GU Residents' Exam 2022

Question 1

Primary muscle of passive urinary continence? (Dunnick, 5)

Answer 1

Circular smooth muscle internal urethral sphincter lies around the bladder neck

Next, if injured: INTRINSIC

Question 2

Shortest male urethral segment (Dunnick, 4)

Answer 2

Membranous urethra

Question 3

This stage consists of a series of uriniferous tubules, each of which is associated with a group of blood vessels to form primitive glomeruli. (Dunnick, 10)

Answer 3

Mesonephros

Question 4

In Weigert-Meyer rule of duplex collecting system, upper pole moiety corresponds to? (Dunnick,21)

Answer 4

Ectopic ureter inserts to the bladder inferiorly and medially, which may obstruct

U EIMO

Question 5

Most common congenital bladder anomaly (Dunnick, 28)

Answer 5

Urinary bladder herniation through an underdeveloped abdominal wall muscle defect.

Exstrophy

Question 6

Congenital disorders in which the incidence of horseshoe kidneys is increased? EXCEPT (Pollack, 739)
a. Trisomy 18
b. Down syndrome
c. Turner syndrome
d. Fanconi’s anemia
e. Thalidomide embryopathy

Answer 6

b. Down syndrome

Horseshoe kidney is the mort common renal anomaly, occuning in approximately 1:400 births. There is a 2:1 male predominance. The abnormality occurs when the kidneys are connected by an ISTHMUS. The anomaly is thought to occur because an abnormal position of the umbilical artery results in disturbance of the normal pattern of cephalic migration. As a result, there is contact between the developing metanephric blastema on each side that leads to partial fusion.

BAND: anterior to IVC and aorta, posterior to IMA

Question 7

Most common anomalies associated with horseshoe kidney? (Pollack, 739)

Answer 7

Ureteropelvic junction obstruction

Imaging findings in patients with a horseshoe kidney include
(1) An abnormal axis for each kidney with the lower poles more medially located than the upper poles
(2) The kidneys lie in a more caudad position
(3) A bilateral malrotation with the renal pelves in an anterior position so that the lower calyces are projected in a more medial position than the proximal ureter

Question 8

Congenital disorder in the bladder, in which a thick transverse band of muscle, incompletely divides the bladder into two unequal segments. (Pollack, 836)

Answer 8

Hour glass bladder

Question 9

Which is correct blood supply of adrenal gland (Dunnick, 1)
a. Superior adrenal artery branch from aorta
b. Superior adrenal artery branch from the ipsilateral renal artery
c. Middle adrenal artery branch from phrenic artery
d. Middle adrenal artery branch from ipsilateral renal artery
e. Inferior adrenal artery branch from ipsilateral renal artery

Answer 9

e. Inferior adrenal artery branch from ipsilateral renal artery

Superior adrenal artery from inferior phrenic artery
Middle adrenal artery from aorta
Inferior adrenal artery from renal artery

Question 10

Size discrepancies in kidneys may suggest a pathology if? (Dunnick, 40)

Answer 10

Right kidney is 1.5 longer than left

R > L by 1.5 cm
L > R by 2.0 cm

Question 11

Most common type of posterior urethral valve (Dunnick, 31)
a. Leaflets from distal veromontanum to urethral wall
b. Leaflets from proximal veromontanum to urethra wall
c. Leaflets from proximal prostatic urethra
d. Leaflets from distal prostatic urethra
e. Leaflets from proximal prostatic urethra representing redundant mucosal folds

Answer 11

a. Leaflets from distal veromontanum to urethral wall

Question 12

Which of the following is a risk factor for adverse reactions to contrast media? (Dunnick Textbook of Uroradiology, 5th ed, p. 64)
a. Anxiety
b. Cardiac disease
c. History of asthma or allergy
d. Medications such as beta-blockers & interleukin
e. All of the above

Answer 12

e. AOTA

In a randomized prospective study designed to identify which risk factors were important predictors of an increased risk of a contrastreaction, it was concluded that a history of prior contrast medium reaction, asthma, and a history of allergy to food or drugs were the only independent risk factors associated with a statistically important increased risk of reaction.

A history of a SEVERE reaction to contrast media is considered a contraindication to reexamination in all but the most urgent cases.

