Urinary Tract Flashcards
What organ is retroperitoneal, lying against the deep muscles of the back?
The paired kidneys and ureter
Which kidney (right or left) is slightly inferior in location
The right
Name the 3 notable structures that are located on the posterior aspect of the kidneys
1) diaphragm
2) psosas muscle
3) quadratus lumborum
What is the echogenicity of the renal cortex
Isoechoc or hypoechoic
What is the echogenicity of the medullary pyramids
Anechoic
What is the echogenicity of the renal sinus
Hyperechoic
At the hilum of the kidney where does the vein exit?
Anterior
At the hilum of the kidney does the vein or artery enter between the vein and ureter
Artery
At the hilum of the kidney where does the ureter exit
Posteriorly
The outer renal parenchyma from renal sinus to renal capusle describes the
Renal cortex
The inner portion of kidney from base of pyramids to center of kidney describes
Renal medulla
Inner hyperechoic portion of kidney which contains fat, calyces, renal pelvis, connective tissue, renal vessels, and lymphatics describes
Renal sinus
Anechoic, equally spaced triangles of collecting tubules between cortex and renal sinus. Commonly seen in neonatal and pediatric kidneys
Medullary pyramids
Funnel shaped transition from the major calyces to the ureter
Renal pelvis
Medial opening for entry/exit of artery, vein and ureter
Renal hilum
3 extensions of the renal pelvis
Major calyces
Extensions of the major calyces that collects urine from the medullary pyramids
Minor calyces
Apex of medullary pyramids
Renal papilla
Fibrous sheath enclosing kidney and adrenal glands.
Gerota’s fascia
What is another name for the Gerota’s fascia
Perirenal space
Functional unit of kidney consisting of the renal corpuscle, proximal convoluted tubule, descending and ascending limbs of Henle’s loop, distal convoluted tuble and collecting tuble
Nephron
Consists of glomerulus and glomerular capsule
Renal corpuscle (Malpighian body)
What is another name for the renal corpuscle
Bowmans capsule
The kidneys are supplied with arterial blood via the _________ which branches off the aorta
Main renal artery
At the level of the medullary pyramids, the segmental arteries divide into the _______
Interlobar arteries
At the base of the medullary pyramids, the ________ branch in a manner that is parallel to the renal capsule
Arcuate arteries
The_______ are the smallest renal arteries that branch of the arcuates running perpendicular to the renal capsule
Interlobular arteries
Embryologically, the kidneys orginate in the _____ and ascend to the upper abdomen so that the upper pole of the each kidney is more medial then the lower pole
Pelvis
Congential anomalies of the _______ are more common than any other organ system
Genitourinary tract
Complications (obstruction, stasis) associated with congenital abnormalities include:
1)
2)
3)
1) impaired renal function
2) infection
3) calculus formation
What word means displaced or in a location away from the normal position
ectopic
This kidney abnormality results from failure of kidneys to “ascend’ into the abdomen
Ectopic kidney
What is another name for ectopic kidney
Pelvic kidney
With ectopic kidneys, there is an increased incidence of
1)
2)
3)
1) ureteropelvic junction obstruction
2) ureteral reflux
3) multicystic renal dysplasia
What is the most common fusion anomaly in which the lower poles typically connect across the midline anterior to the aorta
Horseshoe kidney
The largest U-shaped kidneys lies in the _________ at the lower lumbar verebrae level, because ascent is prevented by the IMA
hypogastrium
Sonographically, the isthums or connection anterior to the aorta is frequently mistaken for________
Lymphadenopathy
The ureters are typically located
Anterior to the isthmus
Bilateral renal agensis associated with oligohydraminos and pulmonary hypopasia is incompatible with life. What is associated with unilateral renal agensis?
