Workbook Flashcards
The kidneys and ureters are located in the
Retroperitoneal
The ? glands are located directly superior to the kidneys.
suprerenal (adrenal)
Which structures create a 20 degree angle between the upper pole and lower pole of the kidney?
psoas major muscles
What is the specific name for the mass of fat that surrounds each kidney?
perirenal fat or adipose capsule
What degree of rotation from supine is required to place the kidneys parallel to the IR?
30 degrees
Which two landmarks can be palpated to locate the kidneys?
xiphoid process and iliac crest
Which term describes an abnormal drop of the kidneys when the patient is placed erect?
nephroptosis
List the three functions of the urinary system.
Remove nitrogenous
Regulate water levels
Regulate acid base balance
A buildup of nitrogenous waste in the blood is called.
Uremia
The longitudinal fissure found along the central medial border of the kidney is called the
Hilum
The peripheral or outer portion of the kidney is called the
Cortex
The term that describes the total functioning portion of the kidney is
Renal parenchyma
The microscopic functional and structural unit of the kidney is the
Nephron
The efferent arterioles carry blood on the glomeruli.
False
What is another (older) name for the glomerular capsule?
Bowman capsule
The glomerular capsule and proximal and distal convoluted tubules are located in the medulla of the kidney.
False
Which structure of the medulla is made up of a collection of tubules that drain into the minor calyx?
Renal pyramids
Which two processes move urine through the ureters to the bladder?
Peristalsis
Gravity
Which one of the following structures is located most anterior as compared with the others?
Urinary bladder
What is the name of the junction found between the distal ureters and urinary bladder?
Ureterovesical junction
What is the name of the inner, posterior region of the bladder formed by the two ureters entering and the urethra exiting?
Trigone
What is the name of the small gland found just inferior to the male bladder?
Prostate gland
The total capacity for the average adult bladder is:
350 to 500ML
Which one of the following structures is considered to be most posterior?
Kidneys
Intravenous contrast media may be administered by either:
Bolus injection
Drip infusion
The patient (or legal guardian) must sign an informed consent form before a venipuncture procedure is performed on a pediatric patient.
True
For most IVUs, veins in the ? are recommended for venipuncture.
Antecubital fossa
The most common size of needle used for bolus injections on adults is:
18 to 22 gauge
The two most common types of needles used for bolus injection of contrast media are
Butterfly
Over the needle catheter
In the correct order, list the six steps followed during a venipuncture procedure as listed and described in the textbook
1) wash hands and put on gloves
2) select site, apply tourniquet, and cleanse the site
3) initiate puncture
4) confirm entry and secure needle
5) prepare and proceed with injection
6) Remove needle or catheter
The bevel of the needle needs to be facing downward during the actual puncture into a vein.
False
If extravasation occurs during the puncture, the technologist should slightly retract the needle and then push it forward again
False
If unsuccessful during the initial puncture, a new needle should be used during the second attempt.
True
The radiologist is responsible for documenting all aspects of the venipuncture procedure in the patient’s chart.
False
Uses a parent compound of venzoic acid
Ionic
Will not significantly increase the osmolality of the blood plasma
Nonionic
Incorporates sodium or meglumine to increase solubility of the contrast media.
ionic
Creates a hypertonic condition in the blood plasma
ionic
Is more expensive
nonionic
Produces less severe reactions
nonionic
Is a near isotonic solution
nonionic
Poses a greater risk for disrupting homeostasis
ionic
Uses a parent compound of an amide or glucose group
nonionic
May increase the severity of side effects
ionic
Which one of the following compounds is a common anion found in ionic contrast media?
Diatrizoate or iothalamate
Any disruption in the physiologic functions o the body that may lead to a contrast media reaction is the basis for the:
Chemotoxic theory
An expected outcome to the introduction of contrast media is described as a
Side Effect
The normal creatinine level for an adult should range between
0.6 to 1.5 mg/dl
Normal BUN levels for an adult should range between
8 to 25 mg/100ML
Metformin hydrochloride is a drug that is taken for the management of
Diabetes/Mellitus
The American College of Radiology recommends that metformin be withhelf for ? hours after a contrast medium procedure and resumed only if kidney function is again determined to be within normal limits.