Most contrast reactions occur within the first 10 minutes after injection of the contrast medium

Question 13

This systemic disorder occurs almost exclusively in patients with renal failure and is associated with the administration of with gadolinium-based contrast material for MR examinations. (Dunnick Textbook of Uroradiology, 5th ed, p. 69)

Answer 13

Nephrogenic systemic fibrosis

Question 14

Lactic acidosis is a possible complication associated with the continued use of this drug in patients who undergo examinations
requiring contrast administration. Which among the following drugs fits is this? (Dunnick Textbook of Uroradiology, 5th ed, p. 68)

Answer 14

Metformin

Question 15

Retrocrural lymph nodes are considered enlarged if they measure greater than: (Dunnick Textbook of Uroradiology, 5th ed, p. 79)

Answer 15

6 mm

Question 16

What is the most common malignant tumor to arise in the retroperitoneum? (Dunnick Textbook of Uroradiology, 5th ed, p. 80)

Answer 16

Lymphoma

Question 17

What is the most common primary retroperitoneal malignancy? (Dunnick Textbook of Uroradiology, 5th ed, p. 82)

Answer 17

Liposarcoma

Question 18

What is the most common cause of spontaneous retroperitoneal hemorrhage? (Dunnick Textbook of Uroradiology, 5th ed, p. 74)

Answer 18

Rupture of an abdominal aortic aneurysm

Question 19

Which of the following is the ideal modality for detecting retroperitoneal hemorrhages or abscesses and defining their extent?
(Dunnick Textbook of Uroradiology, 5th ed, p. 75-76)

Answer 19

CT

Question 20

Which of the following can be a cause of retroperitoneal fibrosis? (Dunnick Textbook of Uroradiology, 5th ed, p. 77)
a. Retroperitoneal bleeding
b. Malignancy
c. Radiation therapy
d. All of the above

Answer 20

d. AOTa

Question 21

What is the stage of a neuroblastoma with contiguous extension beyond the midline with possible bilateral involvement of the regional
nodes? (Dunnick Textbook of Uroradiology, 5th ed, p. 91)

Answer 21

Stage III

The most common location of neuroblastoma is the ADRENAL GLAND. It is also the most common extracranial malignant tumor in childhood

Question 22

Adrenal masses with a percentage enhancement washout of > 60% or a relative enhancement washout of > 40% can be confidently diagnosed
as ____. (Dunnick Textbook of Uroradiology, 5th ed, p. 99)

Answer 22

Adenoma

Low signal on both T1, T2
Loss of signal going from in-phase images to out-of-phase images is a more reliable method to identify an adenoma.

AW = (Enhanced - Delayed) / Enhanced - Plain
RW = (Enhanced - Delayed) / Enhanced

Question 23

Bosniak classification of renal cortical cysts with few, thin septations with minimal enhancement (Dunnick Textbook of Uroradiology, 5th ed,
p109)

Answer 23

IIF

I: Simple cyst
II: Non-enhancing thin septa, rim calcifications, exophytic hyperdense cyst
IIF: Perceived enhancing thin septa or minimal wall/septal thickening, large hyperdense cyst (>3 cm)
III: Measurable enhancement, one or more thick. or irregular septationa, some thickened walls. or large, nonborder-forming calcifications
IV: Large cyst with enhancing nodular component apart from the wall

Question 24

True or False: For patients with infantile polycystic disease, when the disease presents in older children, the hepatic component is mild, where
as the renal manifestation is more severe (Dunnick Textbook of
Uroradiology, 5th ed, p112)

Answer 24

False

Patients with severe fonns of IPCD have renal failure at birth and most die within the first few days of life.

There seems to be an inverse relationship between the renal and the hepatic manifestations of the disease; when the renal disease is present at birth, the hepatic manifestations are mild.

When the disease present in older children, the hepatic component dominates; whereas the renal manifestations are less severe

In summary:
At birth: renal > hepatic
Older: hepatic > renal

Question 25

It consists of a collection of irregularly sized cysts and fibrous tissue but no functioning renal parenchyma. The cysts do not communicate, the renal collecting system is small or absent, and there are atretic ipsilateral renal vessels. (Dunnick Textbook of Uroradiology, 5th ed, p114)

Answer 25

Multicystic dysplastic kidney ## Footnote MCDK is the second most common cause of an abdominal mass in the neonate, trailing only hydronephrosis in frequency.