When renal agenesis is unilateral, it is associated with uterine duplication (bicornuate uterus) in females and seminal vesicle agenesis in males
What is the 2nd most common renal fusion anomaly
Crossed fused renal ectopia
Kidneys that fuse to form a round mass in the pelvis is known as
Discoid or pancake kidney
A common variant of cortical thickening on the lateral aspect of the left kidney is known as
Dromedary Hump
This defect is songraphically seen as a triangular area on the anterior aspect of the upper pole of the right kidney
Junctional Parenchymal deft
What is another name for junctional parenchymal defect
Fetal lobulation which is partial fusion of the renunculi (embryonic kidney)
A duplicate kidney may be complete with how many ureters
2 ureters
A duplicate kidney may be incomplete with how many ureters
1 ureter
What is a frequent complication of an ectopic ureter
Ureterocele
This is associated with oligohydramnios and pulmonary hypoplasia and it is incompatible with life
Bilateral renal agenesis
This is frequently associated with uterine duplication (bicornuate uterus) in females and seminal vesicle agesesis in males
Unilateral renal agenesis
What lies outside the renal sinus sonographically appearing as a cystic collection medial to the renal hilum
Extrarenal pelvis
A common cause of urinary obstruction in the male neonate patient is
Posterior urethral valve
Name the 4 sonographic findings of posterior urethral valve
1) large bladder
2) hydroureter
3) hydronephrosis
4) urinoma
Name the 4 sonographic criteria that is included for renal cysts
1) acoustic enhancement
2) absence of internal echoes
3) sharply defined thin wall
4) round or oval shape
Most renal cysts are __________ cysts that originate from uriniferous tubules
Simple cortical
What are the 3 types of renal cysts
1) pyelogenic cysts
2) parapelvic cysts
3) peripelvic cysts
This renal cyst is a calyceal diverticula that sonographically appears as a simple cyst
Pyelogenic cyst
This renal cyst is a cortical cyst that bulges into the central sinus of the kidney
Parapelvic cyst
This renal cyst is a lymphatic cyst in the central sinus
Peripelvic cyst
A renal sonogram is performed and an echogenic well-defined mass is identified in the renal cortex. This is characteristic of which of the following?
a) angiomyolipoma
b) column of Bertin
c) adenocarcinoma
d) pyonephrosis
e) renal stone
a) angiomyolipoma
Which lab test is used to asses renal function?
a) serum creatinine
b) serum bilirubin
c) aspartate aminotransferase (AST)
d) alkaline phosphatase
e) serum amylase
a) serum creatinine
Adult polycystic disease may be characterized by all of the following except:
a) it is autosomal dominant disease
b) it may be associated with cysts in the liver, pancreas, and spleen
c) bilateral small and echogenic kidneys
d) usually does not produce any symptoms until the third or fourth decade of life
e) the kidneys lose their reniform shape
c) bilateral small and echogenic kidneys
Bilateral hydronephrosis frequently occurs in all of the following except:
a) urinoma
b) posterior urethral valve
c) late pregnancy
d) fibroid uterus
e) benign prostate hypertrophy
a) urinoma
What is a hypertrophied column of Bertin
a) benign tumor of the kidney
b) malignant tumor of the lower urinary tract
c) renal variant
d) a common cause of hydronephrosis
e) complication of a renal transplant
c) renal variant
What is a ureterovesical junction
a) junction between the renal pelvis joins the proximal ureter
b) junction between the distal ureter and the base of the bladder
c) junction between the renal pyramids and the distal calyces
d) junction between the ejaculatory ducts and urethra
b) junction between the distal ureter and the base of the bladder
Which of the following is not a clinical sign of renal disease?
a) oliguria
b) palpable flank mass
c) generalized edema
d) hypertension
e) jaundice
e) jaundice
The kidneys, the perinephric fat, and the adrenal glands are all covered by which of the following?
a) a true capsule
b) Gerota’s fascia
c) peritoneum
d) Glisson’s capsule
e) quadratus lumborum muscle
b) Gerota’s fascia
A malignant solid renal mass can be all of the following except:
a) renal cell carcinoma
b) adenocarcinoma of the kidney
c) oncocytoma
d) transitional cell carcinoma
c) oncocytoma
Where are the renal pyramids found?
a) cortex
b) medulla
c) renal pelvis
d) renal sinus
e) loop of Henle
b) medulla
Which of the of the following is chronic renal disease associated with?
a) an enlarged kidney with a small contralateral kidney
b) unilateral hydronephrosis
c) small echogenic kidneys
d) renal carbuncle
e) an ectopic kidney
c) small echogenic kidneys
Which of the following is characteristic of a pelvic kidney
a) an abnormal appearance in a normal location
b) a normal appearance in an abnormal location
c) a normal appearance in a normal location
d) an irregular shape
e) twice the renal volume
b) a normal appearance in an abnormal location
The ureteropelvic junction is located between which of the following
a) renal pelvis and the proximal portion of the ureter
b) distal ureter and base of the bladder
c) urethra and the bladder
d) medulla and the cortex
e) apex and the base of the bladder
a) renal pelvis and the proximal portion of the ureter
One method to diagnosis renal obstruction is to document a resistive index (RI) of greater than
a) 0.07
b) 0.09
c) 0.30
d) 0.50
e) 0.70
e) 0.70
A normal functioning transplanted kidney will appear sonographically as which of the following?