48
The leakage of contrast media from a vessel into the surrounding soft tissues is called
Extravascation (infiltration)
List the two general categories of contrast media reactions:
Local
Systemic
Which type of reaction is a true allergic response to iodinated contrast media?
anaphylactic reactor
Which type of reaction is caused by the stimulation of the vagus nerve by introduction of a contrast medium, which causes heart rate and blood pressure to fall?
Vasovagal reaction
Vasovagal reactions are not considered to be life threatening
False
Brachycardia (<50 beats/minute)
Severe (reaction to contrast)
Tachycardis (>100 beats/minute)
Moderate (reaction to contrast)
Angioedema
Moderate (reaction to contrast)
Lightheadedness
Mild (reaction to contrast)
Hypotension (systolic blood pressure <80 mm Hg)
Severe (reaction to contrast)
Temporary renal failure
Severe (reaction to contrast)
Laryngeal swelling
Severe (reaction to contrast)
Cardiac Arrest
Severe (reaction to contrast)
Mild hives
Mild (reaction to contrast)
Mild level contrast media reactions do not usually require medication or medical assistance.
True
Urticaria is the formal term for excessive vomiting.
False (hives)
A temporary failure of the renal system is an example of a(n) ? reaction.
Severe
Convulsions
Severe systemic (reaction)
Metallic taste
Side effect (reaction)
Angioedema
Moderate systemic (reaction)
Bradycardia
Severe systemic (reaction)
itching
Mild systemic (reaction)
Vomiting
Mild systemic (reaction)
Temporary hot flash
Side effect (reaction)
Respiratory arrest
Severe systemic (reaction)
Pulmonary edema
Local (reaction)
Extravasation
Severe systemic (reaction)
Severe urticaria
Moderate systemic (reaction)
What should the technologist do first when a patient is experiencing either a moderate or a severe level contrast media reaction?
call for medical assistance
What is the primary purpose of the premedication procedure before an iodinated contrast media procedure?
to reduce the severity of contrast media reactions
Which of the following drugs is often given to the patient as part of the premedication procedure?
combination of Benadryl and prednisone.
Which type of patient is a likely candidate for the premedication procedure before a contrast media study?
Asthmatic patient
In addition to notifying a nurse or physician when contrast media has extravasated into the soft tissues, what should the technologist first do to increase reabsorption?
Elevate the affected extremity or use a cold compress followed by a warm compress
Tissue inflammation from extravasated contrast media peaks 1 to 2 hours after the incident.
False
Acute renal failure may occur 48 hours after an iodinated contrast media procedure.
True
List 10 contraindications that may prevent a patient from having a contrast media procedure performed.
1) hypersensitivity to iodinated contrast media
2) Anuria
3) Multiple myeloma
4) Diabetes Mellitus
5) Sever hepatic or renal disease
6) congestive heart failure
7) pheochromocytoma
8) sickle cell anemia
9) patients taking metforming or similar medication
10) renal failure acute or chronic
A trademark name for a diuretic drug is
Lasix
Why is the term IVP incorrect in describing a radiographic examination of the kidneys, ureters, and bladder after intravenous injection and contrast media?
An IVP (intravenous pyelogram) is a study of the renal pelvis.
What is the correct term for an (IVU)?
Intravenous urogram
Which specific aspect of the kidney is visualized during an IVU?
The collecting system of the kidney.
Which one of the following conditions is a common pathologic indication for an IVU?
Hematuria
Which one of the following conditions is described as a rare tumor of the kidney?
Pheochromocytoma
Pneumouria
Presence of gas in urine
Urinary reflux
Backward return flow of urine
Uremia
Excess urea and creatinine in the blood
Anuria
Complete cessation of urinary secretion
Polyuria
Passage of large volume of urine
Micturition
Act of voiding
Retention
Inability to void
Oliguria
Diminished amount of urine being excreted
Glucosuria
Presence of glucose in urine
Urinary incontinence
Constant or frequent involuntary passage of urine
Renal agenesis
Absence of a functioning kidney
Acute renal failure
Indicated by presence of uremia, oliguria, or anuria
Enlargement of the prostate gland
Benign prostatic hyperplasia
Fusion of the lower poles of kidneys during the development of the fetus
Horseshoe kidney
inflammation of the capillary loops of the glomeruli of the kidneys
Glomerulonephritis
Artificial opening between the urinary bladder and aspects of the large intestine.