Question 26

Renal cysts and cancers are not present in this type of Von Hippel-Lindau disease (Dunnick Textbook of Uroradiology, 5th ed, p117)

Answer 26

IIA

Question 27

Type of renal cell carcinoma with the best overall prognosis (Dunnick Textbook of Uroradiology, 5th ed, p127)

Answer 27

Chromophobe

Question 28

This syndrome comprises of macroglossia, omphalocele, adrenal cytomegaly, and visceromegaly, which includes Wilms tumor (Dunnick Textbook of Uroradiology, 5th ed, p144)

Answer 28

Beckwith-Wiedemann

Question 29

This tumor is usually present at birth and has been described as a congenital Wilms tumor or fetal mesenchymal hamartoma (Dunnick Textbook of Uroradiology, 5th ed, p146)

Answer 29

Mesoblastic nephroma

Question 30

Most common manifestation of renal lymphoma (Dunnick Textbook *0/1 of Uroradiology, 5th ed, p151)

Answer 30

Multiple cortical nodules

Question 31

Hallmark of renal tuberculosis (Dunnick Textbook of Uroradiology, 5th ed, p170)

Answer 31

Infundibular stenosis

Question 32

The following are features of a renal inflammatory disease characterized by the presence of lipid-laden macrophages, except: (Dunnick Textbook of Uroradiology, 5th ed, p167) a. Male predominance b. Obstructing pelvocalyceal stone c. Poorly defined mass d. Nonfunctioning kidney e. NOTA

Answer 32

a. Male predominance ## Footnote The classically described triad of findings includes: (1) a staghom calculus. (2) absent or diminished excretion of contrast medium, and (3) a poorly defined renal mass.

Question 33

Renal ultrasound findings in patient with acute pyelonephritis may show normal findings (Dunnick Textbook of Uroradiology, 5th ed, p157)

Answer 33

True ## Footnote Utz findings in acute uncomplicated pyelonephritis may be normal or shows diffuse or focal renal enlargement with regions of increased or decreased echogenicity of the renal parenchyma (Fig. 9.3). The normal cortioomedullary di1ferentiation may be lost

Question 34

RENAL nephrometry score of an endophytic solid renal tumor, which measures 4.0 cm, seen in the ventral region, 5mm from the collecting system, and crosses the polar line

Answer 34

8

Question 35

Which of the following is false about circumcaval ureters? (Dunnick 5th ed., p 179): a. Secondary to persistence of the right subcardinal vein, trapping the ureter behind the IVC b. More common in men than in women c. The most common complication is obstruction d. None of the above

Answer 35

d. None of the above

Question 36

Identify the collagen vascular disease affecting small arteries and veins presenting with glomerulitis and necrotizing granulomas of the respiratory tract (Dunnick 5th ed., p 180) a. Polyarteritis nodosa b. Wegener granulomatosis c. Systemic lupus erythematosus d. Scleroderma

Answer 36

b. Wegener granulomatosis

Question 37

Segmental hypoplasia of the kidney has been recognized as a cause of severe hypertension. The affected kidney is small, has few pyramids, and has a deep cortical scar or groove overlying an abnormal calyx. The calyx underlying the cortical scar is dilated and clubbed. This disease is termed? (Dunnic 5th ed., p 190)

Answer 37

Ask-Upmark kidney

Question 38

Most common cause of renal artery stenosis: (Dunnick 5th ed., p 191) a. Trauma b. Fibromuscular dysplasia c. Takayasu aortitis d. None of the above

Answer 38

d. NOTA

Question 39

The most common etiology of renovascular hypertension among children is? (Dunnick 5th ed., 197)

Answer 39

Fibromuscular dysplasia

Question 40

Bilateralnephromegalywithdiminishedopacificationofthecollecting system on excretory urography is most characteristic of? (Dunnick 5th ed., p. 205)

Answer 40

Acute interstitial nephritis

Question 41

Most common malignant cause of bilateral nephromegaly in children? (Dunnick 5th ed., p. 206)

Answer 41

Leukemia

Question 42

The association of chronic hereditary renal disease, deafness, and ocular abnormalities is known as: (Dunnick 5th ed., p. 208)

Answer 42

Alport syndrome

Question 43

Complication of renal transplantation occuring 1-4 weeks after surgery characterized by renal swelling, altered echogenicity of the renal pyramids and cortex, edema of the renal sinus fat and collecting system walls (Dunnick 5th ed., p. 215).

