VIQ - GU Flashcards
@# 47. A 50-year-old female undergoes CT for an echogenic lesion on ultrasound. Pre-contrast CT shows a lesion, which is well-defned and has increased attenuation (60HU). Postcontrast the lesion appears low in attenuation related to the surrounding parenchyma (61 HU). The diagnosis is:
A. Haemorrhagic renal cell carcinoma
B. Angiomyolipoma (AML) that has bled
C. Lymphoma
D. Haemorrhagic renal cyst
E. AML
D. Haemorrhagic renal cyst
A less than 10 HU increase post-contrast indicates benign hyperdense cyst. Other benign features include being sharply marginated and homogenous.
@#e 1 A 52 year old man presents with loin pain and microscopic haematuria. KUB reveals no abnormality. A CT KUB demonstrates a 7 mm mid-ureteric calculus. What is the most likely composition of the calculus?
(a) Calcium phosphate
(b) Calcium oxalate
(c) Urate
(d) Xanthine
(e) Cystine
(c) Urate
Although both xanthine and urate stones are radiolucent, urate stones are much more common. Cystine stones are mildly opaque. Calcium oxalate and calcium phosphate stones are radio-opaque
@#e QUESTION 29
A 35-year-old patient received a cadaveric renal transplant 5 days ago and now presents with worsening renal function and decreasing urine output. Which one of the following findings on a Tc-99m DTPA radionuclide scan would favour a diagnosis of acute tubular necrosis (ATN) over acute rejection?
A Delayed renal excretion
B Elevated resistive index greater than 0.7
C Increased renal perfusion after administration of an ACEI (eg Captopril)
D Poor/impaired graft perfusion
E Preserved renal transplant perfusion
E Preserved renal transplant perfusion
ATN is an early complication in cadaveric allografts and frequently resolves spontaneously in 1—3 weeks. The radionuclide imaging findings of ATN are of preserved perfusion but poor renal function and urine excretion. In acute rejection however, there is both impaired renal function and reduced perfusion on radionuclide imaging.
@#e QUESTION 35
A 24-year-old motorcyclist is involved in a high-speed accident and is brought to the Emergency Department. He has abdominal guarding and is haemodynamically unstable. An ultrasound abdomen performed in the Emergency Department demonstrates free peritoneal fluid and a laparotomy is performed. In addition to liver and splenic lacerations, the surgeon finds a left retroperitoneal haematoma. Postoperatively, the on-call urologist requests a CT abdomen to assess the left renal injury. Which one of the following findings would indicate a Grade 4 renal laceration?
A Extravasation of contrast from the pelvicalyceal system on delayed phase (5 min) images
B Large (2-cm) subcapsular haematoma
C Perinephric haematoma that extends into the pararenal spaces
D Ill-defined low attenuation change in the lower pole renal cortex
E Segmental renal infarction
A Extravasation of contrast from the pelvicalyceal system on delayed phase (5 min) images
A deep renal laceration that extends into the collecting system is indicative of a grade 4 injury
@#e QUESTION 38
A 64-year-old man has an abdominal MRI to further characterise a well-defined 2.5-cm solid renal mass at the left upper pole. The lesion was hyperechoic on ultrasound. Which one of the following MRI findings would favour a diagnosis of angiomyolipoma?
A High signal on Tlw and low signal on T2w sequences
B High signal on Tlw and STIR sequences
C High signal on Tlw and T2w sequences
D High signal on T2w and low signal on proton density sequences
E Low signal on both T2w and proton density sequences
C High signal on Tlw and T2w sequences
Angiomyolipomas appear high signal on both Tlw and T2w sequences due to their high fat content
@#e QUESTION 51
A 22-year-old pregnant woman (30 weeks’ gestation) presents with right flank pain. She has an abdominal ultrasound which shows dilatation of the right pelvicalyceai system. Which one of the following additional findings would suggest a diagnosis of mechanical ureteric obstruction rather than pregnancy-related dilatation?
A An elevated resistive index (RI)
B Decreased corticomedullary differentiation
C Hyperechoic renal parenchyma
D Renal parenchymal thinning
E Ureteric and pelvicalyceai dilatation
A An elevated resistive index (RI)
Mechanical obstruction is associated with elevation of the RI.
@# 41) A patient with a lower ureteric transitional cell carcinoma has an MRI for locoregional staging purposes and a CT of the abdomen and pelvis for lymph node involvement and metastases. An 8 mm short axis node is recorded. In which of the following abdominopelvic groups would this be significant by size criteria?
a. inguinal
b. common iliac
c. external iliac
d. internal iliac
e. retroperitoneal
d. internal iliac
A short axis measurement of 7mm or greater represents significant enlargement of internal iliac nodes.
Regarding other nodal regions, significant enlargement
for inguinal nodes is 10mm,
for common iliac 9mm,
for external iliac 10mm,
for obturator 8mm
and for retroperitoneal nodes between renal arteries and the aortic bifurcation 12mm.
In addition to size, there may be morphological clues to nodal involvement by cancer.