vesicorectal fistula
A large stone that grows and completely fills the renal pelvis
Staghorn calculus
Increased blood pressure to the kidneys due to atherosclerosis
Renal hypertension
Normal kidney that fails to ascent into the abdomen but remains in the pelvis
Ectopic kidney
Multiple cysts in one or both kidneys
Polycystic kidney disease
Rapid excretion of contrast media
Renal hypertension
Mucosal changes within bladder
Cystitis
Bilateral, small kidneys with blunted calyces
Chronic Bright disease
Irregular appearance of renal parenchyma or collecting system
Renal cell carcinoma
signs of abnormal fluid collections
Vesicorectal fistula
Abnormal rotation of the kidney
Malrotation
Elevated or indented floor of bladder
BPH
signs of obstruction of urinary system
Renal Calculi
A condition characterized by regions or areas of subcutaneous swelling caused by allergic reaction to food or drugs is termed
Angioedema
contraction of the muscles within the walls of the bronchi and bronchioles, producing a restriction of air passing through them, is a condition called
Bronchospasm
Loss of consciousness resulting from reduced cerebral blood flow is termed
syncope
An eruption of welts (hives) often caused by a hypersensitivity to food or drugs is a condition termed
Uriticaria
What type of renal calculi is often associated with chronic urinary tract infections?
Staghorn calculi
The patient should void before an IVU to prevent possible rupture of the bladder if compression is applied.
True
What is the primary purpose of ureteric compression?
to enhance filling of the pelvicaliceal system w/ contrast medium
List the six conditions that could contraindicate the use of ureteric compression:
Possible ureteric stones Abdominal mass Abdominal aortic aneurysum recent abdominal surgery severe abdominal pain acute abdominal pain
What does the timing for an IVU exam start?
at start of injection of contrast media
List the routine five-step imaging sequence for a routine IVU:
1 minute nephrogram or nephrotomography 5 minute full KUB 10 to 15 minute full KUB 20 minute posterior R and L oblique posterior postvoid (prone PA or erect AP)
What is the primary difference between a standard and hypertensive IVU?
A hpertensive IVU requires a shorter span of time between projections.
In which department are most retrograde urograms performed?
surgery (inpatient or outpatient facility)
A retrograde urogram examines the anatomy and function of the pelvicaliceal system.
False (nonfunction)
The Brodney clamp is used for male and female retrograde cystourethrograms.
False
Which of the following involves a direct introduction of the contrast media into the structure being studied?
Retrograde urogram
Retrograde cystogram
Retrograde urethorogram
Which of the following alternative imaging modalities is not routinely being used to diagnose renal calculi?
Magnetic resonance imaging
urinary studies on pediatric patients should be scheduled early in the morning to minimize the risk for dehydration.
True
The number of retrograde urography procedures for urethral calculi has been reduced as a result of the increased use of CT.
True
Exposure factors used during a CT procedure can be adjusted to compensate for a decrease or increase in body size according to ? and ?.
height
weight
The patient does not require extensive bowel preparation before a CT scan for renal calculi.
True
Which imaging modality is used to detect subtle tissue changes following a renal transplant?
MRI
Nuclear medicine is highly effective in demonstrating signs of vesicoureteral reflux.
True
How will an enlarged prostate gland appear on a postvoid radiograph taken during an IVU?
the prostate gland will indent the floor of the bladder.
Where should the pneumatic paddle be placed for the ureteric compression phase of an IVU?
just medial to the ASIS and lateral to the spine.
What can be done to enhance filling of the calyces of the kidney if ureteric compression is contraindicated?
place the patient in a 15 degree trendenlenburg position
A retrograde pyelogram is primarily a nonfunctional study of the
renal pelvis, major and minor calyces of the kidneys
What are the four reasons a scout projection is taken before the injection of contrast media for an IVU?
Verify patient preparation
determine whether exposure forms are acceptable
verify positioning
detect any abnormal calcifications
What specific anatomy is examined during a retrograde ureterogram?
Primarily the ureters
Which specific position is recommended for a male patient during a voiding cystourethrogram?
30 degree RPO
What KV range (analog and digital) is recommended for an IVU?
