GU Flashcards
(137 cards)
1
Q
Causes Dromedary hump
A
Spleen
2
Q
Man with renal agenesis:
A
Ipsi absent epididymis, Vas,
Or
Ipsi seminal vesicle cyst
3
Q
Horsehoe kidney gets hung up on:
A
IMA
4
Q
AML vs Clear cell RCC?
A
Calcification
5
Q
Clear cell looks like?
A/W
A
Enhancement equal to cortex, calcifications
VHL
6
Q
Papillary RCC
MRI look
A
T2 Dark
Enhance less than clear cell (less than cortex)
7
Q
Medullary RCC
A/W?
Presentation
A
Sickle cell
Large, metastasized, aggressive
8
Q
Chromophobe RCC
A
Burt Hogge Dubbe
9
Q
RCC Stage 1
A
<7cm
10
Q
RCC stage 2
A
>7cm
11
Q
RCC stage 3A
A
Renal Vein
12
Q
RCC 3B
A
IVC below phragm
13
Q
RCC 3C
A
above phragm
14
Q
RCC stage 4
A
Beyond Gerota’s fascia
15
Q
Nephrogenic phase =
A
80 seconds
16
Q
Renal lymphoma MC appearance
A
BILATERAL enlarged kidneys with small low attenuation cortically based solid nodules
17
Q
MC visceral organ involved in leukemia
A
Kidney
18
Q
AML A/W
A
TS
19
Q
AML with calcs =
A
a clear cell RCC (not an AML)
20
Q
Lipid poor AML=
A
T2 dark
21
Q
Oncocytoma vs. RCC?
A
Central scar
Spoke wheel vascular pattern US
22
Q
Oncocytoma vs RCC PET
A
Onco HOT
RCC cold
-er than surrounding parenchyma
23
Q
Bilateral Oncocytomas
A
Burt Hogge Dube
(DONT FORGET CHROMOPHOBE RCC TOO)
24
Q
Multilocular cystic nephroma
A
Non-communicating fluid filled nodules with thick capsule
PROTRUDES INTO RENAL PELVIS
BIMODAL
4 year old boys and middle aged women
25
Boz 2f
Hyperdense \>3cm
THIN calcs
\<5% chance of cancer
26
Boz 3
Thick calcs
mural nodule
50% cancer
27
Boz 4
ANY enhancement
Cancer
28
ADPKD cysts where?
LIVER and SEMINAL VESICLES
29
HD kidney (Uremic cystic kidney disease)
3-6x risk of cancer
cysts regress after transplant
SMALL KIDNEYS
30
VHL Pancreas?
cysts
serous microcystic adenomas
islet cell tumors
31
VHL adrenal
PheoS
32
TS
kidney?
lung?
Cardiac?
AML (RCC at young age)
LAM
Rhabdomyosarcoma (septum)
33
Lithium kidney
Diabetes insipidus
innumeralble tiny cysts
34
Multicystic Dysplastic ?
PEDS
No functioning renal tissue
a/w contralateral tract abnormalities
35
T2 dark renal cyst
Lipid poor AML
Hemorrhagic cyst (T1 bright)
Papillary RCC (less enhancement than clear cell)
36
emphysematous pyelo
diabetics
37
emphysematous pyelitis
Gas localized to collecting system
diabetics, women, h/o obstruction
38
papillary necrosis causes
DM!
pyelo
sickle cell
TB
analgesics
cirrhosis
39
TB kidney
shrunken and calcified
40
HIV nephropathy
PCP kidney?
Big, echogenic
loss of renal sinus fat
PCP= punctate cortical calcs
41
CIN risk factors
DM
RF
CHF
Myeloma!
42
MC stones
Ca oxalate
43
Women and UTI stones
Struvite
44
Unseen on Xray
Uric acid
Also fat, diabetics
MAIN stones that can be treated MEDICALLY
Futz with pH
45
Only stones not seen on CT?
Indinavir
HIV patients!
46
Identifying Uric acid stones?
Lower attenuation \<500
Little change between high and low energy on dual energy CT...
47
Cortical nephrocalcinosis
Usually sequela of hypoperfusion injury,
hypodense rim --\> thin calcifications
48
medullary nephrocalcinosis
4 causes
hyperechoic papilla
hyperPTH or medullary sponge (usually asymmetric)
lasix in a kid
RTA type 1
49
Medullary sponge associations?