Clustering of nodes, round nodes, nodes with irregular capsules, and nodes sharing CTor MRI characteristics of the primary tumour (attenuation, signal, cystic or necrotic changes, and contrast-enhancement pattern) are features suggesting lymph node involvement
@# 14 A 50 year old woman is found to have multiple, round, well defined filling defects in her left ureter on IVU.
Which of the following is the least likely diagnosis?
(a) Emphysematous ureteritis
(b) Ureteritis cystica
(c) Malakoplakia
(d) Leukoplakia
(e) Cervical carcinoma
(a) Emphysematous ureteritis
The differential diagnosis for ureteric filling defects also includes TCC and radiolucent calculi. Emphysematous
ureteritis typically causes streak like filling defects on IVU.
@#e QUESTION 34
A 68-year-old man is involved in a traffic accident and sustains a pelvic fracture, head and limb injuries.
Attempted urethral catheterisation in the Emergency Department is unsuccessful and a cystourethrogram is
requested to exclude urethral injuries. Regarding urethral injuries, which one of the following statements is
correct?
A Anterior urethral injury is more commonly due to iatrogenic or penetrating trauma than to blunt traiima.
B Cystography should precede a retrograde urethrogram in a patient with suspected urethral injury.
C In men, on digital rectal examination the prostate is lower than normal in patients with urethral trauma.
D Urethral injuries occur in 50% of major pelvic fractures.
E Urethral injury due to blunt trauma more commonly affects the penile urethra.
A Anterior urethral injury is more commonly due to iatrogenic or penetrating trauma than to blunt traiima.
@#e QUESTION 56
An immunosuppressed 24-year-old man presents with left renal colic. He is referred for an IVU. The control film
shows a gas containing, round lamellated mass within the urinary bladder. Postcontrast, there are multiple filling
defects within the urinary bladder. What is the most likely cause of these appearances?
A Blood clot
B Bladder calculi
C Cystitis
D Fungal ball
E Schistosomiasis
D Fungal ball
@#e QUESTION 80
Which one of the following statements best describes the characteristic radiological features of retroperitoneal
fibrosis?
A A plaque-like mass that encases the aorta and displaces it laterally, most commonly to the left
B A plaque-like mass that displaces the kidneys and ureters laterally at the Ll-2 level
C A plaque-like mass that displaces the aorta and iliac arteries anteriorly
D A plaque-like mass that narrows and displaces the ureters laterally at the L4-5 level
E A plaque-like mass that narrows and medially displaces the ureters at the L4-5 level
E A plaque-like mass that narrows and medially displaces the ureters at the L4-5 level
@#e QUESTION 4
A 13-year-old boy presents to the Emergency Department with sudden onset of left scrotal pain, fever and
vomiting. The referring clinician suspects left testicular torsion and requests an urgent ultrasound prior to surgical
exploration. Which of the following radiological findings would suggest that the left testis is still viable?
A A diffusely enlarged hypoechoic left testis
B A normal echogenicity testis on grey-scale imaging
C A small shrunken left testis with a surrounding hydrocoele and scrotal wall thickening
D Absent blood flow within the left testis on colour flow Doppler but good flow within the tunica vaginalis
E An enlarged heterogeneous left testis
B A normal echogenicity testis on grey-scale imaging
The section on testicular torsion within the comprehensive review by Fiitterer et al provides useful additional
information
@#e QUESTION 5
A 25-year-old man presents with a tender right scrotum. Which one of the following statements best describes
the expected ultrasound findings in acute, uncomplicated epididymo-orchitis?
A A small atrophic right testis
B A well-defined testicular mass of mixed echogenicity that has a whorled appearance and reduced flow on colour
Doppler
C Multiple small (approx. 1 mm) echogenic foci scattered throughout the
D Patchy areas of increased echogenicity within the testis with reduced flow on colour Doppler
E Well-defined, patchy areas of decreased echogenicity within the right
E Well-defined, patchy areas of decreased echogenicity within the right
In the early phase of acute orchitis, there is oedema of the testis leading to swelling and diffuse low reflectivity
on ultrasound. The ultrasound appearances then evolve to increasingly well-defined areas of patchy low
reflectivity. Colour Doppler flow is typically increased within these areas of low reflectivity.
@#e QUESTION 6
A 35-year-old man is discovered to have a right testicular mass on ultrasound. Which additional ultrasound
finding would suggest a diagnosis of teratoma rather than seminoma?
A A testicular mass that contains areas of calcification
B A testicular mass that demonstrates increased colour Doppler flow
C A testicular mass that is homogeneously anechoic with posterior acoustic enhancement
D A testicular mass that is hypoechoic compared with the surrounding testicular parenchyma
E A testicular mass that has well-defined margins
A A testicular mass that contains areas of calcification
@#e QUESTION 60
A 70-year-old man with prostate cancer has an MRI examination to locally stage the disease. In which part of the prostate gland is a carcinoma most likely
A Central zone
B Peripheral zone
C Peri-urethral zone
D Transitional zone
E Within the verumontanum
B Peripheral zone
Seventy per cent of prostate cancers arise from the peripheral zone.
