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Genitourinary > Opening Round > Flashcards

Opening Round Flashcards

1
Q

Case 1

Is there an increased risk of Renal Cell in ADPKD

A

No

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2
Q

Case 1

How does ADPKD tend to present clinically?

A

Hematuria
Hypertension
Renal Insufficiency

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3
Q

Case 1

Name two Complications of Autosomal Dominant Polycystic Kidney Disease

A

Renal failure
- Nearly all patients

Intracranial aneurysms
- 15% of patients

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4
Q

Case 2

Define the four classes of Renal Trauma

A

Class I
- Contusion or Capsular hematoma

Class II
- Major Laceration

Class III
- Multifocal laceration or renal vessel injury

Class IV
- UPJ disruption

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5
Q

Case 2

How do you manage renal injury based on class

A

Class I
- Conservative

Class II/III
- Depends on patient stability

Class IV
- Surgery

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6
Q

Case 3

What is the normal path of renal migration during development?

A

Ureteral bud

  • Develops at the S1 level
  • Migrates cranially to the L2 level
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7
Q

Case 3

What is the most common complication of a pelvic kidney?

A

UPJ Obstruction

Followed by

  • Reflux
  • Stone formation
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8
Q

Case 4

What single imaging feature is diagnostic of multilocular cystic nephroma?

A

Herniation in to the renal pelvis

  • Very specific
  • Not very sensitive
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9
Q

Case 3

What causes pelvic ectopia of a kidney?

A

Arrest of cranial migration of the ureteral bud as it tries to join the metanephric bud

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10
Q

Case 4

DDX of a renal mass with septations and thickened margins

A
  • Renal cell carcinoma
  • Multilocular cystic nephroma
  • Complicated renal cyst
    • Infection
    • Hemorrhage
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11
Q

Case 5

Causes of unilateral papillary necrosis?

A

Pyelonephritis
Ureteral Obstruction
Tuberculosis
Renal Vein Thrombosis

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12
Q 
Case 4
What Bosniak class cystic masses require surgery?
A

III and IV

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13
Q

Case 5

Name causes of Papillary Necrosis

A

POSTCARD

Pyelonephritis
Obstruction
Sickle Cell Disease
TB
Cirrhosis / Pancreatitis
Analgesic Abuse
Renal Vein Thrombosis
Diabetes
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14
Q

Case 6
T/F
Hydronephrosis in the setting of pyeolonephritis may be nonobstructive

A

True

  • Bacterial Endotoxin
    • Smooth muscle paralysis
    • Non-obstructive hydronephrosis
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15
Q

Case 6

What is the mechanism by which Pyelonephritis occurs

A

Infection ascending from the bladder via reflux

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16
Q

Case 5

Are filling defects in Papillary Necrosis in the renal calyx or the medulla

A

Medulla

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17
Q

Case 6

What else can look like pyeolonephritis?

A

Renal contusion

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18
Q

Case 6

What is the cause of decreased enhancement in pyelonephritis?

A

Papillary necrosis

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19
Q

Case 7

What is the likelihood that a calcified renal mass is a renal cell?

A

60%

–> All calcified renal masses should be further evaluated

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20
Q

Case 7

Is rim calcification a benign or malignant feature

A

80% Benign

  • Cysts complicated by
    • Infection
    • Hemorrhage

20 % malignant!
(the q may be asked in reverse)

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21
Q

Case 8

What stage is an RCC with renal vein tumor thrombosis?

A

III

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22
Q

Case 8

How often do you see synchronous RCC lesions?

A

2%

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23
Q

Case 9

Is RCC more common in men or women?

A

Men

  • x 2
  • Age 50-70
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24
Q

Case 10

How often do you see synchronous TCC lesions?

A

40%

vs RCC
- 2%

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25
Q

Case 10

What percentage of TCC’s develop in the bladder

A

90%

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26
Q

Case 10

DDX of a non-calcified filling defect on a urogram

A

Radiolucent stone
TCC
Air bubble
Infectious debris

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27
Q

Case 11
T/F
Uric acid stones are radiolucent on CT.

