HomeStretch CRACK vol 1. GU/Repro

Question 1

Mayer-Rokitasky-Huster-Hauser Syndrome

Answer 1

Mullërian agenesis

Question 2

What is the most senstive contrast phase to detect RCC?

Answer 2

Nephrographic phase (~80 seconds)

Question 3

RCC Subtypes

Answer 3

Clear Cell: Most common; VHL

Papillary: Second most common, less aggressive, on T2 dark ddx, hereditary papillary renal carcinoma, transplant kidney

Medullary: Sickle Cell TRAIT; bad prognosis

Chromophome: Birt Hogg Dube

Translocation: Most common subtype in kids; prior cytotoxic chemo

Question 4

Bourneville Disease

Answer 4

Tuberous Sclerosis

“Tuberous Bourneville Sclerosis”

Question 5

T2 Dark Renal Cyst DDx

Answer 5

Lipid poor AML

Hemorrhagic cyst (these will be T1 bright)

Papillary subtype RCC

Question 6

Medullary sponge kindey syndromic associations

Answer 6

Ehlers-Danlos

Caroli’s

Beckwith-Wiedeman

Question 7

Vascular complications of renal transplant

What are they, when do they happen?

Answer 7

• Renal vein thrombosis - within first week - can show renal artery doppler with reversed diastolic flow
• Renal artery thrombosis - within first month (or post op)
• renal artery stenosis = seen within first year - refractory HTN
  
  • PSV > 200-300m/s
  • PSV Ratio > 1.8-2.5x
  • Tardus parvus
  • anastomatic jetting

Question 8

1. Most common RCC subtype in renal transplant?
2. PTLD associated virus and drug
3. Renal transplant + BK Virus = ?

Answer 8

1. Papillary
2. EBV; rituximab
3. urothelial cancer

Question 9

Renal trauma grading

Answer 9

• grade I: subcapsular hematoma or contusion, without laceration
• grade II: superficial laceration ≤1 cm depth not involving the collecting system (no evidence of urine extravasation); perirenal hematoma confined within the perirenal fascia
• REMEMBER THIS ONE: grade III: laceration >1 cm not involving the collecting system (no evidence of urine extravasation) vascular injury or active bleeding confined within the perirenal fascia
• grade IV: laceration involving the collecting system with urinary extravasation laceration of the renal pelvis and/or complete ureteropelvic disruption vascular injury to segmental renal artery or vein; segmental infarctions without associated active bleeding (i.e. due to vessel thrombosis); active bleeding extending beyond the perirenal fascia (i.e. into the retroperitoneum or peritoneum)
• grade V: shattered kidney; avulsion of renal hilum or laceration of the main renal artery or vein: devascularisation of a kidney due to hilar injury; devascularised kidney with active bleeding

Question 10

Malakoplakia vs leukoplakia

Answer 10

Malakoplakia = NOT premalignant; michaelis-gutmann bodies, often in immunocompromised females

leukoplakia = premalignant. . “ew”

Question 11

Ormond disease

Answer 11

Retroperitoneal fibrosis

Question 12

Subepithelial renal pelvis hematoma

Answer 12

mimmic for TCC

happens in patients on long-term anticoagulation or hx of hemophilia

hyperdense blood clot in renal pelvis that does not enhance

Question 13

Eagle-Barrett Syndrome

Answer 13

prune belly syndrome

Question 14

verumonatanum

Answer 14

ovoid mound that lies in the posterior wall of the prostatis urethra and contains the prostatic utricle

Question 15

fossa navicularis

Answer 15

Most anterior portion of the urethra

Question 16

Bladder cancer and Urethral Cancer BLITZ!

Answer 16

• Transitional (urothelial) cell CA
  
  • most common in subtype in bladder and prostatic urethra (thick about it like a bladder CA)
• Squamous cell CA
  
  • In the bladder it is associated with Schistosomiasis and Suprapubic catheter/urinary stasis
  • Seen in bulbar/penile urethra cancers (think of the squamous cells from the head of penis growing inward - HPV style)
• AdenoCA
  
  • Midline, associated with urachal remnant and bladder extrophy
  • also associated with urethral diverticulums (think of these almost as urachal remnants).

Question 17

Uterus didelphys

Answer 17

fusion failure with complete uterine duplication

This is the one with a vaginal septum

Question 18

Unicornuate uterus

Answer 18

Failure to form, therefore has u/l renal issues

has 4 variants: isolated, +noncavitary rudimentary horn, +communicating cavitary horn, +noncommunicating cavitary horn

Question 19

best time for HSG?

Answer 19

proliferative phase (day 7-12)

Question 20

The critical stage for endometrial cancer?

Answer 20

Stage 1 -> stage 2

Stage 2 is defined by cervical stromal invasion

Question 21

The critical stage for cervical cancer?

Answer 21

Stage IIA - Stage IIB

spread beyond the cervix + parametrial invasion

2B or not 2B?!

Question 22

cumulus oophorus

Answer 22

collection of cells in a mature dominant follicle that protrudes into follicular cavity and signal imminent ovulation

Question 23

best time to do PET in premenopausal person

Answer 23

the first week of menstrual cycle

Question 24

decidualized endometrioma

Answer 24

solid nodule with blood flow in and endometrioma of a pregnant girl

(same findings without pregnancy = malignant degeneration).

Question 25

What does T2 shading of an endometrioma refer to?

Answer 25

T2 shortening (darker) of a lesion that is T1 bright

Question 26

rare cancer transformation subtypes

Endometrioma -> ?

Dermoid -> ?

Answer 26

Endometrioma -> Clear Cell

Dermoid -> squamous cell

Question 27

MRI characteristics of Hemorrhagic cyst, endometrioma and dermoid

Answer 27

Hemorrhagic Cyst: bright on T1, T1FS and T2

Endometrioma: Bright on T1, T1FS and “shading” on T2 (ie dark)

Dermoid: Bright on T1 and T2, and then fat sats out

Question 28

Meigs syndrome

Answer 28

triad of ascites, pleural effusion and benign ovarian tumor (fibroma).

Question 29

Critical stage point for prostate cancer

Answer 29

Stage II versus stage III

extracapsular extension = stage IIIa

stage IIIb is when you get seminal vesicles and nerve bundle extension

Question 30

Zinner syndrome

Answer 30

triad of mesonephric (wolffian) duct anomalies

u/l renal agenesis, i/l seminal vesicle cyst and ejaculatory duct obstruction

Question 31

Syndromes associated with male infertility

Answer 31

• Pituatary adenoma (increase prolactin)
• Kallman syndrome (can’t smell + infertile)
• Klinefelter syndrome (tall + gynecomastia + infertile)
• Zinner syndrome (u/l renal agensis, i/l seminal vesicle cyst and ejaculatory duct obstruction)
• CF - absent vas deference
• Immotile ciliary syndrome

Question 32

if you see an aplastic or hypoplastic humeral head in a kid, what should you think?

Answer 32

Erb’s palsy

Question 33

When is nuchal lucency measured? Whats the upper limit of normal?

How about nuchal fold thickness?

Answer 33

Nuchal lucency: 9-12 weeks; should be < 3mm to be normal

Nuchal thickness: 2nd trimester; < 6mm is normal