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Radiology oral boards review > GU > Flashcards

GU Flashcards

1
Q

Duplicated collecting system - what inserts where?
What’s the problem with the upper pole ureter?
What’s the problem with the lower pole ureter?

A

Upper pole inserts inferomedially and ectopically. Obstructs, usually ureterocele.
Lower pole refluxes, inserts normally.

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2
Q

Differences among sepate, arcuate, bicornuate, didelphys

A

Septate- normal fundal contour, muscular and/or fibrous septum (needs to be removed)
Arcuate-normal outer contour, slight dip in myometrium, no consequence (fairly normal, actually)
bicornuate- separated horns/dip in contour
didelphys- separate uterus including cervix

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3
Q

Ddx for cortical nephrocalcinosis

A

*chronic glomerulonephritis
*acute cortical necrosis
*rejected renal transplant
*Alport syndrome
*oxalosis
putty kidney from TB
renal infarction / ischaemia
sepsis
drugs
hemolytic uraemic syndrome (HUS)

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4
Q

Ddx for medullary nephrocalcinosis

A

*hyperparathyroidism
*medullary sponge kidney
*renal tubular acidosis
hypervitaminosis D
milk-alkali syndrome
sarcoid
other pathological hypercalcemic or hypercalciuric states

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5
Q

What’s medullary sponge kidney?

A

The medullary and papillary portions of the collecting ducts are dysplastic and dilated and in most cases develop medullary nephrocalcinosis.

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6
Q

Ddx renal hemosiderosis

A

sickle cell
thalassemia
*Paroxysmal nocturnal hemoglobinuria
mechanical valves causing chronic hemolysis

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7
Q

Ddx striated nephrogram (unilateral)

A

Pyelonephritis
obstruction
renal vein thrombosis
(contusion, radiation)

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8
Q

Ddx striated nephrogram (bilateral)

A 
acute pyelonephritis
acute tubular necrosis (e.g. from contrast)
hypotension
infarcts/PAN
SLE
lymphoma
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9
Q

What stage is an RCC with IVC extension below the diaphragm? Above?

A

T3b

T3c for above

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10
Q

Ddx retroperitoneal adenopathy

A

lymphoma
mets from testicular, prostate, endometrial, cervical
infection: TB, HIV

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11
Q

On what side should scrotal varicoceles raise concern?

A

the right side is abnormal and raises concern for an RP mass

80% of varicoceles are left-sided

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12
Q

large mass ~upper pole kidney

A

RCC, adrenal cortical carcinoma, pheo, mets, retroperitoneal sarcoma, malignant fibrous histiocytoma

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13
Q

hysterosalpingogram - diverticula off tube

A

Salpingitis isthmica nodosa (asociated with PID, infertility, ectopic pregnancy)
Tubal TB
tubal endometriosis

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14
Q

when you see a large adnexal nonvascular (noncystic) mass, what should you include?

A

ovarian torsion

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15
Q

Parts of the male urethra, bladder out:

Where is the verumontanum? Where are posterior urethral valves?

A

prostatic, membranous
bulbar (turns and becomes horizontal), penile
verumontanum is posterior of prostatic portion, posterior urethral valves begin here and go to distal prostatic urethra

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16
Q

Ddx for male urethral stricture

A

Carcinoma (TCC in prostatic, adeno (at Cowper’s glands just below prostate), squamous cell (from prior stricture of anterior urethra)
Post-infectious stricture
post-catheter stricture (penoscrotal jctn or membranous)

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17
Q

Ddx for fat-containing mass in region of adrenal gland

A

myelolipoma of adrenal gland
AML of kidney
liposarcoma
HCC/adeno of liver

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18
Q

ddx for renal papillary necrosis (sloughing of papilla)

A 
P : pyelonephritis
O : obstruction
S : sickle cell disease
T : tuberculosis
C : cirrhosis
A : *analgesic abuse* - NSAIDS
R : renal vein thrombosis
D : *diabetes mellitus*
S : systemic vasculitis/des
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19
Q

ddx of omental caking

A

mets (ovarian, GI, pancreas, GB)
TB
Lymphoma
Mesothelioma

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20
Q

Pt with rcc and multiple renal cysts might have?