A

False

- virtually all calculi are radiodense on CT

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28
Q

Case 10

Risk factors for urinary bladder cancer?

A 
Smoking
Benze exposure
Analgesic abuse
Balkan nephropathy
Some oncologic chemoRx
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29
Q

Case 12

What modalities can help to differentiate hydronephrosis versus peripelvic cysts seen on Ultrasound

A

Postcontrast CT
Postconstrast MRI
IVP

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30
Q

Case 11

What is soft tissue rim sign?

A

Collar of ST around a ureteral stone on CT

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31
Q

Case 13

Two causes of immobile, off-midline stone in the bladder

A 
Stone in
 - Bladder Diverticulum
 - Ureterocele
Displacement of a stone by
 - Mass
 - Enlarged prostate
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32
Q

Case 13

Define a Ureterocele

A

Focal dilation of the distal end of the ureter

- Typically smooth regular wall

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33
Q

Case 13

Define a Pseudoureterocele

A

Dilation of the intramural ureter

  • 2o to contiguous bladder dz
  • Irregular thick, nodular wall
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34
Q

Case 13

What are the most common complications of an intravesical ureterocele?

A
  • Obstruction
  • Stones
  • Milk of Ca+
  • Recurrent UTIs
  • Hydronephrosis
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35
Q

Case 14

What makes up most radiolucent urinary tract stones?

A

Uric acid

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36
Q

Case 14

DDx for filling defect in collecting system?

A 
Radiolucent stone
TCC
Blood Clot
Infectious debris
Sloughed papillae
Ari bubble
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38
Q

Case 15

Is UPJ obstruction functional or anatomic?

A

Functional

  • Ureteral smooth muscle
    • Deficiency
    • Derangement
  • > Failure of normal peristalsis
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39
Q

Case 15

What is congenital UPJ obstruction associated with?

A 
Horseshoe kidney
Contralateral multicystic dysplastic kidney
Contralateral renal agenesis
Ureteral duplication
Vesicoureteral reflux
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40
Q

Case 15
How often is congenital UPJ obstruction bilateral?

How is it treated?

A

20%

Surgically

  • Endopyelotomy
  • Open Pyeloplasty
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41
Q

Case 16

When does the portal venous phase of contrast enhancement occur?

A

70-90 seconds

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42
Q

Case 16

When does the pyelographic phase of contrast enhancement occur?

A

120-180 seconds

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43
Q

Case 16

What are three most common primary renal tumors in adults?

A

Renal cell carcinoma
Transitional cell carcinoma
Squamous cell carcinoma

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44
Q

Case 17

Causes of hematuria

A 
Stones
UTI
Malignancy
Glomoerulonephritis
Prostatic hypertrophy
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45
Q

Case 19

Is TCC more common in men or women?

A

Men

  • 3 x
  • 50-60 yo
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46
Q

Case 15

Most common cause of abdominal masses in neonates?

A

UPJ Obstruction

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47
Q

Case 18

Name four causes of bladder stones

A 
Urinary stasis
Foreign body
Stones from kidneys
1o endemic stone dz
 - PESD
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48
Q

Case 19

What are two reasons to get a postvoid film on an IVP

A

Evaluate bladder

  • Mucosa
  • Function
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49
Q

Case 17

DDX of an adherent and irregular bladder mass

A 
Bladder carcinoma
Benign bladder tumor
Fungal infection
Cystitis
Fibrosis
Adherent blood products
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50
Q

Case 20

What is the most important feature of bladder cancer to determine therapy and prognosis?

A

Extension through the muscular bladder wall

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51
Q

Case 20

What stage is a bladder tumor that breaches the muscular layer of the bladder wall?

A

T3a

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52
Q

Case 20
What is the most common histologic subtype of bladder CA?

