Urinary System

Question 1

What describes the typical sonographic appearance of the medullary pyramids in the neonate?

Answer 1

Anechoic

Question 2

What conditions are associated with a decrease in blood urea nitrogen? (BUN)

Answer 2

Liver failure, overhydration, pregnancy, smoking, and decrease in protein intake

Question 3

Fusion of the ENTIRE medial aspect of BOTH kidneys is a congenital anomaly termed something tasty - what is it?

Answer 3

Cake kidney

Question 4

What is the most common renal neoplasm identified in a patient over the age of 55? It’s not scary!

Answer 4

Simple renal cyst

Question 5

A glomerulus is composed of what?

Answer 5

Blood vessels or nerve fibers ,

Question 6

What structures are contained in the renal sinus?

Answer 6

Lymphatics, peripelvic fat, major calyces

Question 7

Where are the lymphatics, peripelvic fat, and major calyces located in the kidney?

Answer 7

Renal sinus

Question 8

What muscle is lateral to each kidney? You’ll see in a TRANSVERSUS cut

Answer 8

Tranversus abdominis

Question 9

An an asymptomatic patient, a trigangular shaped hyperechoic focus located in the anterior renal cortex most likely represents…?

Answer 9

A junctional parenchymal defect

(key word is anterior)

Question 10

Case Study:

A 43yo female complains of right flank pain and dysuria. A generalized swelling of the kidney is demonstrated. Medullary pyramids appear well defined. What is most likely?

Answer 10

Pyelonephritis - characterized by kidney swelling and prominent pyramids

Question 11

Which patient position is typical for a renal biopsy procedure?

Answer 11

Prone (lying on tummy)

Question 12

Patients w/ adult polycystic renal disease have an increased incidence of developing..?

Answer 12

Renal calculi

Question 13

Renal calculi is more common in adult patients who have which renal disease?

Answer 13

Adult polycystic renal disease

Question 14

RCC shows as what kind of echo texture most commonly?

Answer 14

Hypoechoic

Question 15

Mesoblastic nephromas are more likely to occur for patients under the age of…?

Answer 15

1 years old

Question 16

Fibromuscular hyperplasia is most commonly associated with stenosis in what renal artery?

Answer 16

Main renal artery

Question 17

Painless hematuria is most likely associated with which condition?

Answer 17

RCC

Question 18

Urinary stasis is most likely to cause which condition?

Answer 18

Nephrolithiasis

Question 19

Fusion of SUPERIOR POLE of one kidney to the INFERIOR POLE of the CONTRALATERAL KIDNEY is most consistent with which congenital anomaly?

Answer 19

Sigmoid kidney

Question 20

An image with a hyperechoic pelvis/renal pyramids, and loss of cortical structure, should demonstrate which condition?

Answer 20

Nephrocalcinosis (pyramids turn white)

(Nephrocalcinosis is when high deposits of salt/calcium are deposited in the kidney parenchyma and tubules)

Question 21

A patient hospitalized with malaria presents with a history of proteinuria. Renal cortex appears hyperechoic, normal medulla, and kidney is enlarged. What condition?

Answer 21

Glomerulonephritis

(damage done to the filtering part of the kidney - glomerulus)

Question 22

Glomerulonephritis is caused by what?

Answer 22

Immune diseases, infection, strep throat, lupous, chronic hep C, vasculitis

Question 23

When vessels are seen in the cortex of the pole, it is most likely showing which vessel?

Answer 23

Arcuate vessels

Question 24

Where do the arcuate veins travel?

Answer 24

Along the base of the medullary pyramids

Question 25

Where do the interlobar veins travel?

Answer 25

Between medullary pyramids

Question 26

What does the convergence of the segmental and interlobar veins form?

Answer 26

Main renal vein

Question 27

A patient with a known bladder outlet obstruction and thickening of the urinary bladder wall most likely indicates what type of etiology for the wall thickening?

Answer 27

Muscular hypertrophy

Question 28

What is the sonographic appearance for lymphoma of the kidney?

Answer 28

Multiple, bilateral, hypoechoic masses in ENLARGED kidneys

Question 29

Irregular thickening of the bladder wall in a 53 yo male with hydronephrosis and a dilated ureter makes the sonographer suspect which disease?

Answer 29

TCC

Question 30

The renal artery is usually anastomosed to which artery after a renal transplant?

Answer 30

External iliac artery

Question 31

The external iliac artery is connected to what after a renal transplant?

Answer 31

Renal artery

Question 32

How would you describe the anatomic location of the ureteral orifices in the urinary bladder?

Answer 32

Base of the trigone, along posterior aspect

Question 33

What is not a sign of the MCDK?

• multiple variably sized cysts
• nonmedial location of largest cyst
• dilated ureter
• no identifiable renal sinus
• brightly echogenic tissue interfaces between cysts

Answer 33

Dilated ureter

Question 34

US on a pt with hypertension shows a left kidney measuring 6.8cm and right kidney measuring 11.7 cm. What condition is most consistent with those findings?

Answer 34

Occlusion of left main renal artery

Chronic renal artery occlusion causes a small, echogenic kidney in comparison to the opposite side. An acute occlusion may not show anything.

Question 35

The left renal vein courses between which two vessels?

Answer 35

Superior mesenteric artery and the aorta

Question 36

A history of chronic medical renal diseases will cause what sort of sonographic appearance?

Answer 36

Small, HYPERECHOIC kidneys

Question 37

What helps distinguish a Column of Bertin “pseudomass”?

Answer 37

• isoechogenicity w/ rest of renal cortex
• continuity with renal cortex
• lack of mass effect or splaying of central sinus fat
• normal vascularity by colour doppler

Question 38

A patient shows with bilaterally small, echogenic kidneys with multiple cysts of varying sizes. What treatment are they most likely on?

Answer 38

Dialysis