70-75 KV analog
70-80 KV digital
There is a change in SID recommendations when placing a patient erect versus supine for an IVU AP projection.
False
Both the AP erect and supine IVU image have recommended 40” SID
Male and female patients should have the gonads shielded for an AP scout projection
False
not female; would obstruct essential anatomy
Tomograms taken during an IVU with an exposure angle of 10 degree or less are called zonography.
True
How many tomogranms (zonograms) are usually produced during a routine IVU?
Three
At what stage of an IVU is the renal parenchyma best seen?
within 1 minute after injection
Where is the CR centered for a nephrotomogram?
midway between xiphoid process and iliac crest
Which specific position, taken during an IVU, places the left kidney parallel to the IR?
RPO
How much obliquity is required for the LPO/RPO projections taken during an IVU?
30 degrees
Which position best demonstrates possible nephroptosis?
erect position
What CR angle is used for the AP projection taken during a cystogram?
10 to 15 degree caudad
A radiograph of an AP scout projection of the abdomen, taken during an IVU, reveals that the symphysis pubis is cut off slightly. The patient is too large to include the entire abdomen on a 14 times 17 inch IR. What should the technologist do in this situation?
A second projection of the bladder should be taken, using a smaller IR paced crosswise to include this region the large IR should be centered 1 or 2 inches higher to include the upper abdomen.
A nephrogram is ordered a part of an IVU study. When the nephogram image is processed, there is a minimal amount of contrast media within the renal parenchyma and the calyces are beginning to fill with contrast media. What specific problem led to this radiographic outcome?
Too long of a delay between the injection of contrast media and the imaging of nephrogram. The nephogram needs to be taken no later than 60 seconds after injection.
A 45 degree RPO radiograph taken during an IVU reveals that the left kidney is foreshortened. What modification is needed to improve this image during the repeat exposure?
Decrease the obliquity of the RPO to no more than 30 degrees.
An AP projection taken during the compression phase of an IVU reveals that the majority of the contrast media has left the collecting system of the kidneys. The technologist placed the pneumatic paddles near the umbilicus and ensured that they were inflated. What can the technologist do to ensure better retention of contrast media in the collecting system during the compression phase of future IVUs?
Place the neumatic paddles just medial to the ASIS to allow for compression of the distal ureters against the pelvic brim.
An AP axial projection radiograph taken during a cystogram reveals that the floor of the bladder is superimposed over the symphysis pubis. What can the technologist do to correct this problem during the repeat exposure?
Increase caudad angulation of the CR to project the synphysis pubis below the bladder. The typical CR angle is 10-15 degrees caudad.
A patient comes to the radiology department for an IVU. While taking the clinical history, the technologist learns the patient has renal hypertension. How must the technologists modify the IVU imaging sequence to accommodate this patient’s condition?
Decrease the span of time between projections to capture all phases of the urinary system. (take images at 1, 2, and 3 minutes rather than 1, 5, and 15.
A the technologist patient comes to the radiology department for an IVU. The AP scout reveals an abnormal density near the lumbar spine that the radiologist suspects is an abdominal aortic aneurysm. What should the technologist do about the ureteric compression phase of the study that is part of the procedure protocol?
The technologist should not perform the compression phase of the study. Uretric compression is contraindicated when an abdominal aortic areurism is suspected (the technologist should consult with the radiologhist or physician.
A patient comes to the radiology department for an IVU. The patient history indicates that he may have an enlarged prostate gland. What projection will best demonstrate this condition?
The erect prevoid AP projection will best demonstrate an enlarged prostate gland.
A patient with a history of bladder calculi comes to the radiology department. A retrograde cystogram has been ordered. During the interview, the patient reports that he had a severe reaction to contrast media in the past. What other imaging modality can be performed to best diagnose this condition?
Ultrasound, CT or nuclear medicine scan
The same patient described in question 9 may also have calculi in the kidney. What is the preferred imaging modality for this situation when iodinated contrast media cannot be used.?
Ct is preferred but a nuclear medicine procedure can also be performd
A patient comes to the radiology department for an IVU. As the patient’s clinical history is being reviewed. It is discovered that he is diabetic. What additional question(s) should the patient be asked during the interview before the procedure?