What histologic subtype is associated with urachal remnants?

A

TCC - 85%

AdenoCA

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53
Q

Case 21

What are two risk factors for emphysematous cystitis

A

Diabetes

Bladder outlet obstruction

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54
Q

Case 21
Is emphysematous cystitis an emergency?

How is it treated?

A

No, it’s not an emergency

Antibiotics
Bladder drainage (foley or suprapubic)
Treat the hyperglycemia in diabetics

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55
Q

Case 21

What common bacterial organisms cause emphysematous cystitis?

A

Most common

  • E. coli
  • Enterobacter

Followed by

  • Clostredium perfringes
  • Nocardia
  • Candida
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56
Q

Case 22

What are the features of an intraperitoneal bladder rupture?

A 
Cloud-like
Collect in
 - Rectouterine
 - Rectovesical pouch
Outline small bowel loops
Extends to paracolic gutters
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57
Q

Case 20

DDx for multiple polypoid bladder masses

A

Multifocal bladder CA
Fungal infection
Focal proliferative cystitis

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58
Q

Case 23

How are extraperitoneal ruptures treated?

A

Foley Decompression

- Allows for spontaneous healing

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59
Q

Case 23

Which type of bladder rupture is considered a surgical emergency?

A

Intraperitoneal

60
Q

Case 23

At least how much contrast is needed in the bladder to adequately evaluate for bladder rupture?

A

300 cc

Infused by low-pressure gravity infusion

61
Q

Case 22

What are the features of an extraperitoneal bladder rupture?

A 
Flame-shaped
Collect in extra peritoneal spaces
 - Perivesical
 - Anterior prevesical (Retzius)
 - Retrorectal space
64
Q

Case 24
T/F
Glands of Littre visualization is always a sign of pathology.

A

False

  • Commonly seen in urethritis
  • Can also be seen as normal variant
65
Q

Case 24

In a RUG, what gives a slightly irregular contour along the dorsal aspect of the anterior male urethra?

A

Glands of Littre

66
Q

Case 26

What are the two segments of the posterior male urethra?

A

Membranous

Prostatic

67
Q

Case 26

What causes anterior urethral injury?

A

Straddle injury

- Bulbous urethera

68
Q

Case 26

What causes posterior urethral injury?

A

MVA

  • w/ pelvic fractures
  • Esp anterior arch
69
Q

Case 27

DDX for a spiral appearing fallopian tube

A

Salpingitis isthmica nodosa
Tuberculosis
Tubal adenomyosis

70
Q

Case 27

What are the two complications associated with Salpingitis isthmica nodosa?

A

Infertility

Ectopic pregnancy

71
Q

Case 27

What are contraindications to performing an HSG

A

Pregnancy
Active menstruation
PID
Recent D and C

72
Q

Case 24

What is the duct that is seen arising posterolateral to the membranous urethra?

A

Cowper’s duct

- Imbedded in the urogenital diaphragm

73
Q

Case 25

Iatrogenic strictures affect what part of the male urethra most commonly?

A

Membranous urethra

- penoscrotal junction

74
Q

Case 28

What are the features of a Septate Uterus on ULTRASOUND?

A

Intercornual

  • Distance less than 4 cm
  • Angle less than 75 deg

Fundus

  • Convex
  • Flat
  • Minimally concave
75
Q

Case 29

Corpus luteum cysts are expected to resolve by when during pregnancy?

A

16 weeks

76
Q

Case 29
Cysts of what size MUST be removed during pregnancy and at what point is it best to remove them?

What size cysts in pregnancy may be managed conservatively?

A

10cm (Controversy regarding cysts that are 5-10cm)
2nd trimester

5 cm

77
Q

Case 30

What colonic wall thickness is considered abnormal and a sign of radiation colitis? When does it occur after radiation?

A

4 mm

Approx 2 yrs

78
Q

Case 30

Is radiation colitis more common in cervical or endometrial cancer? Why?