What other features of this diz?

A

think vHL
also have pheos, pancreatic islet cell tumors and panc cysts
cerebellar and retinal hemangioblastomas

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21
Q

numerous cysts in atropied kidneys

A

acquired renal cystic disease of dialysis

increased risk of RCC

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22
Q

What’s adenomyosis? What dx criteria?

A

the presence of ectopic endometrial tissue within the myometrium
junctional zone greater than 12mm

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23
Q

Bosniak renal cyst classification system:

A

1-simple
2-single thin septation or thin calc or high attenuation non-enhancing
2F-thicker septations or thicker calc
3-more complex
4-obviously malignant, a lot of solid parts
1 & 2 - no follow-up, never malignant
2F-4 - follow-up

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24
Q

renal mass with multiple cysts, herniates into renal pelvis - what is it? Who gets it?

A

Multilocular cystic nephroma
males under 5
women in their 40s

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25
Q

Hysterosalpingogram - intrauterine senechiae

A

Asherman’s syndrome, usually 2/2 D&C, IUD, severe endometritis

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26
Q

causes of RP fibrosis

A

idiopathic, meds, blood (rp bleed), radiation, peri-aneurysmal, malignancy

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27
Q

Ureters pushed away from spine vs pulled medially - what does that distinguish?

A

Pushed away - lymphoma

Pulled medially - RP fibrosis

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28
Q

Ddx of multiple filling defects of ureter

A 
spreading or multifocal TCC
vascular indentations
multiple ureteral stones (steinstrasse)
blood clots
ureteritis cystica
Stevens-Johnson syndrome
Malakoplakia (benign, related to chronic infection)
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29
Q

What’s ureteritis/pyeloureteritis cystica?

A

benign supepithelial cysts, likely 2/2 chronic UTIs

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30
Q

Where does prostate cancer usually originate?

A

Peripheral zone (thus easy to feel on rectal exam)

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31
Q

what are you looking for on prostate US or MRI?

A

hypointensity of peripheral zone, extracapsular spread, invasion of neurovascular bundle or seminal vessicles, lymph nodes, bone mets

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32
Q

What does a goblet sign on retrograde ureterography mean?

A

slow-growing TCC (not a stone) - results from peristalsis

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33
Q

Ddx for single ureteral filling defect

A

tumor, stone, clot, sloughed papilla, fungus ball, air bubble

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34
Q

Air in scrotal wall or perineum = worry about

A

Fournier gangrene (necrotizing fasciitis)

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35
Q

Ddx perirenal stuff/soft tissue

A 
lymphoma
blood
urine
(infiltrative TCC or RCC)
extramedullary hematopoesis
Erdheim-Chester dz
lymphangiomatosis
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36
Q

urachal diverticulum - what kind of cancer?

A

adenoca

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37
Q

cyst adjacent to urethra

A

urethral diverticulum
Gartner duct cyst - high, anterolat wall of vagina
Bartholin gland cyst - low, posterolateral

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38
Q

what’s nutcracker syndrome?

A

compression of left renal vein between aorta and SMA
pt gets hematuria
Rx stent

39
Q

adrenal masses

A

hemorrhage, cortical carcinoma, adenoma (fat or >50% washout), myelolipoma, pheo

40
Q

focal calcium in renal cortex

A

calyceal diverticulum with stone

at risk for infection and neoplasm

41
Q

ddx cause of colovesicle fistula

A

diverticulitis, cancer, crohn’s

42
Q

“teardrop” shaped bladder - what caused it?

