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AA ST2 > G Urinary > Flashcards

G Urinary Flashcards

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1
Q

RCC is what kind of cancers?

A

adenocarcinomas (mostly)
arise from the proximal tubule

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2
Q

types of tumour found in kidenys

A

RCC
Transitional cell carcinoma
Lymphoma
Epithelial _ carcinoid / teratoma

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3
Q

RCC T staging,

what are the main jump points?

A

T1a less than 4cm

T3a - extends in to renal vein

T4 - beyond grottas fascia

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4
Q

when are RCC best seen - time of scans

is there benefit to earlier cortico medullary phas?

A

100s

yes for vascular anatomy, and pseudo tumours

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5
Q

what will an RCC look like?

A

lobulated contour of the kidney
central calcification (often present / bad)

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6
Q

RCC enhancement and deliniate from a benign lesions

what are the HU metrics

A

if pre and post difference 20HU - likely tumour

10-20 - indeterminate

les than 10HU is benign

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7
Q

vasculairty of cystic septa

A

badness.
Cystic morphology RCC is possible

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8
Q

signs that help differentiate a true tumour invasion of the veins from bland thrombus are:

A

tumour expands the vessel

expansion could be just increased flow though, be careful

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9
Q

If a threshold of 1 cm short axis is used there will be what false negative rate

A

4%

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10
Q

ARE RCC VASCULAR

A

YES - brighlty seen on arterial phase

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11
Q

conditions that increase risk of RCC

A

Tuberous sclerosis
VHL
End stage renal failure

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12
Q

What is Von Hippel Lindau Syndrome?

A

Auto Dom disease.
VHL gene is a tumour supressor gene.

lots of cysts present that lined by clear cells, can become malignant

if over 3cm remove

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13
Q

What are the other tumours of the kideny?

A

Urothelial: TCC / SCC
Wilms nephroblastoma
Collecting duct carcinoma
medullary carcinoma (sickle cell trai ax)
Sarcomas
Epithelial: Teratoma / Carcinoid
Lymphoma
Mets

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14
Q

histology of Wilms tumour

A

Macroscopic jelly-like areas and haemorrhage producing a cystic appearance and microscopically epithelial and non-epithelial elements which may produce muscular, fatty or bone components.

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15
Q

do kidneys contain lymphoid tissue?V

A

no

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16
Q

mets to kidney is from which organs?

A

opposite kidney
breast and lung

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17
Q

Typically has necrotic lymph node metastases and arises from squamous metaplasia of chronically-inflamed urothelium, usually due to stone disease.

A

SCC

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18
Q

prostate cancers are mostly what type of cancer?

A

adenocarcinoma arising from glandular epithelial lining

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19
Q

Gleason charachterises what?

A

aggressiveness

Based on very well differentiated to undifferentiated

scored out of 10. 8-10 aggressive

Each tumour focus is individually graded on a five-point scale (the Gleason grades) and the two most common grades are added together to give a Gleason score or sum

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20
Q

Prostate cancer T staging

A

T1 abc, present, incidental <5% or more than, tumour on biospy.

T2 abc- gland confined, one lobe two lobes

T3 out of capsule

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21
Q

link between PSA level and positive bone scan

A

If the PSA levels are between 10.1-19.9 ng/ml, the likelihood is 5%
If the PSA levels >20 ng/ml, the likelihood is 16%

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22
Q

prostate capsule will have tumour extension through which parts? due to weakness

A

Neurovascular bundles
Seminal vesicles
Ejaculatory ducts
Apex of the gland
Prostate capsule

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23
Q

Magnetic resonance spectroscopy
Three metabolites are measured:

A

Citrate
Creatine
Choline

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24
Q

Magnetic resonance spectroscopy

how does it work

A

Prostate cancer has significantly higher choline and lower citrate levels compared to normal tissue and benign prostatic hyperplasia.