A

Cervical

Higher radiation dose

79
Q

Case 28

The mullerian or parasmesonephric ducts form what female structures?

A

Upper vagina
Uterus
Fallopian tubes

80
Q

Case 25

What are causes of a urethral stricture?

A 
Iatrogenic
 - most common cause in kids
Infection
Trauma
Noninfectious urethritis
 - chemical irritation
Neoplasm
 - long irregular strictures
81
Q

Case 26

The membranous urethra is contained within what structure?

A

Urogenital diaphragm

82
Q

Case 31

What complications occur with Dermoid cysts?

A 
Torsion (most common)
Infection
Trauma
Rupture w slow leak
Malignant transformation (2% -> Squamous cell CA)
83
Q

Case 31
T/F
Malignant transformation of dermoids most commonly occurs in postmenopausal women.

A

True

84
Q

Case 32

Hydronephrosis indicates what T stage of cervical cancer?

A

T3a

85
Q

Case 32

Is CT or MRI better for primary staging of cervical cancer?

A

MRI

  • High spacial contrast
  • Allows ID of dz beyond cervical stroma
  • Best to evaluate for parametrial extension
  • Must be used for any cervical mass > 1.5cm

CT

  • Essential for advanced disease
  • Best modality to look for distant mets
86
Q

Case 32

In cervical CA, what stage allows for surgical cure?

A

T2A

- No parametrial invasion

87
Q

Case 32
What T stages require brachytherapy?

Define each of those T stages?

A

T2B
- Parametrial invasion

T3
- Lower third of the vagina

T4

  • Invasion of
    • Rectum
    • Bladder
    • Vaginal fornices
88
Q

Case 33

What is the most common appearance of ovarian cystadenocarcinoma?

A

Mixed fluid and soft tissue mass
Enhancing nodules
Thick septations
Usually seen w/ ascites

89
Q

Case 33

What age group is affected by ovarian cancer

A

45-55 yo

- Perimenopausal

90
Q

Case 33

In ovarian CA, why is hydronephrosis important to identify prior to CTX?

A

Because it must be treated with stents to allow for good renal function prior to chemotherapy

91
Q

Case 27

What are the major differences between water-soluble and oil-soluble types of contrast media used for HSG?

A

Image detail

Peritoneal absorption

92
Q

Case 32
What do you look for on MRI to determine if there is parametrial invasion?

What are the signal characteristics of cervical CA on T2?

A

Disruption
- Black ring of cervical stroma on T2

Cervical CA is bright on T2

93
Q

Case 34
How often are Dermoid cysts bilateral?

How often are mature cystic teratomas bilateral?

A

20%
(p50 CR)

10%
(p52 CR)

94
Q

Case 34

How do you differentiate between a dermoid and a mature cystic teratoma?

A

Dermoid
- Skin and dermal appendages

Mature Cystic Teratoma

  • All three primitive germ cell layers
  • Includes a Rokatansky nodule (solid/calcified)
95
Q

Case 34

What feature in an ovarian cyst is diagnostic of a dermoid?

A

Fat attenuation

96
Q

Case 36

What is needed for primary staging of ovarian cancer?

A 
Total abdominal hysterectomy
Bilateral salphino-oophorectomy
Omentectomy
Peritoneal washings
Wall samplings
Lymph node sampling
97
Q

Case 36

How is ovarian cancer spread?

A

Intraperitoneal dissemination via ascites

98
Q

Case 36

Define the four stages of ovarian cancer?

A

Stage I
- Cancer confined to the ovaries

Stage II
- Spread into the true pelvis

Stage III
- Extrapelvic peritoneal implants or LN mets

StageIV
- Distant hematogenous metastasis (usually liver)

99
Q

Case 36

What is the sensitivity of CT for ovarian peritoneal implants?

A

90%

100
Q

Case 37

What size hemorrhagic cyst requires 6 week followup?