A

trauma with hematoma, pelvic lipomatosis, lymphadenopathy

43
Q

rx of intraperitoneal versus extraperitoneal

A

intra - Surgery, top of bladder - direct trauma

extra - just decompress, pelvic fracture

44
Q

childhood renal tumors - names and ages:

A

Mesoblastic nephroma: under 1 year
ossyfying renal tumor of infancy: under 1 year
Nephroblastoma/tosis: 1 year, can be any age
Multilocular cystic nephroma: boys under 5 (and middle-aged women)
Wilms: peak at 3-4 (rarely up to 15)
RCC (in vHL): teens

45
Q

renal tumor in pts with sickle trait or SC disease:

A

renal medullary carcinoma

46
Q

Ddx bilateral enlarged ureters

A 
Congenital (eg post urethral valves
Reflux
Bilat UVJ obstruction
bilat stones
RP fibrosis
bladder neoplasm
47
Q

Complications of urethral diverticulum

A

Stones, infection, squamous cell ca

48
Q

Hepatic mass in infant, elevated AFP:

A

hepatoblastoma

49
Q

Ddx bladder calcification

A

Schistosomiasis, TB (thimble bladder), cancer, radiation

others are less common

50
Q

Who gets renal medullary carcinoma?

A

Young patients

Sickle trait or SC (NOT sickle cell dz)

51
Q

What is nephroblastomatosis, what age, and what’s the concern?

A

Multiple/diffuse nephrogenic rests (foci of metanephric blastema that persist beyond 36 weeks gestation), they have the potential for malignant transformation into Wilms tumour.
Age newborn-7y

52
Q

What’s the risk with schistosomiasis of the bladder?

A

Increased risk of squamous cell cancer of bladder (Schisto is Squamous)

53
Q

What’s the treatment for gonadal vein thrombosis?

A

Anticoagulation and Abx

54
Q

Ddx multiple renal aneurysms. What do the aneurysms cause?

A

PolyArteritis Nodosa, speed kidney (amphetamine abuse).

The aneurysms thrombosis and cause infarcts.

55
Q

Multiple ureteral wall outpouchings

A

Ureteral pseudodiverticulosis.

Increased risk of infection and of malignancy.

56
Q

Dilated rete testis is called:

A

Tubular ectasia of the rete testis (benign)

57
Q

Causes of hematometrocolpos

A

Imperforate hymen, cervical stenosis, vaginal atresia

58
Q

Dx for rapidly enlarging uterine mass

A

leiomyosarcoma (needs surgery)

59
Q

Solid ovarian neoplasms ddx:

A

Brenner tumor, stromal (fibroma, fibrothecoma, etc.), germ cell (non-cystic teratoma, dysgerminoma), met (Krukenberg), lymphoma

60
Q

What’s the problem with a cancer within a bladder diverticulum?

A

It’s a pseudodiverticulum and there’s no containment - tumor just spreads

61
Q

How do you distinguish a Gartner’s duct cyst from a Bartolin’s gland cyst?

A

Gartner’s duct - above inferior part of the pubic symphysis, anterolateral
Bartolin’s gland cyst is inferior, posterolateral, near labia

62
Q

Tubular ureteral filling defect

A

ureteral fibroepithelial polyp (removed because they cause intermittent obstruction)

63
Q

sites of botryoid rhabdomyosarcoma:
What does it look like?
Who gets it?

A

polypoid or “grape like lesion” beneath the mucosa: vagina, cervix, urinary bladder, nasopharynx, biliary tract
kids - birth to 15y

64
Q

Ddx for hyperenhancing lymph nodes:

A

castleman disease, Kaposi sarcoma, hypervascular mets (thyroid, renal)

65
Q

Explain the difference between the pararenal and perirenal spaces

A

Perirenal is right around the kidney

Pararenal includes the fat outside the perirenal space and the space including the colon and pancreas.

66
Q

Ddx midline prostate cyst

A

Prostatic utricle cyst, mullerian duct cyst

67
Q

characteristic appearance of a urethral cyst in a woman

A

“biloed” or “horseshoe” cyst posterior to the urethra.

Dx with double-balloon urethrogram

68
Q

list the non-CNS lesions associated with VHL

A

RCC, renal cysts, pancreatic cysts, pheos, liver cysts

69
Q

Which Bosniak lesions are surgical?

A

3 and 4

70
Q

What’s Hemolytic uremic syndrome? What does it look like on imaging? What causes it?

