Neonatal/pediatric Adrenal & Urinary System

Question 1

Infant and young child renal views are obtained from a ____ position

Answer 1

Prone

Question 2

Children and adolescents renal views are obtained in the __

Answer 2

Decubitus position

Question 3

Dilation of renal pelvis

Answer 3

Pelvietasis

Question 4

Medullary pyramids and large and ______

Answer 4

Hypoechoic

Question 5

______ kidney is somewhat longer

Answer 5

Left

Question 6

A kidney measurement of ____ should be monitored closely and may indicate infection, scarring, abnormalities

Answer 6

Greater than 1cm side-to-side

Question 7

Normal neonatal adrenal glands are _______ than in the older infant/child

Answer 7

Larger

Question 8

Left adrenal glad extends slightly more ____ that the right one

Answer 8

Medial

Question 9

Adrenal gland sonographically

Answer 9

Inverted V or Y shape in the longitudinal plane

Question 10

Central medulla in neonate is

Answer 10

Thin, echogenic stripe—-linear

Question 11

Normal bladder should measure _____ in AP

Answer 11

<3mm

Question 12

When bladder is empty, the bladder wall should measure ____

Answer 12

<5mm

Question 13

Most common urinary tract anomaly in children

Answer 13

Congenital hydroneohrosis

Question 14

Sonographic features of congenital hydronephrosis

Answer 14

Dilated calyces budding of large central cyst(renal pelvis)

Visualization of dilated ureter

Question 15

Abnormal reflux infection of urine from the bladder and into the kidney

Answer 15

Vesicoureteral Reflux(VUR)

Question 16

How many grades of VUR

Answer 16

5

1 being the least severe(ureters only)

5 being the worst(severe dilation of ureters and kidney w loss of papillary impressions)

Question 17

Most common type of obstruction causing hydronephrosis of upper urinary tract in peds

Answer 17

Ureteralpelvic Junction obstruction (UPJ)

Question 18

Most often results from intrinsic narrowing or extrinsic vascular compression at level of uteropelvic junction

Answer 18

UPJ

Question 19

Ectopic ureterocele and duplex kidney more commonly occurs in ___

Answer 19

Female and left side

Question 20

Seen as a fluid mass within the bladder

Answer 20

Ectopic ureterocele

Question 21

Most common cause of bladder outlet obstruction in male neonate

Answer 21

Posterior urethral valves

Question 22

Sonographic features of bladder outlet obstruction

Answer 22

Bladder wall is thickened

Question 23

Prune-belly syndrome includes triad of :

Answer 23

Hypoplasia or deficiency of the abdominal musculature

Cryptorchidism

Urinary tract anomalies

Question 24

Anomaly that includes Congenital absence or deficiency of the abdominal musculature, large hypotonic dilated tortuous ureters, large bladder, patent urachus, bilateral cryptorchidism, dilated prostatic urethra

Answer 24

Prune-belly syndrome

Question 25

____% of prune-belly syndrome is associated with VUR

Answer 25

85%

Question 26

Long tubular structure which connects the dome of the bladder to the umbilicus

Answer 26

Urachus

Question 27

Urachus normally closes during the ___

Answer 27

4th and 5th month of gestation

Question 28

Urachus sometimes remains patent——either at the ____ or the ____

Answer 28

Bladder or umbilical end

Question 29

Most common cause of renal cystic disease in neonates

Answer 29

Multicystic Dysplastic Kidney Disease(MCDK)

Question 30

Most common cause of abdominal mass in newborn/neonate

Answer 30

MCDK

Question 31

Sonographic features MCDK

Answer 31

Cluster of grapes—largest cysts in the peripheral No identifiable renal pelvis If bilateral, usually fatal

Question 32

Sonographic findings in ARPKD

Answer 32

Bilateral renal enlargement diffuse increased echogenicity Loss of definition of renal sinus, medulla, and cortex Hypoechoic outer rim

Question 33

Less severe cases of ARPKD sonographic findings

Answer 33

Hepatosplenomegaly Portal hypertension Renal parenchyma normal to echogenic

Question 34

ADPKD have an increased incidence of

Answer 34

Renal cell carcinoma (RCC)

Question 35

Sonographic findings of ADPKD

Answer 35

Bilateral, well defined cysts Macroscopic cysts of varying size that can form in liver, spleen, pancreas

Question 36

May be associated with tuberous sclerosis and Von Hippel-Lindau disease:

Answer 36

Renal cysts

Question 37

Pts with tuberous sclerosis have a ___% incidence of having _____ which may resemble polycistic renal disease

Answer 37

40% Renal cysts

Question 38

Both tuberous sclerosis and von hippel lindau disease are associated with an increased incidence of

Answer 38

RCC

Question 39

UTI— infection usually begins in ___

Answer 39

Bladder and ascends through ureter into the renal pelvis

Question 40

Acute pylonepritis clinical symptoms

Answer 40

Sudden fever, flank pain, tenderness

Question 41

Acute pylonephritis sonographic findings

Answer 41

Enlarged renal size Altered echogenicity secondary to edema

Question 42

Repeated episodes of acute pylonephritis causing kidney to become scarred and decrease in size

Answer 42

Chronic pylonephritis

Question 43

Calcification of renal parenchyma, identified in the medulla and rarely in the cortex

Answer 43

Nephrocalcinosis

Question 44

Most common neonatal adrenal mass

Answer 44

Adrenal hemorrhage

Question 45

Predispose neonate to adrenal hemorrhage:

Answer 45

Difficult delivery, large size, diabetic mother, stress, hypoxia, septicemia, shock

Question 46

Adrenal Hemorrhage is usually found secondary to other complications like:

Answer 46

Uncontrolled bleeding Jaundice Intestinal obstruction Hypertension Adrenal abscess Impaired renal function

Question 47

Most common intraadbominal malignant renal tumor in young children

Answer 47

Wilms tumor/ nephroblastoma

Question 48

Wilms tumor/nephroblastoma incidence peaks between ____

Answer 48

2-5 years old

Question 49

Nephroblastoma/Wilms tumor sonographic:

Answer 49

Unilateral Adjacent renal tissue becomes compressed Echogenic areas w calcification Hydronephrosis may result Well defined borders

Question 50

Most common renal tumor of neonate

Answer 50

Congenital Mesoblastic Nephroma

Question 51

Most common malignancy in children under 1

Answer 51

Neuroblastoma

Question 52

Malignant tumor arises in the adrenal medulla

Answer 52

Neuroblastoma

Question 53

Sonographic features of neuroblastoma

Answer 53

Highly echogenic Increased vascularity Adjacent kidney displaces inferiorily and sometimes laterally