a) more echogenic than a normal kidney
b) with a thin renal cortex and prominent medullary pyramids
c) the same as a normal kidney
d) twice the size of a normal kidney
e) with the renal sinus and renal cortex being isoechoic
c) the same as a normal kidney
Where are transplanted kidneys usually placed?
a) within the renal fossa
b) in the pelvis along the iliopsoas margin
c) in the pelvis anterior to the bladder
d) within the abdominal rectus sheath
e) in Morrisons pouch
b) in the pelvis along the iliopsoas margin
Where are the quadratus lumborum muscles located?
a) medial to the lumbar spine
b) in the anterior abdominal space
c) between the kidneys and the adrenal glands
d) posterior to the kidneys
e) perirenal
d) posterior to the kidneys
A cystic mass that extends form the renal pelvis to outside the renal capsule is
a) a parapelvic cyst
b) an extrarenal pelvis
c) a renal artery aneurysm
d) a grade 2 hydronephrosis
e) duplex collecting system
b) an extrarenal pelvis
A 1 week old male infant presents with a left flank mass. An IVP demonstrates a normal right kidney, but there is no visualization of the left kidney. A sonogram is performed and numerous noncommunicating round cystic structures are demonstrated in the left renal fossa, the largest of which is located laterally. No renal parenchyma is identified. The right kidney is normal. This most probably represents which of the following?
a) severe hydronephrosis
b) polycystic kidneys
c) a multicystic kidney
d) nephroblastoma
e) unilateral renal agenesis
c) a multicystic kidney
What is the most common medical disease that causes acute renal failure?
a) acute tubular necrosis
b) renal infarction
c) diabetes
d) hypertension
e)nephrocalcinosis
a) acute tubular necrosis
The laboratory findings of renal failure include which of the following?
a) creatinine and alkaline phosphatase
b) creatinine and blood urea nitrogen
c) serum amylase and lipase
d) serum amylase and creatinine
e) alkaline phosphatase and alpha-fetoprotein
b) creatinine and blood urea nitrogen
A resistive index (RI) >0.70 in a kidney is consistent with early
a) obstructive jaundice
b) obstructive hydronephrosis
c) renal cell carcinoma
d) benign renal cyst
e) polycystic renal disease
b) obstructive hydronephrosis
A postrenal transplant perirenal fluid collection can be all of the following except?
a) parapelvic cyst
b) urinoma
c) lymphoma
d) hematoma
e) abscess
a) parapelvic cyst
Horseshoe kidney may be confused sonographically with which of the following?
a) carcinoma of the head of the pancreas
b) lymphadenopathy
c) hypernephroma
d) gastric mass
e) aortic aneurysm
b) lymphadenopathy
Which of the following will not increase the chance of documenting shadowing posterior to a small renal stone?
a) decreasing gain
b) focal zone set at the level of the calculi
c) increasing the transducer frequency
d) using a linear probe
e) use of tissue harmonics
d) using a linear probe
What is the most common congenital cause of urinary track obstruction in males?
a) ureteropelvic junction obstruction (UPJ)
b) posterior urethral valve (PUV)
c) infantile polycystic kidney diease
d) undescended testes
e) duplex collecting system
b) posterior urethral valve (PUV)
Characteristics that are atypical and may suggest a malignant cystic lesion include:
1) multiple thick septation
2) irregular walls
3) solid components
Cysts with a single thin septation, minimal wall calcification, internal echoes caused by artifact or lobulated shapes may all be associated with
simple benign cysts
This kidney disease presents as bilateral renal enlargement caused by numerous cysts of varying sizes
Autosomal dominant polycystic kidney disease
What type of kidney disease is associated with cysts in the liver, pancreas, and spleen
Auttosomal dominanat polycystic kidney disease
What is the most common genetically determined childhood cystic disease of the kidneys
Autosomal recessive polycystic kidney disease
3 sonographic findings of autosomal recessive polycystic kidney disease are
1) enlarged kindeys bilaterally