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25
signs of extra-capsular tumour are:
Irregular capsular bulge or retraction Periprostatic fat irregularity Obliteration of rectoprostatic angle Enlarged neurovascular bundle Long length of contact
26
adrenal medulla contains what kind of cells
neuroendocrine cells
27
ways to classify adrenal masses
small large cystic
28
small adrenal masses list
Adenomas Metastases Phaechromocytoma Tuberculosis (TB) Myelolipoma
29
large adrenal masses (>3cm)
Cortical adenocarcinoma Phaechromocytoma Ganglioneuroma/neuroblastoma Myelolipoma Metastases Abscesses
30
cystic adrneal masses list
Previous haemorrhage True cysts (epithelial lining) Mesothelial inclusion cyst Vascular cystic spaces (endothelial lining) Lymphangioma Parasitic cyst Hydatid Cystic degeneration in tumours
31
how frequent are adrenal incidental lesions
1 in 30 scans should have one
32
adrenal Ct does what contrast phases
Pre-contrast Dynamically (1 minute post-contrast) On the delayed phase
33
adrenal percentage washout - criteria
Percentages above 60 are indicative of benign adenomas. Percentages below 60 may indicate metastases, tumours or phaeochromocytomas.
34
how to use in and out phase imaging for benign adenomata
Lipid-rich adenomata show signal drop-out on opposed-phase sequence, which will characterise them as benign
35
common primary tumours giving rise to adrenal metastases include: L
lung Breast Melanoma Kidney Thyroid Colon cancer
36
can lymphoma and mets in the adrenals gland be distinguished on imaging?
no
37
what do phaeo arise from
paraganglion cells within the autonomic nervous system. Phaeochromocytomas arise in the neuroectodermal tissue of the adrenal medulla
38
what can phaeo secrete
Adrenaline Noradrenaline Dopamine Parathyroid hormone Calcitonin Gastrin Serotonin Adrenocorticotropic hormone (ACTH)
39
Diseases of the adrenal cortex can be divided into three groups:
Disorders associated with hyperfunction and steroid excess Disorders that reduce steroid output Diseases with no functional effect
40
hereditory RCC is linked to what
VHL
41
in kidney cancer renform shape of the kidney is maintained - what does this mean?
Suggests TCC or lymphoma RCC would change the shape
42
kidney cancer ring enhancing necrotic lymph nodes think
SCC
43
common benignbrenal lesions
AML Multilocular cystic nephroma oncocytoma
44
renal nodules of less than 3 cm are considered
'renal carcinoma of low metastatic potential'
45
charachteristic features of an oncytoma
well circumscribed, homogenous or radiatin low density central scar spoke wheel pattern angiography
46
Kidney conditions that predisoose to truamatic kidney injury
Hydronephrosis Pelvi-ureteric junction obstruction (PUJO) Renal ectopia (e.g. pelvic or horseshoe kidney) Renal cysts Tumours
47
renal injuries grades
1 - contusions. haematoma 2 - superfical laceration <1cm. No urine extravasation 3 - >1cm , no urinary extravastion 4 - deep laceration 5 - shattered kidney
48
Criteria to investigate blunt renal truauma
Gross haematuria Microscopic haematuria WITH systemic shock low low BP Microscopic haematuria with significant associated injuries
49
retropeirtoneal haematoma after kidney injury will cause the ureter to be dsicplace...
laterally
50
ureteric injury garding system
1 - heamatoma 2 - lacerated <50% 3 - >50% 4Complete tear, <2cm devascularisaiton 5 - complete tear, >2cm of devascularisation
51
bladder trauma grades
1 Bladder contusion 2 Intraperitoneal rupture (surgery) 3 Interstitial bladder injury 4a Simple extraperitoneal rupture 4b Complex extraperitoneal rupture 5 Combined bladder injury (surgery)
52
Some predictors of bladder injury
Gross haematuria Pelvic fractures Unexplained pelvic fluid Combination of above three
53
criteria for VHL syndrome?
CNS haemangioblasdtoma with at least one other VHLD lesion in an individual or their family memeber
54
types of VHL
1 - no phaeo 2 - with pheo / RCC
55
VHL in yees develops what
Reintal angiomas 0 blindlness - cataracts - retinal detachement
56
where do VHL patietns hget haemangioblastomas?
cerebellum most commonly but all of the cns
57
VHL complex cysts what to do ?
Precurosrs to RCC and need surgery or close follow up
58
VHL can manifest in the kidneys as
Cysts Angiomas RCC
59
nuc med scan for phaeo
MIBG
60
VHL in the ear
endolymphatic tumours
61
VHL in the pancreas
cysts serous cystadenomas islet cell tumours
62
the classic tuberous sclerosis triad
low IQ epilepsy adenoma sebaceum (facial angiogibroma)
63
what are the major features of TS
Cortical tubers Cardiac rhabdomyoma Retinal hamartoma Renal angiomyolipoma
64
What are the minor features of TS
renal cysts and bone cysts
65
ts renal manifests as what type of lesion
AML
66
TS manifestations intracranially
Subependymal nodules corticol tubers giant cell satrocytomas linear abnormalities through white matter

AA ST2 (14 decks)

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