Answer 43

Acute rejection

Question 44

Most common peritransplant fluid collection after renal transplant: (Dunnick 5th ed., p. 226)

Answer 44

Lymphocele

Question 45

True or false: Torsion of a transplanted kidney is more likely to occur when the transplant kidney is placed in the peritoneal cavity (Dunnick 5th ed., p. 222).

Answer 45

True

Question 46

Which of the following arteries can serve as collateral pathway when the main renal artery is compromised? (Dunnick 5th ed., p. 176)

Answer 46

Lumbar arteries

Question 47

Among the causes of medullary nephrocalcinosis which usually present bilaterally, medullary sponge kidney is an exception since it may occur unilaterally or segmentally. This is because: (Dunnick: Textbook of Uroradiology, 5th ed., p 231)

Answer 47

It is an anatomic rather than a metabolic defect.

Question 48

Staghorn calculi are composed of: (Dunnick: Textbook of Uroradiology, 5th ed., p 233)

Answer 48

Triple phosphate + uric acid + cystine

Question 49

The following findings help differentiate a ureteral stone from phleboliths on CT except? (Dunnick: Textbook of Uroradiology, 5th ed., p 237) a. Perinephric stranding b. Periureteral edema c. Always lateral to the gonadal vein d. Hydronephrosis

Answer 49

c. Always lateral to the gonadal vein

Question 50

What is the most common radiolucent stone? (Dunnick: Textbook of Uroradiology, 5th ed., p 233)

Answer 50

Uric acid

Question 51

Most common site of ureteral obstruction: (Dunnick: Textbook of Uroradiology, 5th ed., p 234)

Answer 51

Ureterovesical junction

Question 52

True or False: Retrocaval ureter can only occur on the right side. (Dunnick: Textbook of Uroradiology, 5th ed., p 252)

Answer 52

True

Question 53

A voiding cystourethrogram, was requested for a 1-year-old female with urinary tract infection. During the examination, you noted reflux into the mildly dilated collecting system on the right, with minimal blunting of the fornices. Based on the International Classification of Vesicoureteral Reflux, what is the grade of reflux? (Dunnick: Textbook of Uroradiology, 5th ed., p 262)

Answer 53

III

Question 54

This type of backflow observed during retrograde pyelogram is seen as streaks of contrast extending from the calyces into the parenchyma of the kidney. (Dunnick: Textbook of Uroradiology, 5th ed., p 263)

Answer 54

Pyelotubular

Question 55

A 52-year-old female underwent KUB intravenous pyelography for recurrent urinary tract infection. Radiographs show multiple, small (2-3 mm), radiolucent filling defects along the nondilated ureters, bilaterally. What will be your impression? (Dunnick: Textbook of Uroradiology, 5th ed., p 271)

Answer 55

Findings are suggestive of ureteritis cystica

Question 56

Which of the following may cause urinary bladder wall calcifications? (Dunnick: Textbook of Uroradiology, 5th ed., p 282) a. Schistosomiasis b. Radiation cystitis c. Tuberculosis d. A and B only e. All of the above

Answer 56

e. AOTA

Question 57

57.Itisthemostcommonsecondarytumorfoundintheurinarybladder? (Dunnick: Textbook of Uroradiology, 5th ed., p 303)

Answer 57

Melanoma

Question 58

A 30-year-old male is for work-up of neurogenic bladder with no perception of bladder filling or emptying. You noted a Christmas tree bladder on voiding cystourethrogram. Where is the probable lesion causing the neurogenic bladder which will be the focus of further imaging? (Dunnick: Textbook of Uroradiology, 5th ed., p 315)

Answer 58

Suprasacral but below the pons

Question 59

Which of the following are CT findings suggestive of bladder outlet obstruction? (Dunnick 319) a. Bladder wall thickening b. Indentation of the bladder base c. Poor emptying of the bladder on post-void imaging d. All of the above

