Flashcards in GU Deck (94)
Duplicated collecting system - what inserts where?
What's the problem with the upper pole ureter?
What's the problem with the lower pole ureter?
Upper pole inserts inferomedially and ectopically. Obstructs, usually ureterocele.
Lower pole refluxes, inserts normally.
Differences among sepate, arcuate, bicornuate, didelphys
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
Ddx for cortical nephrocalcinosis
*acute cortical necrosis
*rejected renal transplant
putty kidney from TB
renal infarction / ischaemia
hemolytic uraemic syndrome (HUS)
Ddx for medullary nephrocalcinosis
*medullary sponge kidney
*renal tubular acidosis
other pathological hypercalcemic or hypercalciuric states
What's medullary sponge kidney?
The medullary and papillary portions of the collecting ducts are dysplastic and dilated and in most cases develop medullary nephrocalcinosis.
Ddx renal hemosiderosis
*Paroxysmal nocturnal hemoglobinuria
mechanical valves causing chronic hemolysis
Ddx striated nephrogram (unilateral)
renal vein thrombosis
Ddx striated nephrogram (bilateral)
acute tubular necrosis (e.g. from contrast)
What stage is an RCC with IVC extension below the diaphragm? Above?
T3c for above
Ddx retroperitoneal adenopathy
mets from testicular, prostate, endometrial, cervical
infection: TB, HIV
On what side should scrotal varicoceles raise concern?
the right side is abnormal and raises concern for an RP mass
80% of varicoceles are left-sided
large mass ~upper pole kidney
RCC, adrenal cortical carcinoma, pheo, mets, retroperitoneal sarcoma, malignant fibrous histiocytoma
hysterosalpingogram - diverticula off tube
Salpingitis isthmica nodosa (asociated with PID, infertility, ectopic pregnancy)
when you see a large adnexal nonvascular (noncystic) mass, what should you include?
Parts of the male urethra, bladder out:
Where is the verumontanum? Where are posterior urethral valves?
bulbar (turns and becomes horizontal), penile
verumontanum is posterior of prostatic portion, posterior urethral valves begin here and go to distal prostatic urethra
Ddx for male urethral stricture
Carcinoma (TCC in prostatic, adeno (at Cowper's glands just below prostate), squamous cell (from prior stricture of anterior urethra)
post-catheter stricture (penoscrotal jctn or membranous)
Ddx for fat-containing mass in region of adrenal gland
myelolipoma of adrenal gland
AML of kidney
HCC/adeno of liver
ddx for renal papillary necrosis (sloughing of papilla)
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
ddx of omental caking
mets (ovarian, GI, pancreas, GB)
Pt with rcc and multiple renal cysts might have?
What other features of this diz?
also have pheos, pancreatic islet cell tumors and panc cysts
cerebellar and retinal hemangioblastomas
numerous cysts in atropied kidneys
acquired renal cystic disease of dialysis
increased risk of RCC
What's adenomyosis? What dx criteria?
the presence of ectopic endometrial tissue within the myometrium
junctional zone greater than 12mm
Bosniak renal cyst classification system:
2-single thin septation or thin calc or high attenuation non-enhancing
2F-thicker septations or thicker calc
4-obviously malignant, a lot of solid parts
1 & 2 - no follow-up, never malignant
2F-4 - follow-up
renal mass with multiple cysts, herniates into renal pelvis - what is it? Who gets it?
Multilocular cystic nephroma
males under 5
women in their 40s
Hysterosalpingogram - intrauterine senechiae
Asherman's syndrome, usually 2/2 D&C, IUD, severe endometritis
causes of RP fibrosis
idiopathic, meds, blood (rp bleed), radiation, peri-aneurysmal, malignancy
Ureters pushed away from spine vs pulled medially - what does that distinguish?
Pushed away - lymphoma
Pulled medially - RP fibrosis
Ddx of multiple filling defects of ureter
spreading or multifocal TCC
multiple ureteral stones (steinstrasse)
Malakoplakia (benign, related to chronic infection)
What's ureteritis/pyeloureteritis cystica?
benign supepithelial cysts, likely 2/2 chronic UTIs