Ehlers Danlos
Carolis
Beckwith Wideman
Review, hyperechoic shadowing pyramids
50
Persistent nephrogram
Shock/ATN
Bilateral
enhancement at 2-3 hours
51
Renal vein thrombosis US
Reversed arterial diastolic flow
absent venous flow
big kid with delayed nephrogram
52
Post transplant complication
First two weeks
Urinoma
53
Renal transplant immediate collection
hematoma
54
1-2 months after transplant
lymphocele
MC fluid collection to cause hydro
compress ipsi femoral vein --\> leg swelling
55
Acute rejection/ATN
Both in first week
prominent pyramids, increased size
elevated RI's
56
ATN vs Acute rejection
MAG 3
ATN - normal perfusion
Acute rejection Decrased
BOTH delayed excrn
57
1 year post transplant
Chronic rej
non-specific
elevated RI's
may enlarge
may lose CM differentiation
58
Vascular complication first week
vein thrombosis
reversed diasolic arterial
kinking
hypercoag
hyperacute rej
delayed thrombosis 2/2 stenosis
59
vascular complx weeks to months
artery stenosis
MC vascular complx
at anastamosis
60
Transplant artery stenosis criteria
PSV\>200
PSV ratio \> 3.0 (with ext iliac)
tardus parvus
jetting
61
pseudoaneurysm vs avf
pseudoan = yinyang, doppler with biphasic flow at neck
avf = vibration artifact (perivascular mosaic color assignment)
62
RCC in transplant patient
100x risk
location?
native kidney
63
PTLD
First year, multiple organs
tx = back off immunosupp
BCELL proliferation
64
Cyclophosphamide risk?
Urothelial cancer
65
week 1 transplant complx?
Vein thrombosis
Urinoma
hematoma
66
week 1-4 complx
Artery thrombosis
Lymphocele
67
transplant complx Months 1-6
Artery STENOSIS
Lymphocele
biopsy injury (avf/pseudoan)
Drug tox
68
After 6 months
Chronic rejection
RCC
Lymphoma
PTLD
69
Obstruction vs. adynamic primary megaureter?
Collecting system dilatation = actual obstruction
70
primary megaureter
Side, location
Most lower third
Left more common, usually unilateral
71
Retrocaval ureter
developmental anomaly of IVC
72
weigart meyer
upper inserts inferior and medial, ureterocele, obstructs
73
MC GU congenital anomaly
UPJ obstruction
74
UPJ obstrx a/w
crossing vessels
Multi-cystic dysplastic on other side\*\*
75
Extrarenal pelvis vs congenital UPJ obstrx?
Whitaker test
urodynamics study with antegrade pyelogram
76
Ureteral wall calcs (2)
TB
Schistosomiasis
77
Ureteritis cystica
tindy subepithelial cysts within wall
2/2 chronic inflamm (stones, infx)
diabetics with recurrent UTI
Maybe increased cancer risk
78
Ureteral pseudodiverticulosis
Like ureteritis cystica but small outpouchings not cysts
favors upper and middle thirds
a/w cancer
79
bladder/Ureter leukoplakia
squamous cell
more common in bladder
80
malakoplakia?
Chronic UTI's (e coli)
female immunocomp\*\*
plaque like, nodular lesions
More common in bladder
Can cause obstrx
NOT PREMALIG
81
Leuko vs Malako
Leuko premalig
MALAKO NOT
82
retroperitoneal fibrosis
80% idiopathic
Radiation
'erg's and methyldopa
panc, pyelonephritis
inflamm aneurysm
lymphoma, desmoplastic rxn
Active will be GALLIUM AND PET HOT
83
Thickenend upper tract wall in an anticoagulated patient
Subepithelial renal pelvis hematoma
ANTICOAGULATED
Hyperdense on PRE contrast
84
Least common site for TCC
URETER
(75% of ureter TCC affect bottom 1/3)
Renal pelvis 2-3x more common
Bladder 100x more common
85
Upper/ lower TCC
IF you have upper, 40% chance of developing lower
If you have bladder, 4% chance of developing upper tract
86
Balkan nephropathy
High rate of upper tract TCC's
2/2 aristolochic acid
87
Squamous
MUCH less common
2/2 Schistosomiasis
88
smooth, oblong mobile defect on urography
Fibroepithelial polyp
benign
89
Eagle Barrett (3)
Deficient abdominal muscles
hydroureteronephrosis
cryptorchidism (big belly keeps testes from dropping)
90
Acquired bladder tics
Big prostate
91
Syndrome bladder tic
Elhlers Danlos
92
Hutch Diverticula
a/w ipsi reflux
at UVJ
Not a/w posterior valves
93
urachal remnant cancer?
ADENO!
MIDLINE!