Answer 59

c. AOTA

Question 60

The modality used for the most accurate staging of localized prostate malignancy is? (Dunnick 325)

Answer 60

MRI

Question 61

In prostate malignancy, osseous metastasis typically appear as what kind of lesions? (Dunnick 329)

Answer 61

Blastic

Question 62

In prostate malignancy, osseous metastasis can be differentiated from sclerotic bone islands using what modality? (Dunnick 329)

Answer 62

Scintigraphy

Question 63

Which is a pathognomonic finding in prostatitis? (Dunnick 332) a. Prostate hyperenhancement b. Prostate hypoenhancement c. Prostate enlargement d. None of the above

Answer 63

d. NOTA

Question 64

Non-specific prostate calcifications tend to appear in which zone of the prostate gland? (Dunnick 333)

Answer 64

Peripheral Zone

Question 65

Which of the following is described as an ovoid filling defect in the prostatic urethra? (Dunnick 336)

Answer 65

Verumontanum

Question 66

Urethral strictures from gonorrhea infection are most common in which segment? (Dunnick 338)

Answer 66

Bulbar

Question 67

TRUE or FALSE: The male urethra is fixed along two locations: the penoscrotal junction and the membranous urethra. (Dunnick 341)

Answer 67

True

Question 68

Themostcommonhistopathologyofmalignanttumorsoftheurethra is? (Dunnick 343)

Answer 68

Squamous cell carcinoma

Question 69

The mainstay modality for diagnosis of pelvic inflammatory disease is? (Dunnick 354)

Answer 69

Ultrasound

Question 70

TRUE or FALSE: Hysterosalpingography has a role in evaluation of ACUTE pelvic inflammatory disease? (Dunnick 356)

Answer 70

False

Question 71

Which of the following is true? (Dunnick, 376) a. MRI is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids b. CT is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids c. Necrotic or degenerated fibroids are avidly enhancing d. Calcified regions have high signal intensity on all sequences

Answer 71

a. MRI is the most accurate of all imaging techniques for detecting and delineating the anatomy of uterine fibroids

Question 72

Most common type of testicular tumor? (Dunnick, 389)

Answer 72

Seminoma

Question 73

Which of the following is correct about staging of testicular tumors? (Dunnick 391) a. Stage III disease – tumor confined to the scrotum b. Stage IV disease – metastasis to extra-abdominal lymph nodes c. Stage I lesion – extranodal disease d. Stage II disease – involves lymph nodes inferior to the diaphragm

Answer 73

d. Stage II disease – involves lymph nodes inferior to the diaphragm

Question 74

True of testicular torsion? (Dunnick, 396) a. Markedly diminished or absent intratesticular flow b. Complete testicular ischemia lasting longer than 24 hours causes reversible infarction c. Bell-clapper deformity reduces the chance of testicular torsion Radionuclide scanning is the ideal initial examination

Answer 74

a. Markedly diminished or absent intratesticular flow

Question 75

Grade 1 Renal Injury? (Renal Injury Scale of the American Association of Surgeons in Trauma) (Dunnick, 407) a. Nonexpanding perirenal hematoma confined to the retroperitoneum; superficial lacerations (<1 em depth) in the renal cortex b. Lacerations extending through the renal cortex, medulla, and collecting system; injuries to the main renal artery or vein with contained hemorrhage; thrombosis of a segmental renal artery without parenchymal laceration c. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration d. Lacerations that completely shatter the kidney; injuries to the renal hilum with devascularization of the kidney; traumatic renal arterial occlusion

Answer 75

c. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration

Question 76

Type that accounts for approximately one-third of bladder injuries? (Dunnick, 415) a. Type IV: Extraperitoneal rupture b. Type V: Combined bladder injury c. Type I: Bladder contusion d. Type III: Interstitial bladder injury e. Type II Intraperitoneal rupture

Answer 76

e. Type II Intraperitoneal rupture

Question 77

Type of bladder injury associated with one or more fractures of the pubic rami or diastasis of the symphysis pubis? Dunnick 415 a. Type I: Bladder contusion b. Type II Intraperitoneal rupture c. Type III: Interstitial bladder injury d. Type IV: Extraperitoneal rupture e. Type V: Combined bladder injury