A

> 3cm

101
Q

Case 37

DDx for a complex cystic ovarian/paraovarian mass

A

Hemorrhagic cyst
Tuboovarian abscess
Ectopic pregnancy
Ovarian tumor

102
Q

Case 37

Classical clinical presentation of hemorrhagic cyst?

A

Pelvic or abdominal pain that may wake the patient from sleep

103
Q

Case 38
T/F
Gas bubbles are common in TOA on CT.

A

False

104
Q

Case 38

How does a TOA occur?

A

Cervical or vaginal infection

  • Chlamydia
  • Gonorrhea

Spreads into

  • Endometrium
  • Fallopian tubes
  • Ovaries
105
Q

Case 39
What do fibroids look like on MRI?

What do degenerated fibroids look like?

A

Fibroids

  • Well-defined
  • Homogenous
  • Low T1/T2 relative to myometrium

Degenerating fibroids

  • Heterogenous
  • High T2 signal
  • Irregular enhancement
  • Difficult to differentiate vs Leiomyosarcoma
106
Q

Case 40

What is the most common cause of postmenopausal bleeding and how is it defined?

A

Endometrial atrophy

- ES thickness less than 4 mm

107
Q

Case 40

What endometrial thickness should prompt biopsy in a postmenopausal woman who is bleeding?

A

> 5 mm

Doesn’t matter if they are on hormones or not!

108
Q

Case 40

What endometrial thickness should prompt biopsy in a postmenopausal woman who is NOT bleeding?

A

> 8 mm

109
Q

Case 41
What feature makes a cervical cancer inoperable?

What stage would that be defined at?

A

Parametrial invasion

Stage IIb

110
Q

Case 41

How is cervical cancer treated based on stage (Ib/IIa vs IIb and higher)?

A

Ib and IIa

  • Radical hysterectomy
  • XRT

IIb and higher

  • XRT
  • Chemotherapy

“2b or not 2b” is what determines if surgery is possible

111
Q

Case 41

Is the incidence of cervical CA increasing or decreasing over the past 30 years?

A

Decreasing

112
Q

Case 41

FIGO guidelines for clinical staging of cervical cancer

A 
Bimanual pelvic exam
CXR
IVP
Cystoscopy
Imaging of lungs and skeleton
113
Q

Case 42

DDX for bilateral adrenal masses

A 
Adenomas
Metastasis
Hemorrhage
Granulomatous adrenalitis
Pheochormocytoma 
 - 10% are bilateral
114
Q

Case 42

What CT washout parameters define an adenoma?

A

50% washout at 10 minutes

60% washout at 15 minutes

115
Q

Case 43

What are causes of adrenal hemorrhage?

A 
Trauma
Sepsis
Coagulapthy
Anticoagulation therapy
Surgery
116
Q

Case 43

How often is adrenal hemorrhage bilateral in Neonates and adults?

A

Neonates
- 10%

Adults
- 20%

117
Q

Case 44
What is the most common cause of Adrenal pseudotumor?

Additional DDx?

A

Exophytic renal cyst

Splenule
Splenic artery aneurysm
Exophytic upper pole renal mass
Pancreatic body or tail mass
Gastric diverticulum
118
Q

Case 44
When is it advised to treat a splenic artery aneurysm and how is it treated?

Men vs Women?

A

If it is >2cm

  • Stenting
  • Embolization
  • Resection

Women
- 90% found in women pregnant more than once

119
Q

Case 44

Pseudolesions of the adrenal gland occur more frequently on which side?

A

Left

120
Q

Case 45

DDX of an adrenal mass that contains fat

A 
Adenoma
Myelolipoma
Exophytic renal AML
Retroperitoneal
 - Lipoma
 - Liposarcoma
121
Q

Case 45

An adrenal myelolipoma must be resected. True or False

A

False

  • Growth not an indication
  • Must be symptomatic
122
Q

Case 46

What are two entities that give false POSITIVE adrenal FDG-uptake in a patient with lung cancer and an adrenal mass?