2) hyperechoic parenchyma
3) loss of cortical medullary distinction
Name 4 things autosomal recessive polycystic kidney disease is associated with
1) renal dysfunction
2) pulmonary hypoplasia
3) periportal fibrosis
4) portal hypertension
Autosomal recessive polycystic kidney disease may be detected in utero with
oligohydramnios
What is the most common cause of an abdominal mass in a newborn
Multicystic dysplastic kidney
Contralateral renal anomalies of multicystic dysplastic kidney include
1) ureteropelvic junction obstruction
2) renal agenesis or hypoplasia
This kidney disease is the development of multiple cysts in chronically failed kidneys during long-term hemodiaylsis
Acquired cystic disease
What kidney disease is associated with an increased incidence of renal cell carcinoma
Acquired cystic disease
A congenital dysplastic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia is due to
Medullary sponge kidney
This disease is an inherited disease which usually presents in the second to third decade of life with serious visual impairments
Von Hippel-Lindau disease
Although Von Hippel-Lindau syndrome is characterized by retinal and central nervous system hemangioblastomas, sonographers need to be aware of other related tumors that can be found while performing a complete abdominal evaluation such as:
1) renal cell carcinomas
2) pheochromocytomas
3) Islet cell tumors
4) renal and pancreatic cysts
This is a benign hyperechoic renal tumor. It’s echogenicity is greater than or equal to that of the renal sinus
Angiomyolipoma
What is another name for angiomyolipoma
Renal harmartoma
Angiomyolipoma is associated with
Tuberous Sclerosis
This is a multi-system genetic disease that causes benign tumors to grown on organs such as the brain, kidneys, heart, eyes, lungs, and skin
Tuberous Sclerosis
Tuberous sclerosis commonly affects the
Central nervous system
Patients with tuberous sclerosis have an increased incidence of what 2 things
1) renal cysts
2) angiomyolipomas
What is the most common solid renal mass in the adult
Renal cell carcinoma
sonographically, renal cell carcinoma is_______ relative to the normal adjacent renal parenchyma
Hypoechoic
Common symptoms of renal cell carcinoma include
1) hematuria
2) flank pain
3) palpable mass
4) fever of unknown origin
The____ are the most common site of distant metastases
Lungs
Renal cell carcinoma has an increased incidence associated with
1) acquired cystic disease
2) von Hippel-LIndau syndrome
3) Tuberous sclerosis
Renal metastatses sonographically presents as
1) hypoechoic masses
2) diffusely enlarged inhomogeneous kidney
What is the most common childhood renal tumor
Wilms tumor
4 symptoms of wilms tumor include
1) hypertension
2) fever
3) hematuria
4) anemia
Metastasis can be seen to the
1) lungs
2) liver
3) bone
4 ) lymph nodes
5) retroperitoneum
Tumor extension of Wilms tumor can been into the
1) renal vein
2) IVC
Ultrasound findings of acute pyelonephritis include
1) renal enlargement
2) hypoechoic parenchyma
3) absence of sinus echoes
When acute pyelonephritis is focal it is called what 2 things
1) acute focal bacterial nephritis
2) lobar nephronia
This is a bacterial infection associated with renal ischemia
Emphysematous pyelonephritis
Another name for an increase in nitrogen waste is
Azotemia
A reduction in glomerular filtration rate is associated with what kidney diease
Acute renal failure (ARF)
Name the 3 main mechanisms of ARF
1) Prerenal failure (decreased perfusion
2) Intrinsic (Intrarenal) renal failure
3) Post renal failure
What is the most common cause of acute intrinsic renal failure
Acute tubular necrosis
Name 4 causes of prerenal failure
1) hypotension
2) hypovolemia
3) cardiac failure
4) renal artery stenosis
Name 4 causes of intrinsic renal failure
1) acute tubular necrosis
2) glomerular diseases
3) interstial nephritis
4) autoimmune diseases
What is the cause of post renal failure
bilateral renal obstruction
Ultrasounds role in diagnosing the cause of acute renal failure is to determine what 2 things?