94
MC bladder ca \<10yo
Rhabdomyosarcoma
buncha grapes = botyroid
met to lungs, nodes, bones
95
MC TCC subtype bladder
superficial papillary
96
schisto squamous look
heavily calcified bladder and distal ureters
97
MC mesenchymal bladder tumor
leiomyoma
MC at trigone
98
Diversions
conduits
reservoirs
MC early comp
Adynamic ileus
25% of cases
3% SBO
adhesive disease near enteroenteric anastamosis
99
stricture with diversion
left side higher risk than right (angulation under mesentery)
100
101
Psoas hitch
long segment distal ureter resected, bladder pulled up and sewn to psoas as a hitch
102
Emphysematous cystitis
E coli
diabetes
103
Bladder TB
affects upper tract more (shrunken, calcified putty kids)
can secondarily involve the bladder (thick, contracted +/- calcs)
104
Schisto bladder
entirely calcified
105
colovesicular fistula
Diverticular disease
106
ileovesicular fistula
Crohns
107
Rectovesical fistula
trauma or cancer
108
neurogenic bladder
small, contracted
atonic, large
stasis--\>cancer, stones, infections
109
Extraperitoneal bladder rupture
More common (80-90%)
a/w pelvic fracture
managed MEDICALLY
110
extraperitoneal bladder rupture sign
molar tooth, contrast in prevesicle space of Rezius
111
Intraperitoneal rupture
full bladder dome pops under pressure
SURGERY
112
Urethral injury
Type I
STRETCHED
PERIURETERAL HEMATOMA
PROBLY NORMAL RUG
113
Type II urethral injury
Rupture above UG diaphragm
extraperitoneal contrast
114
Type III urethral injury
BELOW UG diaphragm
extraperitoneal and perineal contrast
115
Type IV urethral injury
Injury invovles bladder extending to urethra
116
Type V urethral injury
Injury to anterior urethra
117
urethral stricture
Traumatic
Bulbar
short segment
118
urethral stricture
infectious
long segment
irregular
bulbar also
gonococcal
119
urethral diverticula
almost always 2/2 long term foley placement
CANCER, ALMOST ALWAYS ADENO!
120
urethral diverticula in females
way more common
2/2 repeated UTI
saddle bag appearance
ADENO CA RISK
121
Urethral cancer
In a tic?
bulbar/penile?
prostatic?
tic ADENO
bulbar/penile SQUAMOUS
prostatic TRANSITIONAL CELL
122
Fluoro sign of bladder Ca muscle wall invasion?
Wall retraction
necesitates radical cystectomy over TUBRT
123
Renal cancer staging
T3a
T3b
T3c
T4
T3a = Renal vein or perinephric space
T3**b** = IVC **B**elow diaphragm
T3c = IVC above diaphragm
T4 = 'Surrounding structures'
124
Renal lymphoma
uni or bilateral?
90% BILATERAL
125
Ureteral displacement
MEDIAL?
LATERAL ?
MEDIAL = RETROPERITONEAL FIBROSIS
LATERAL = LAD, Retroperitoneal mass, AAA
126
Upper tract TCC.
% chance of contra ureteral ca?
Bladder?
3-5% contra ureter
bladder cancer in 30-50%
127
Retroperitoneal liposarc
tx = ?
Calcs = ?
Large fatty tumor in the retroperitoneum, not arising from kidney and without vessels = retroperitoneal liposarc UPO
tx = debulking surgery
Calcs mean higher grade
128
Mechanism of reflux in lower moiety ureter
Shorter intramural course
129
Bladder Ca T4 staging
a vs b
T4a bladder ca invades pelvic viscera
T4b invades pelvic or abdominal wall
130
location of urachus ?
fascia wise?
Space of Retzius?
Between fascia transversalis and parietal peritoneum
Urachal cancer invades abd wall early
131
Neurogenic bladde on ivp
deformed with lots of tics
132
Types of neurogenic bladder (lesion location)
**Above T12** \> christmas tree bladder
spastic detrusor with sphincter dyssenergy
**Sacral and peripheral neuropathy** \> atonic/distended
**Above pons** \> spastic bladder with normal sphincters
133
Bladder mycetoma
A/W
Lamellated air in a fibrous appearing bladder mass
DM
134
Timing for CT urogram
6-10 minute delay to evaluate collecting system/ureters
135
AAST
renal injury grades 1-4
1 non expanding subcapsular hematoma
**2 superficial lac \< 1cm**
**3 superficial lac \>1cm**
4 collecting system or main vessels with contained hemorrhage
136
RPF vs Lymphoma
Both PET hot
Lymphoma lifts aorta, tends to be larger
RPF - ureteral obstruction, ureters MEDIALLY deviated
137
Common appearance of DM nephropathy
bilateral nephromegaly
