Session 1

Question 1

At which vertebral level are the kidneys located?

Answer 1

T11/T12.

Question 2

Which kidney is positioned lower in the abdomen and why?

Answer 2

Left kidney as the liver pushes it downwards.

Question 3

The left kidney lies below which rib?

Answer 3

The 12th rib.

Question 4

The right kidney lies below which rib?

Answer 4

The 11th/12th rib.

Question 5

What is the outer portion of the kidney called and what is it comprised of?

Answer 5

The parenchyma; comprised of the cortex (outer) and medulla (inner).

Question 6

Describe the structured which urine flows through in order from the nephron to bladder.

Answer 6

Collecting duct, papilla, minor calyx, major calyx, renal pelvis, ureter, bladder.

Question 7

Which artery supplies blood to the kidneys?

Answer 7

Renal artery.

Question 8

Where specifically does the renal artery originate from?

Answer 8

The abdominal aorta inferior to the superior mesenteric artery.

Question 9

Describe the blood flow through the kidneys from renal artery to renal vein.

Answer 9

Renal artery, interloper artery, arcuate artery, interlobular artery, afferent arteriole, glomerular capillaries, efferent arteriole, peritubular capillaries or vasa recta, interlobular vein, arcuate vein, interloper vein, renal vein.

Question 10

What structures does the renal corpuscle consist of?

Answer 10

Bowman’s capsule and glomerulus.

Question 11

What is the macula densa?

Answer 11

The point at which the distal convoluted tubule touches the glomerulus, it allows communication between the two structures for regulation.

Question 12

What is the function of the glomerulus?

Answer 12

Acts as a filter: water, salts and small molecules are forced out of the blood by filtration pressure.

Question 13

What is the function of the proximal convoluted tubule?

Answer 13

The primary site of resorption.

Question 14

Why are tubular epithelial polarised and how do they achieve polarisation?

Answer 14

Polarisation allows selective movement of substances across the epithelium. Achieved by placing different transporters on the luminal and basolateral membrane which are kept in place by tight gap junctions between cells.

Question 15

What is the function of the loop of Henle?

Answer 15

Further site of resorption: creates a gradient of increasing osmolarity in the medulla via counter-current multiplication so concentrated urine can be formed if water must be conserved.

Question 16

What is the function of the distal convoluted tubule?

Answer 16

Site of variable water and salt resorption: fluid leaving here is hypotonic.

Question 17

How can ECF osmolarity be estimated clinically and why?

Answer 17

By doubling serum sodium because osmolality is mainly determined by [NaCl].

Question 18

How can ICF osmolality be determined clinically?

Answer 18

By doubling [K].

Question 19

What is the endocrine function of the kidneys?

Answer 19

Synthesis of renin, erythropoietin and prostaglandins.

Question 20

What is the metabolic function of the kidneys?

Answer 20

Metabolism of active vitamin D, insulin and PTH calcitonin.

Question 21

Why is X-ray not usually useful in viewing renal stones?

Answer 21

Stones are usually small so not easy to see on plain film X-ray.

Question 22

What may an intravenous urogram be useful for in respect to the urinary system?

Answer 22

Assessing the collecting system of the kidneys.

Question 23

Which high-risk patient groups is ultrasound useful for and why?

Answer 23

Paediatrics and pregnany women, uses non-ionising radiation.

Question 24

What are the pros/cons of assessing the urinary system via US?

Answer 24

Pros: cheap and accessible; good to view kidneys and bladder; can be used to assess flow.
Cons: quality of image is operator dependent.

Question 25

Why is CT used preferentially over X-ray and MRI when imaging the urinary system?

Answer 25

Better resolution than X-ray and quicker/cheaper than MRI.

Question 26

What is a CT particularly useful for when imaging the urinary system?

Answer 26

Assessing stones, trauma, tumours and infection.

Question 27

What is MRI particularly useful for in assessing the urinary system?

Answer 27

Assessing soft tissues.

Question 28

What is nuclear medicine useful for in imaging the urinary system?

Answer 28

Assessing renal function and obstruction; not useful for anatomical information.

Question 29

What is the course of the ureter through the abdomen?

Answer 29

Begins at the level of the renal artery and courses down the retroperitoneum in an S-shaped curve to the pelvis: moves anteriorly on posts major and crosses under the gonadal vein at the level of the inferior pole of the kidney; courses medially to the sacroiliac joint and then laterally into the pelvis.

Question 30

What is the course of the ureter through the pelvis?

Answer 30

Crosses anteriorly to the iliac vessels upon entry to the pelvis at the bifurcation of the common iliac artery; courses laterally to the ischia spines before moving medially into the bladder.

Question 31

Where does the ureter cross the iliac vessels?

Answer 31

Crosses them on entry to the pelvis at the point where the common iliac artery bifurcates into the internal and external iliac arteries.

Question 32

Where does the ureter move in relation to the uterine vessels?

Answer 32

The uterine artery crosses the ureters anteriorly in the rectouterine fold of peritoneum.

Question 33

Where do the ureters move in relation to the ovaries?

Answer 33

Ureter moves posterior to the ovaries and then deep into the broad ligament.

Question 34

Where do the ureters move in relation to the ductus deferens?

Answer 34

Ureters move posteriorly to the ductus deferens.