1) hydronephrosis ( indicates postrenal failure)
2) abnormal RI (suggests intrinsic)
Name the 4 lab studies used to evaluate ARF
1) urine output
2) urinalysis
3) BUN
4) serum creatinine
What is the most accurate method of determining ARF
changes in serum creatining reflecting changes in GFR
This kidney disease is a sudden cause of prerenal failure
Renal artery thrombosis
Name 3 things that renal artery thrombosis presents as
1) acute flank pain
2) hematuria
3) sudden rise in blood pressure
What are the 3 sonographic findings of renal artery thrombosis
1) focal hypoechoic areas of infarct
2) absence of intrarenal arterial flow
3) renal enlargement
Renal vein thrombosis can be associated with :
1) extrinsic compression
2) nephrotic syndrome
3) renal tumors
4) renal transplants
5) trauma
Sonographic findings of renal vein thrombosis include
1) dilated thrombosed renal vein
2) absent intrarenal venous flow
3) enlarged hypoehoic kidney
4) high-resistance renal artery waveform
This kidney disease is a renal injury induced by recurrent renal infection
Chronic pyelonephritis
Sonographically chronic pyelonephritis appears as
a small hyperechoic kidney
This is a type of chronic pyelonephritis resulting from chronic infections due to a long term obstruction
XGPN
Associated findings of XGPN include
1) renal enlargement
2) parenchymal abscesses
3) staghorn calculus
4) papillary necrosis
5) hydro
6) pyonephrosis
7) loss of corticomedullary boundry
8) cortical thickening
Failure to depict a normal kidney associated with a staghorn calculus suggest the diagnosis of
XGPN
Purulent material in the collection system of the kidney associated with an infection secondary to renal obstruction
Pyonephrosis
Ultrasound findings of pyonephrosis include
Hyperechoic debris in a dilated renal collecting system
What is the most common renal fungal disaease
Candidiasis
What is another name for mycetoma
Fungal ball
Fungal infections result from
1) hematogenus seeding
2) ascend from the bladder
What do fungus balls appear as
Hyperechoic non shadowing masses
Name 6 hyperechoic renal masses
1) mycetoma
2) angiomyolipomas
3) blood clots
4) pyogenic debris
5) sloughed papilla
6) nonshadowing renal stones
What is another name from autosomal recessive polycystic disease
Potter type 1
What is another name for autosomal dominant polycystic kidney disease
Potter type 3
For medullary cystic disease an RI of less that what will substantiate the diagnosis of renal obstruction
Less than 0.70
What organ is reddish brown with convex lateral borders and concave medial borders
The paired kidneys
There are 3 layers of supportive tissue that surround each kidney. Name these layers from innermost to outermost
Innermost- Fibrous renal capsule (covers the surface)
Middle layer- mass of perirenal fat the adipose capsule ( holds the kidney in place)
Outermost- renal fascia AKA- Gerota fascia
What portion of the kidneys serve as a barrier against physical trauma and infection
The renal capsule
What kidney disease is seen sonographically, with medullary pyramids appearing as highly echogenic without shadowing having an appearance similar to that of nephrocalcinosis
Medullary sponge kidney
What small tumor may mimic the sonographic appearance of an angiomyolipoma
Renal cell carcinoma
What kidney disease is the most common cause of medical renal disease or intrinsic (intrarenal) acute renal failure
Acute Tubular Necrosis
What kidney disease results from prolonged ischemia or nephrotoxins causing damage to the tubular epithelium of the nephron leading to acute renal failure
Acute Tubular necrosis
What are the 3 sonographic findings of acute tubular necrosis
1) renal enlargment
2) increased RI
3) Little diastolic flow
What kidney disease is an inflammatory response resulting in glomerular damage caused by an autoimmune reaction, infection, or exposure to toxins
Acute glomerulonephritis
Name 4 presenting symptoms of acute glomeruonephritis
1) sudden onset of hematuria
2) proteinuria
3) azotemia
4) red blood cell casts in urine
What is the sonographic finding of acute glomerulonephritis
Renal enlargement
This renal disease is the dilatation of the renal pelvis and calyces
Hydronephrosis
This kidney disease produces a separation of the normal sinus echogenicity by an anechioc urine collection
Hydronephrosis
If untreated hydronephrosis secondary to obstruction can lead to
1) hypertension
2) loss of renal function
3) sepsis
Name 6 common causes of hydro
1) calculi
2) benign prostatic hypertrophy
3) prostate cancer
4) pelvic malignancies
5) pregnancy
6) ureteropelvic junction obstruction
What are the 3 common areas of obstruction in hydro
1) ureteropelvic junction
2) pelvic brim
3) ureterovesical junction #1
A threshold of what RI is suggestive of obstructive hydro
0.7 or greater
What kidney disease has disorders of calcium metabolism that result in the formation of calcium renal stones and deposition of calcium salts in the renal parenchyma
Nephrocalcinosis
what is nephrolithaisis
Renal stones
What is the main symptom of nephrocalcinosis