The patient should be asked whether he is taking metformin or similar medication to control diabetes. If his response is yes, document and inform this radiologist of the patient’s condition and medication history before injection. The referring physician may be asked to check kidney function, before the patient resumes this medication.
During an IVU, the patient complains of a metallic taste and has a sudden urge to urinate. What action should the technologist take?
There are expected side affects and the technologist should reassure the patient. No medical treatment is required.
While viewing the chart of a patient scheduled for an IVU, the technologist discovers that the BUN of the patient is 15mg/100 mL with a creatinine level of 1.3 mg/dL. Can this patient safely undergo an IVU?
Although the technologist should inform the radiologist or injecting technologist of the blood chemistry levels both BUN and creatine levels are within the range of normal.
The kidneys are ? structures.
Retroperitoneal
The ureters enter the ? aspect of the bladder.
Posterolateral
The kidneys lie at ? angle in relation to the coronal plane.
30 degree
An abnormal drop of more than ? inches, or ? cm, in the position of the kidneys when the patient is erect indicates a condition termed nephroptosis.
2 or 5
The buildup of nitrogenous waste in the blood creates a condition called
Uremia
How much urine is normally produced by the kidneys in 24 hours?
1.5 L
The renal veins connect directly to the
Inferior vena cava
The 8 to 18 conical masses found within the renal medulla are called the
Renal pyramids
The major calyces of the kidney unite to form the
Renal pelvis
The microscope unit of the kidney (of which there are more than 1 million in each kidney) is called the
nephron
About 50% of the glomerular filtrate processed by the nephron is reabsorbed into the kidney’s venous system.
False
The loop of Henle and collecting tubules are located primarily in the medulla of the kidney.
True
The three constricted points along the length of the ureters where a kidney stone is most likely to lodge are:
ureteropelvic (UP) Junction
near brim of pelvis
ureterovesical (UV) junction
The inner, posterior triangular aspect of the bladder that is attached to the floor of the pelvis is called the
Trigone
Under what circumstances should a pregnant patient have an IVU performed?
When the benefit of the procedure outweights the risk of the radiation exposure.
List the two classes of iodinated contrast media used for urinary studies:
Ionic and nonionic
The normal range of creatinine in an adult is:
0.6 to 1.5mg/dL
How long must a patient be withheld from taking metformin after an iodinated contrast media procedure?
48 hours
Hot flashes are classified as a
side effect
Which one of the following veins is not normally selected for venipuncture during an IVU.
axillary
At what angle is the needle advanced into the vein during venipuncture?
20 to 45 degree
How long should the venipuncture site be cleaned with an alcohol wipe before needle insertion?
30 seconds
How high should the tourniquet be placed above the puncture site?
3 to 4 inches
Which one of the following conditions is considered high risk for an iodinated contrast media procedure?
pheochromocytoma
What is the normal range for a patient’s BUN?
8 to 25 mg/100ML
What is the best course of action for a patient experiencing a mild systemic contrast media reaction?
Observe and reassure patient
Which of the following is a symptom of a vasovagal reaction?
Cardiac arhythmias
A true allergic reaction to iodinated contrast agents is classified as a(n)
anaphylactic reaction
Which of the following drugs may be given to minimize the risk for acute renal failure following a contrast media procedure?
Lasix
Metformin is a drug given to patients with:
diabetes
Which one of the following drugs can be given as part of the premedication protool before an iodinated contrast media procedure?
prednisone
excretion of a diminished amount of urine in relation to the fluid intake is the general definition for:
nephroptosis
Constant or frequent involuntary passage of urine is termed:
urinary incontinence
The absence of a functioning kidney is called
renal agenesis
Complete cessation of urinary secretion by the kidneys is termed
anuria
Adult forms of polycystic disease are inherent.
True
Hypernephroma is another term:
renal cell carcinoma
Laryngeal swelling is classified as a:
severe level reaction
Which one of the following conditions may produce hydronephrosis?
renal obstruction
The patient should void before the IVU to prevent dilution of the contrast media in the bladder.
True
Which one of the following conditions would contraindicate the use of ureteric compression?
ureteric calculi
Typically, at what timing sequence during an IVU are the oblique projections taken?
20 minute following injection
Which projections best demonstrates the renal parenchyma? when should it (they) be taken?
nephrogram or nephrotomograp by immediately after completion of injection