Answer 77

d. Type IV: Extraperitoneal rupture

Question 78

Grade 4 Renal Injury? (Renal Injury Scale of the American Association of Surgeons in Trauma) (Dunnick, 407) a. Nonexpanding perirenal hematoma confined to the retroperitoneum; superficial lacerations (<1 em depth) in the renal cortex b. Lacerations extending through the renal cortex, medulla, and collecting system; injuries to the main renal artery or vein with contained hemorrhage; thrombosis of a segmental renal artery without parenchymal laceration c. Lacerations that completely shatter the kidney; injuries to the renal hilum with devascularization of the kidney; traumatic renal arterial occlusion d. Microscopic or gross hematuria with normal findings of imaging studies; renal contusion; nonexpanding subcapsular hematoma without parenchymal laceration

Answer 78

b. Lacerations extending through the renal cortex, medulla, and collecting system; injuries to the main renal artery or vein with contained hemorrhage; thrombosis of a segmental renal artery without parenchymal laceration

Question 79

Type III urethral injury (unified classification of blunt posterior and anterior urethral injuries proposed by Goldman et al.)? Dunnick 418 a. Pure posterior injury with tear of membranous urethra above the UGD-partial or complete b. Bladder neck injury with extension into the urethra c. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete d. Posterior urethra intact, but stretched e. Pure anterior urethral injury-partial or complete

Answer 79

c. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete

Question 80

Type V urethral injury (unified classification of blunt posterior and anterior urethral injuries proposed by Goldman et al.)? Dunnick 418 a. Bladder neck injury with extension into the urethra b. Combined anterior/posterior urethral injury with disruption of the UGD-partial or complete c. Posterior urethra intact, but stretched d. Pure anterior urethral injury-partial or complete e. Pure posterior injury with tear of membranous urethra above the UGD-partial or complete

Answer 80

d. Pure anterior urethral injury-partial or complete

Question 81

Identify

Answer 81

VERUMONTANUM

Question 82

Identify the specific anomaly

Answer 82

HORSESHOE KIDNEY

Question 83

Answer 83

MEDIASTINUM TESTIS

Question 84

50 year old male with ill-defined back pain, s/p ureteral stenting. Diagnosis?

Answer 84

RETROPERITONEAL FIBROSIS

Question 85

Axial T1 in-phase and T1 out-of-phase images. Diagnosis?

Answer 85

ADRENAL ADENOMA

Question 86

Bosniak category

Answer 86

BOSNIAK IIF

Question 87

Diagnosis

Answer 87

Oncocytoma

Question 88

Diagnosis

Answer 88

EMPHYSEMATOUS PYELONEPHRITIS

Question 89

Identify the vascular anomaly

Answer 89

RETROAORTIC LEFT RENAL VEIN

Question 90

Diagnosis

Answer 90

CIRCUMCAVAL URETER

Question 91

This is a renal infarct because of the presence of which radiologic sign?

Answer 91

Cortical rim sign

Question 92

What radiologic sign

Answer 92

CHAMPAGNE GLASS SIGN ## Footnote Transitional cell carcinoma of the ureter: most common

Question 93

Diagnosis

Answer 93

PAPILLARY NECROSIS

Question 94

Diagnosis

Answer 94

MEDULLARY NEPHROCALCINOSIS

Question 95

Intravenous pyelogram; elderly male with obstructive urinary symptoms. Likely diagnosis?

Answer 95

BENIGN PROSTATIC HYPERTROPHY

Question 96

Identify the surgery with changes pointed by the arrow

Answer 96

TRANSURETHRAL RESECTION OF THE PROSTATE

Question 97

True or False: The mass effects seen in the image below are more likely to be caused by lymphadenopathy fibrosis rather than retroperitoneal fibrosis.

Answer 97

True

Question 98

Type of bladder injury?

Answer 98

INTRAPERITONEAL BLADDER RUPTURE

Question 99

Pathology seen in the left kidney?

Answer 99

RENAL INFARCT

Question 100

Type of urethral injury?

Answer 100

Type II