasion
87
Case 32
What T stages require brachytherapy?
Define each of those T stages?
T2B
- Parametrial invasion
T3
- Lower third of the vagina
T4
- Invasion of
- Rectum
- Bladder
- Vaginal fornices
88
Case 33
| What is the most common appearance of ovarian cystadenocarcinoma?
Mixed fluid and soft tissue mass
Enhancing nodules
Thick septations
Usually seen w/ ascites
89
Case 33
| What age group is affected by ovarian cancer
45-55 yo
| - Perimenopausal
90
Case 33
| In ovarian CA, why is hydronephrosis important to identify prior to CTX?
Because it must be treated with stents to allow for good renal function prior to chemotherapy
91
Case 27
| What are the major differences between water-soluble and oil-soluble types of contrast media used for HSG?
Image detail
| Peritoneal absorption
92
Case 32
What do you look for on MRI to determine if there is parametrial invasion?
What are the signal characteristics of cervical CA on T2?
Disruption
- Black ring of cervical stroma on T2
Cervical CA is bright on T2
93
Case 34
How often are Dermoid cysts bilateral?
How often are mature cystic teratomas bilateral?
20%
(p50 CR)
10%
(p52 CR)
94
Case 34
| How do you differentiate between a dermoid and a mature cystic teratoma?
Dermoid
- Skin and dermal appendages
Mature Cystic Teratoma
- All three primitive germ cell layers
- Includes a Rokatansky nodule (solid/calcified)
95
Case 34
| What feature in an ovarian cyst is diagnostic of a dermoid?
Fat attenuation
96
Case 36
| What is needed for primary staging of ovarian cancer?
```
Total abdominal hysterectomy
Bilateral salphino-oophorectomy
Omentectomy
Peritoneal washings
Wall samplings
Lymph node sampling
```
97
Case 36
| How is ovarian cancer spread?
Intraperitoneal dissemination via ascites
98
Case 36
| Define the four stages of ovarian cancer?
Stage I
- Cancer confined to the ovaries
Stage II
- Spread into the true pelvis
Stage III
- Extrapelvic peritoneal implants or LN mets
StageIV
- Distant hematogenous metastasis (usually liver)
99
Case 36
| What is the sensitivity of CT for ovarian peritoneal implants?
90%
100
Case 37
| What size hemorrhagic cyst requires 6 week followup?
>3cm
101
Case 37
| DDx for a complex cystic ovarian/paraovarian mass
Hemorrhagic cyst
Tuboovarian abscess
Ectopic pregnancy
Ovarian tumor
102
Case 37
| Classical clinical presentation of hemorrhagic cyst?
Pelvic or abdominal pain that may wake the patient from sleep
103
Case 38
T/F
Gas bubbles are common in TOA on CT.
False
104
Case 38
| How does a TOA occur?
Cervical or vaginal infection
- Chlamydia
- Gonorrhea
Spreads into
- Endometrium
- Fallopian tubes
- Ovaries
105
Case 39
What do fibroids look like on MRI?
What do degenerated fibroids look like?
Fibroids
- Well-defined
- Homogenous
- Low T1/T2 relative to myometrium
Degenerating fibroids
- Heterogenous
- High T2 signal
- Irregular enhancement
- Difficult to differentiate vs Leiomyosarcoma
106
Case 40
| What is the most common cause of postmenopausal bleeding and how is it defined?
Endometrial atrophy
| - ES thickness less than 4 mm
107
Case 40
| What endometrial thickness should prompt biopsy in a postmenopausal woman who is bleeding?
> 5 mm
| Doesn't matter if they are on hormones or not!
108
Case 40
| What endometrial thickness should prompt biopsy in a postmenopausal woman who is NOT bleeding?
> 8 mm
109
Case 41
What feature makes a cervical cancer inoperable?
What stage would that be defined at?
Parametrial invasion
Stage IIb
110
Case 41
| How is cervical cancer treated based on stage (Ib/IIa vs IIb and higher)?
Ib and IIa
- Radical hysterectomy
- XRT
IIb and higher
- XRT
- Chemotherapy
"2b or not 2b" is what determines if surgery is possible
111
Case 41
| Is the incidence of cervical CA increasing or decreasing over the past 30 years?
Decreasing
112
Case 41
| FIGO guidelines for clinical staging of cervical cancer
```
Bimanual pelvic exam
CXR
IVP
Cystoscopy
Imaging of lungs and skeleton
```
113
Case 42
| DDX for bilateral adrenal masses
```
Adenomas
Metastasis
Hemorrhage
Granulomatous adrenalitis
Pheochormocytoma
- 10% are bilateral
```
114
Case 42
| What CT washout parameters define an adenoma?
50% washout at 10 minutes
60% washout at 15 minutes
115
Case 43
| What are causes of adrenal hemorrhage?