A

Pheochromocytoma

Adenoma

123
Q

Case 46

What are two entities that give false NEGATIVE adrenal FDG-uptake in a patient with lung cancer and an adrenal mass?

A

Neuroendocrine tumor mets

BAC mets

124
Q

Case 47

What causes an adrenal adenoma to drop in signal on out-of-phase MRI in chemical shift imaging

A

Intracellular lipid

125
Q

Case 48

What is the treatment for a renal abscess

A

Antibiotics AND

Percutaneous drainage

126
Q

Case 49

What is a CT sign that there is impending AAA rupture on CT?

A

Intraluminal high density crescent

127
Q

Case 49

What is the likelihood that a >5cm aneurysm will rupture

A

40%

128
Q

Case 50

How does retropertinoeal fibrosis spread?

A

Encasement from the aorta to the IVC and ureters

129
Q

Case 50

How is RPF treated?

A

Ureteral stents temporarily

Surgical dissection or ureters for definitive treatment

130
Q

Case 51

In what zone of the Prostate gland does BPH occur?

A

Transitional zone

131
Q

Case 51
In what zone of the Prostate gland does cancer occur?

Nodules of benign prostate hyperplasia arise from which zone?

A

Peripheral zone - 85%

  • 10% Transitional
  • 5% Central

Transitional zone

132
Q

Case 51

What is the first structure that is affected when Prostate carcinoma transgresses the capsule?

A

The neurovascular bundle

133
Q

Case 52

DDX on US of a hypoechoic nodule in the peripheral zone

A 
Prostate carcinoma
Atypical hyperplasia
BPH nodule
Focal prostatitis
Cyst
134
Q

Case 52

On transrectal prostate US, what percentage of prostate carcinomas are hypoechoic?

A

70%

135
Q

Case 31

Most common malignancy associated with dermoid cyst?

A

Squamous Cell Carcinoma

136
Q

Case 53

What are sentinal nodes for right and left testicular cancer

A

Right

  • Paracaval
  • Inferior to the right renal artery

Left

  • Renal perihilar
  • Inferior to the left renal vein
137
Q

Case 48

What are the two mechanisms that cause a renal abscess?

A

Pyelonephritis

Hematogenous spread

137
Q

Case 53

How is Testicular cancer spread?

A 
First
 - Retroperitoneal lymph nodes
 - Via lymphatics
Then
 - Hematogenously
      - Lungs
      - Liver
      - Bone
      - Brain
137
Q

Case 53

Increased Alfa-fetoprotein and Human chorionic gonadotropin is seen in which types of testicular cancer

A

AFP

  • Yolk sac
  • Embryonal
  • Teratoma

HCG

  • Seminoma
  • Embryonal
  • Choriocarcinoma
137
Q

Case 31

Imaging findings suggesting malignant transformation of dermoid cyst?

A

Rapid growth
Infiltration of adjacent tissues
Extensive adhesions
Peritoneal Implants

137
Q

Case 34

What is a Rotanski nodule?

A
  • Mural nodule in an ovarian Dermoid

- Contains most of the solid teratomatous elements

138
Q

Case 54
Where is a scrotal pearl located?

Benign or premalignant?

A

Extratesticular
- Between the membranes of the tunica vaginalis

Benign

139
Q

Case 54

What are causes of a scrotal pearl?

A 
Inflammation
Torsion
 - Appendix testis
 - Epididymis
 Almost always assoc w/ hydroceles
140
Q

Case 55

What are causes of testicular calcifications

A

Testicular cancer
Resolved infection
Old hematoma
Prior infarct

141
Q

Case 55

What is recommended followup for testicular microlithiasis?

A

Controversial
Now considered benign
- Assoc w GCT based on a single study
- Some will do q 1 yr US to age 40

142
Q

Case 55

What is associated with testicular microlithiasis

A

Cryptorchidism
Testicular atrophy
Infertility

Genitourinary (2 decks)

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