Acute back or flank pain
What are the 8 causes of nephrocalcinosis
1) acute cortical necrosis
2) chronic glomerulonephritis
3) hyperparathyroidism
4) vitamin D intoxication
5) medullary sponge kidney
6) papillary necrosis
7) sarcoidosis
8) malignancies
This kidney disease is ischemia of the medullary pyramids
Papillary necrosis
Papillary necrosis is associated with the following conditions
1) analgesic abuse (most common)
2) diabetes mellitus
3) urinary tract obstruction and infection
4) renal vein thrombosis
5) sickle cell disease
6) chronic heart failure
7) cirrhosis
sono findings of papillary necrosis include
1) echogenic material within the collecting system representing sloughed papillae
2) triangular cystic collections are seen representing the absence of the medullary pyramids
3) bright echoes produced by the arcuate arteries
On ultrasound this kidney disease shows an increase in the central sinus echo complex with cortical thinning
Renal sinus Lipomatosis
What are 2 other names for renal sinus lipomatosis
1) replacement lipomatosis
2) fibrolipomatosis
The urinary bladder is located where in relation to the pubic bone
Behind
The urinary bladder is connected to the umbilicus by the
Median umbilical ligament
the ureters exit the bladder via the
Urethra
Normal bladder wall thickness is typically how many mm in a nondistended bladder
< 5 mm
Normal wall thickness is typically how many mm in a distended bladder
< 3 mm
What bladder anomaly are herniations of the bladder mucosa through the bladder wall musculature
Bladder diverticula
What bladder anomaly is a cystic dilatation of the fetal urachus
Urachal cyst
The ureters exit the kidney where in relation to the renal artery and vein
Posteriorly
Descending inferiorly, the ureters lie where on the psoas muscles
Anterior surface
What ureteral anomaly appears as a cystic- like enlargment of the lower end of the ureter which projects into the bladder lumen at the ureterovesical junction
Ureterocele
What ureteral anomaly is usually associated with a duplex kidney and complete ureteral duplication
Ectopic ureteroceles
What is the most common bladder neoplasm
Transitional cell carcinoma
What is the most common clinical presentation and primary symptom of transitional cell carcinoma
Hematuria
Name 6 bladder masses besides transitional cell carcinoma
1) cystitis
2) prostate cancer
3) squamous cell cancer
4) blood clots
5) pyogenic debris
6) bladder papilloma
What 3 things is resistive index commonly used for?
1) evaluate renal transplant rejection
2) access suspected hydro
3) evaluate medical renal disease
What is a normal resistive index?
less than 0.7
A value comparing the amount of diastole to that of systole and is a relative value (no units) that can be measured in frequency or velocity describes
Resistive index
If the RI= 0.5 what is the diastole
50% systole
If the RI= 0.7 what is the diastole
30% systole
If the RI= 1.0 what is the diastole
Diastole is absent
What are the 2 symptoms of renal artery stenosis
1) sudden onset of hypertension
2) uncontrollable hypertension
What are the 2 renal artery evaluation methods
1) direct evaluation- renal artery velocities
2) indirect evaluation- intrarenal waveform eval. `
What are the 2 things of renal artery stenosis diagnostic criteria of direct evaluation
1) main renal artery velocity > 180 c/s
2) renal artery/ aorta ratio (RAR) > 3.5
What are the 2 renal artery stenosis diagnostic criteria of indirect evaluation
1) pulses parvus et tardus
2) absent early systolic peak
A small hard plus which rises and falls slowly describes
Pulsus parvus et tardus
What is the most common cause of renal disease leading to kidney transplantation
Diabetes
What has become the treatment of choice for end-stage renal disease
Renal transplantation
Harvesting which kidney (right or left) is favored more for a transplant and why
Left kidney due to its longer renal vein
Ultrasound is the most common imaging procedure of the renal transplant. It is utilized in accessing
1) immediate surgical complications
2) Location for renal biopsy
3) vascular status in acute rejection
Name the 3 things that post-transplant complications include
1) fluid collections
- hematomas
-urinomas
-lymphoceles
-abscesses
2) renal artery kinking or thrombosis
3) renal vein thrombosis
Name 3 things sonographic findings of acute rejection include
1) renal enlargement
2) prominent hypoechoic meduallary pyramids
3) loss of cortical-meduallary boundary
A RI of <0.7 indicates
An RI 0.7-0.8 indicates
An RI >0.8 indicates
<0.7= normal RI
0.7-0.8 = questionable RI
>0.8= transplant dysfunction
What lab value inclues the microscopic examination of sediment and qualitative evaluation of protein, glucose, ketones, blood, nitrites, and WBC
Urinalysis
What lab value is inversely related to GFR
serum creatine
What lab value is unsuitable as a single measure of renal function because it varies with urine flow rates and production of urea
BUN
In hydro the incidence occurs greater in which kidney
The right
The normal adult bladder is generally full at how many mL?