```
Trauma
Sepsis
Coagulapthy
Anticoagulation therapy
Surgery
```
116
Case 43
| How often is adrenal hemorrhage bilateral in Neonates and adults?
Neonates
- 10%
Adults
- 20%
117
Case 44
What is the most common cause of Adrenal pseudotumor?
Additional DDx?
Exophytic renal cyst
```
Splenule
Splenic artery aneurysm
Exophytic upper pole renal mass
Pancreatic body or tail mass
Gastric diverticulum
```
118
Case 44
When is it advised to treat a splenic artery aneurysm and how is it treated?
Men vs Women?
If it is >2cm
- Stenting
- Embolization
- Resection
Women
- 90% found in women pregnant more than once
119
Case 44
| Pseudolesions of the adrenal gland occur more frequently on which side?
Left
120
Case 45
| DDX of an adrenal mass that contains fat
```
Adenoma
Myelolipoma
Exophytic renal AML
Retroperitoneal
- Lipoma
- Liposarcoma
```
121
Case 45
| An adrenal myelolipoma must be resected. True or False
False
- Growth not an indication
- Must be symptomatic
122
Case 46
| What are two entities that give false POSITIVE adrenal FDG-uptake in a patient with lung cancer and an adrenal mass?
Pheochromocytoma
| Adenoma
123
Case 46
| What are two entities that give false NEGATIVE adrenal FDG-uptake in a patient with lung cancer and an adrenal mass?
Neuroendocrine tumor mets
| BAC mets
124
Case 47
| What causes an adrenal adenoma to drop in signal on out-of-phase MRI in chemical shift imaging
Intracellular lipid
125
Case 48
| What is the treatment for a renal abscess
Antibiotics AND
| Percutaneous drainage
126
Case 49
| What is a CT sign that there is impending AAA rupture on CT?
Intraluminal high density crescent
127
Case 49
| What is the likelihood that a >5cm aneurysm will rupture
40%
128
Case 50
| How does retropertinoeal fibrosis spread?
Encasement from the aorta to the IVC and ureters
129
Case 50
| How is RPF treated?
Ureteral stents temporarily
| Surgical dissection or ureters for definitive treatment
130
Case 51
| In what zone of the Prostate gland does BPH occur?
Transitional zone
131
Case 51
In what zone of the Prostate gland does cancer occur?
Nodules of benign prostate hyperplasia arise from which zone?
Peripheral zone - 85%
- 10% Transitional
- 5% Central
Transitional zone
132
Case 51
| What is the first structure that is affected when Prostate carcinoma transgresses the capsule?
The neurovascular bundle
133
Case 52
| DDX on US of a hypoechoic nodule in the peripheral zone
```
Prostate carcinoma
Atypical hyperplasia
BPH nodule
Focal prostatitis
Cyst
```
134
Case 52
| On transrectal prostate US, what percentage of prostate carcinomas are hypoechoic?
70%
135
Case 31
| Most common malignancy associated with dermoid cyst?
Squamous Cell Carcinoma
136
Case 53
| What are sentinal nodes for right and left testicular cancer
Right
- Paracaval
- Inferior to the right renal artery
Left
- Renal perihilar
- Inferior to the left renal vein
137
Case 48
| What are the two mechanisms that cause a renal abscess?
Pyelonephritis
| Hematogenous spread
137
Case 53
| How is Testicular cancer spread?
```
First
- Retroperitoneal lymph nodes
- Via lymphatics
Then
- Hematogenously
- Lungs
- Liver
- Bone
- Brain
```
137
Case 53
| Increased Alfa-fetoprotein and Human chorionic gonadotropin is seen in which types of testicular cancer
AFP
- Yolk sac
- Embryonal
- Teratoma
HCG
- Seminoma
- Embryonal
- Choriocarcinoma
137
Case 31
| Imaging findings suggesting malignant transformation of dermoid cyst?
Rapid growth
Infiltration of adjacent tissues
Extensive adhesions
Peritoneal Implants
137
Case 34
| What is a Rotanski nodule?
- Mural nodule in an ovarian Dermoid
| - Contains most of the solid teratomatous elements
138
Case 54
Where is a scrotal pearl located?
Benign or premalignant?
Extratesticular
- Between the membranes of the tunica vaginalis
Benign
139
Case 54
| What are causes of a scrotal pearl?
```
Inflammation
Torsion
- Appendix testis
- Epididymis
Almost always assoc w/ hydroceles
```
140
Case 55
| What are causes of testicular calcifications
Testicular cancer
Resolved infection
Old hematoma
Prior infarct
141
Case 55
| What is recommended followup for testicular microlithiasis?
Controversial
Now considered benign
- Assoc w GCT based on a single study
- Some will do q 1 yr US to age 40
142
Case 55
| What is associated with testicular microlithiasis
Cryptorchidism
Testicular atrophy
Infertility