A

E. coli ( O157:H7), causes damage to blood vessel walls. Mostly affects children.
Echogenic kidneys on US
Acute cortical necrosis and colitis

71
Q

What’s the term for blood-distended uterus? Uterus plus vagina?

A

Uterus: hematometros

plus vagina: hematometrocolpos

72
Q

What’s a faceless kidney? Ddx for this appearance:

A

Effacement of renal hilar fat
TCC, lymphoma, infiltrative RCC
(mets, inflammatory pseudotumor of GU tract)

73
Q

What are the complications/problems with a horseshoe kidney?

A

Increased risk in trauma
stones, infection
(maybe increased RCC)

74
Q

What’s steinstrasse?

A

Complication of ECSWL

multiple tiny stones lined up in ureter, sometimes cause obstruction

75
Q

Complications associated with extra-corporeal shock-wave lithotripsy

A

Steinstrasse, renal hematoma, hematuria

76
Q

Ddx for numerous small cysts in normal-sized kidneys

A

Lithium nephrotoxicity
glomerulocystic disease (congenital)
medical renal disease

77
Q

What disease involving kidney is associated with LAM?

A

TS - tuberous sclerosis

78
Q

What are numerous, peripheral peribiliary lesions in the liver called?

A

multiple biliary hamartomas aka von Myenburg complexes
Benign
Can cause heterogeneous liver on ultrasound, tiny cyst on CT or MR

79
Q

What liver masses tend to bleed?

A

HCC, adenoma (contraceptives or steroids)

80
Q

solid ovarian lesion and ascites

A

Meigs syndrome - can be seen with thecoma, fibrothecoma, granulosa cell tumor

81
Q

Types of urethral injury

A

1: Stretch, no rupture (no extrav)
2: Partial or complete rupture of the
membranous urethra above urogenital
diaphragm or perineal membrane (extrav in pelvis only)
3: Partial or complete rupture of the mem-
branous urethra with disruption of the uro-
genital diaphragm (extrav in pelvis and perineum)
4: Bladder neck injury with extension
into the urethra
5: Pure anterior urethral injury

82
Q

causes of adrenal hemorrhage

A

Sepsis (meningococcemia is Waterhouse-Friderichsen syndrome)
DIC, thrombocytopenia, anticoag
steroids
tumor

83
Q

What non-GU complication is of concern in ADPCK?

A

Berry aneurysms in the brain

84
Q

Renal injury grades:

A

grade I - contusion or non enlarging subcapsular hematoma, but no laceration ;
grade II - superfical laceration < 1cm depth and does not involve the collecting system ; non expanding perirenal haematoma
grade III - laceration > 1cm, without extension into the renal pelvis or collecting system and with no evidence of urine extravasation
grade IV - laceration extends to renal pelvis or urinary extravasation.
grade V - shattered kidney ; devascularisation

85
Q

What’s the concern with metformin use and CT contrast?

A

Increased risk of renal tubular acidosis

86
Q

What organism is associated with xanthogranulomatous pyelonephritis?

A

Proteus (struvite stones)

87
Q

Describe the infectious processes that involve the kidney and renal collecting system:

A

Pyelitis - inflammation of renal pelvis
Pyonephrosis - pus and obstruction (needs drainage and Abx)
Pyelonephritis - inflammation of renal parenchyma (and collecting system)

88
Q

Causes of UPJ obstruction

A 
congenital
tumor
stricture
stone
crossing vessel
89
Q

ddx adrenal calcification

A

TB, histo, old hemorrhage, calcified mass

90
Q

Ddx persistent nephrogram

A

ATN
renal vein thrombosis
obstruction
hypotension (including acute contrast rxn)

91
Q

Hydronephrosis with debris in the collecting system

A

Pyonephrosis

92
Q

Causes of chyluria

A

partial nephrectomy or RFA
childbirth
filariasis

93
Q

Dilated sac beneath / ventral to anterior urethra

A

Cowper’s syringocele (dilitation of Cowper gland)

94
Q

Risk factors for prostatitis:

Concern?

A

DM, immunocompromised, dialysis, repeated catheterization

Could result in abscess

Radiology oral boards review (10 decks)

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