500 or 1 pint
What is the average length and diameter of the ureters
30 cm in length and 6 mm in diameter
What is another name for Renal Cell Carcinoma?
a) Nephroblastoma
b) Neuroblastoma
c) Mesoblasic Nephroma
d) Hypernephroma
D) Hypernephroma
What is the most common cause of neurogenic bladder in infants and children
Myelodysplasia
A renal tumor made of blood vessels, muscle and fat is called a
a) Pheochromocytoma
b) Ganglioma
c) Angiomyolipoma
d) Hypernephroma
C) angiomyolipoma
Hyperechoic renal medullary pyramids with some acoustic shadowing is known as
a) Nephroma
b) Nephrolithaisis
c) Nephrocalcinosis
d) Hydronephrosis
c) nephrocalcinosis
You’re scanning a pediatric patient and notice upper pole hydronephrosis, what can you except to see in the pelvis?
a) Pelvic kidney
b) Ureterocele
c) horseshoe kidney
d) crossed fused renal ectopia
b) ureterocele
The vessel located anterior to the abdominal aorta and posterior to the SMA is the?
a) left renal artery
b) left renal vein
c) celiac artery
d) right renal vein
b) left renal vein
Enlargement of the unaffected contralateral kidney with unilateral renal agenesis or comprised renal function is referred to as
a) dromedary hypertrophy
b) renal hypoplasia
c) supernumerary kidney
d) compensatory hypertrophy
d) compensatory hypertrophy
The term muscle pump refers to:
a) the ventricles of the heart
b) the right atrium of the heart
c) the calf muscles
d) the pulmonary arteries
e) the veins of the groin
c) the calf muscles
Which vein in the antecubital fossa connects the cephalic and basilic veins?
a) axillary vein
b) median cubital vein
c) cephalic vein
d) basilic vein
e) ulnar vein
b) median cubital vein
Which of the following is not a deep vein in the upper extremity?
a) ulnar vein
b) cephalic vein
c) axillary vein
d) radial vein
e) brachial vein
b) cephalic vein
The brachiocephalic vein is found
a) only on the right side
b) only on the left side
c) on both the right and left sides
d) there is no such vein; its called the “innominate”
e) This vein is located centrally in the cranium
c) on both the right and left sides
Which of the following vessels joins the brachial veins to form the axillary vein
a) subclavian vein
b) innominate vein
c) cephalic vein
d) basilic vein
e) ulnar vein
d) basilic vein
Musclar veins of the calf that empty into the popliteal vein behind the knee are:
a) soleal sinuses
b) femoral veins
c) adductor veins
d) gastrocnemius veins
e) perforating veins
d) gastrocnemius veins
Compared to the arteries, veins have
a) thicker, more muscular walls
b) thicker intima
c) thicker adventitia and media
d) thinner intima
e) thinner adventitia and media
e) thinner adventitia and media
Regarding venous valves, which is false?
a) Essential to muscle pump
b) bicuspid
c) endothelial tissue
d) allow flow only away from the heart
e) have sinuses to faciliate closure
d) allow flow only away from the heart
Peripheral resistance increases with
a) greater length, smaller diameter, and lower blood viscosity
b) greater length, larger diameter, and higher blood viscosity
c) shorter length, larger diameter, and lower blood viscosity
d) shorter length, smaller diameter, and lower blood viscosity
e) greater length, smaller diameter, and higher blood viscosity
e) greater length, smaller diameter, and higher blood viscosity
The following arteries have low-resistance flow character:
a) internal carotid, preprandial, superior mesenteric, and renal arteries
b) external carotid, preprandial superior mesenteric, and renal arteries
c) internal carotid, postprandial superior mesenteric, and renal arteries
d) external carotid, postprandial superior mesenteric, and renal arteries
e) internal carotid and superior mesenteric arteries
c) internal carotid, postprandial superior mesenteric, and renal arteries
Which of the following statements about the dorsalis pedis artery is not correct
a) it runs anterior to the medial malleolus
b) it is typically the continuation of the anterior tibial artery
c) it joins the pedal arch about halfway along the dorsum of the foot
d) it is a branch of the peroneal artery
e) it begins at the bend of the foot and ankle
d) it is a branch of the peroneal artery
Vessels and structures of the penis include all of the following except:
a) deep artery of the penis
b) dorsal artery of the penis
c) corpus spongiosum
d) inferior vesicle artery
e) dorsal vein
d) inferior vesicle artery
Which of the following vessels is not found on or near the foot
a) the dorsalis pedis
b) the posterior tibial
c) the peroneal
d) the circumflex
e) all are found on or near the foot
d) the circumflex
In B-mode imaging of the common femoral artery and its bifurcation into the profunda femoris and superficial arteries, normally the profunda femoris artery courses:
a) posterolateral to the superficial femoral artery
b) anterolateral to the superficial femoral artery
c) posteromedial to the superficial femoral artery
d) anteromedial to the superficial femoral artery
e) lateral to the superficial femoral artery
a) posterolateral to the superficial femoral artery
While scanning a patient you see a large tumor, in the kidney, what vessels would be appropriate to scan
a) renal veins and AO
b) renal vein and IVC
c) both
d) none
b) renal vein and IVC
While performing an ultrasound examination, the sonographer finds that both kidneys measure 5 cm in length. They are very echogenic. All of the following are possible except:
a) Chronic glomerulonephritis
b) chronic pyelonephritis
c) renal artery disease
d) renal vein thrombosis
d) renal vein thrombosis
Anechoic masses that occur around a renal transplant include all of the following except:
a) urinoma
b) lymphoma
c) hematoma
d) corpus luteal cyst
e) fibroid
e) fibroid
Ectopic ureterocele is associated with which complication
a) upper pole hydronephrosis
b) stone formation
c) renal cell carcinoma
d) lower pole hydronephrosis
e) vesicourinary reflex
a) upper pole hydronephrosis
Which organ is most likely to be affected in adult PKD
a) ovary
b) pancreas
c) spleen
d) adrenal gland
e) liver
e) liver
All of the following lab values may be elevated in renal failure except
a) protein
b) creatinine
c) alkaline phosphatase
d) BUN
c) alkaline phosphatase
Elevated serum amylase may be secondary to all of the following except:
a) pancreatic duct obstruction
b) acute pancreatitis
c) liver disease
d) obstruction of the ampulla of vater
c) liver disease
The renal cortex contains which of the following?
a) Loops of henle
b) calyces
c) pyramids
d) bowmans capsule
d) bowmans capsule
What is the most common abdominal lesion seen with Von-hippel Landau syndrome
a) liver adenoma
b) fatty liver sparing
c) pancreatic cysts
d) renal cell carcinoma
c) pancreatic cysts
the most common location for a urinary obstruction caused by a renal calculus is in the
a) distal ureter
b) proximal ureter
c) trigone of the bladder
d) distal urethra
a) distal ureter
Which structure is most anterior at the renal hilum
a) ureter
b) vein
c) artery
b) vein
-The vein is most anterior, the artery is in the middle, and the ureter is most posterior
The psoas muscle is _______ to the kidney
a) anterolateral
b) posteromedial
c) posterolateral
d) anteromedial
b) posteromedial
-the psoas muscle is located posteromedial to the left kidney
-the quadratus lumborum lies directly posterior to the kidney
The______ arteries are the vessels that course perpendicular to the renal capsule within the outer renal parenchyma
a) segmental
b) arcuate
c) interlobular
d) interlobar
c) interlobular
Increased serum levels of _______ will reduce urine output and increase blood volume in the body
a) aldosterone
b) bilirubin
c) thryroxine
d) alkaline phosphatase
a) aldosterone
The renal cortex contains which of the following
a) pyramids
b) bowman capsule
c) loops of henele
d) calyces
b) bowmans capsule
A 30 year old male presents with pelvic discomfort. He has a 2 year history of HIV infection and is an insulin dependent diabetic. When evaluating the urinary bladder, you identify a mobile, round, hyperechoic solid mass with no posterior shadowing. What is the most likely diagnosis for these findings
a) transitional cell carcinoma
b) bladder stone
c) fungal ball
d) squamous cell carcinoma
c) fungal ball
A patient presents with a history of high fever, HTN, nausea and vomiting. Lab results indicate the presence of white blood cells, pus and bacteria in the urine. A small, shrunken, misshapen left kidney and a normal right kidney are documented on the ultrasound exam. What are these findings most suggestive of
a) emphysematous phelonephritis
b) acute glomerulonephritis
c) chronic pyelonephritis
d) acute renal failure
c) chronic pyelonephritis
Hutch diverticula are identified in the
a) large bowel
b) gallbladder
c) small bowel
d) urinary bladder
d) urinary bladder
-Hutch diverticula are congenital outpouchings of the bladder wall near the urethral orifice
Which of the following is most likely to produce posterior shadowing
a) angiomyolipoma
b) renal lipoma
c) sloughed papilla
d) mycetoma
c) sloughed papilla
Which of the following is correct regarding acute pyelonephritis
a) diffuse involvement will demonstrate prominent distinction of the renal sinus echoes in affected kidneys/ segment
b) focal involvement will demonstrate a hyperechoic ovoid structure segment of parenchyma
c) critical finding that requires immediate nephrectomy to prevent sepsis
d) usually treated with antibiotics
d) usually treated with antibiotics
A patient presents for a post biopsy of the right kidney. A subcapsular hematoma is suspected. What will the appearance of this abnormality on the image
a) cystic formation with debris found within the renal sinus
b) free fluid beneath the renal capsule that distorts the contour of the parenchyma
c) free fluid with debris levels found within murphy pouch
d) free fluid with debris levels found within morrisons pouch
b) free fluid beneath the renal capsule that distorts the contour of the parenchyma
