Peds GU Flashcards
1
Q
vesicoureteral reflux –> predisposes to what?
A
predispose to acute pyelonephritis –> renal scarring –> irrev loss of renal fx
2
Q
vesicoureteral reflux –> grading?
A
I: reflux into ureter II: reflux into renal pelvis III: blunted calyces IV: mod hydroureter V: severe tortuous hydroureter
3
Q
vesicoureteral reflux –> what nuc med studies can evaluate VUR? (2)
A
- radionuclide cystogram (RNC)
- Tc-99m DMSA renal scintigraphy (DMSA scan)
4
Q
vesicoureteral reflux –> preferred initial study?
A
VCUG
5
Q
vesicoureteral reflux –> most sensitive study?
A
radionuclide cystogram (RNC)
6
Q
radionuclide cystogram (RNC) –> grading?
A
1: ureteral reflux
2: reflux up to calyces
3: hydroureter
7
Q
renal cortical scarring –> gold standard study?
A
Tc-99m DMSA renal scintigraphy (DMSA scan)
8
Q
radionuclide cystogram (RNC) –> what radionuclide?
A
Tc-99m pertechnetate
9
Q
what is Weigert-Meyer rule?
A
renal duplex system:
- upper moiety –> ectopic insertion –> inf-med
- lower moiety –> orthotopic insertion –> sup-lat
10
Q
renal duplex system –> upper vs lower moiety –> predisposed to what?
A
- upper moiety –> ureterocele –> obstruction
- lower moiety –> VUR
11
Q
hydronephrosis –> ddx? (2)
A
- VUR
- UPJ obstruction
12
Q
hydroureteronephrosis –> at UVJ level –> ddx? (2)
A
- VUR
- UVJ obstruction
13
Q
what is renal ptosis (nephroptosis?
A
“floating kidney” –> kidney drops down into pelvis when pt stand
14
Q
hydronephrosis –> unilat –> MCC?
A
UPJ obstruction
15
Q
UPJ obstruction –> cause? (3)
A
- aberrant renal A –> compress ureter
- ureter –> aperistaltic segment
- idiopathic
16
Q
congenital bladder outlet obstruction –> MCC?
A
posterior urethral valve
17
Q
posterior urethral valve –> bladder –> US findings?
A
dilated bladder –> trabeculations
18
Q
posterior urethral valve –> what is “keyhole”?
A
dilated posterior urethra + bladder
19
Q
posterior urethral valve –> which structures will be dilated? (3)
A
- prostatic urethra
- bladder
- renal collecting system
20
Q
prune belly synd –> consists of what triad?
A
- hydroureteronephrosis, renal dysplasia
- ant abd underdevelopmt
- cryptorchidism
21
Q
urethra, bladder, renal collecting system –> dilated –> ddx? (2) how to differentiate?
A
- posterior urethral valve –> only posterior urethra dilated
- prune belly synd –> entire urethra dilated
22
Q
ureterocele –> 2 types?
A
- ectopic –> ectopic ureter
- simple –> orthotopic ureter
23
Q
ureterocele –> US appearance?
A
cyst within bladder
24
Q
ureterocele –> VCUG appearance?
A
round filling defect in the bladder
25
obstruction at the UVJ--> causes? (2)
- ureterocele
| - primary obstructive megaureter
26
bladder outlet obstruction --> causes? (2)
- posterior urethral valve
| - neurogenic bladder
27
multicystic dysplastic kidney --> pathophys?
fetal urinary obstruction --> progressive renal dysplasia --> kidney gradually involutes
28
multicystic dysplastic kidney --> key finding?
mult NON-communicating cysts --> replace renal parenchyma
29
isolated simple renal cyst --> common or rare in children?
rare
30
isolated simple renal cyst --> if seen, may reflect what condition? (2)
- tuberous sclerosis
| - von Hippel-Lindau
31
tuberous sclerosis --> synd? (6)
- renal cysts
- renal angiomyolipoma
- cardiac rhabdomyoma
- CNS cortical hamartoma
- subependymal nodule
- subependymal giant cell astrocytoma
32
von Hippel-Lindau --> synd? (5)
- renal cysts
- RCC
- adrenal pheochromocytoma
- pancreatic cyst/islet cell tumor/serous cystadenoma
- brain/spinal cord hemangioblastoma
33
multilocular cystic nephroma --> benign or malig?
benign
34
multilocular cystic nephroma --> epidemiology?
- 3mo-2yo M
| - middle age F
35
multilocular cystic nephroma --> appearance?
multiseptated cystic mass --> enhancing septa
36
multilocular cystic nephroma --> characteristic finding?
herniate into renal pelvis --> hydronephrosis
37
kidney --> multiseptated cystic mass --> ddx? (2)
- multilocular cystic nephroma
| - cystic Wilms tumor
38
pediatric population --> ADPKD or ARPKD?
recessive
39
ARPKD --> kidneys --> US appearance?
cysts too small to see --> kidneys are enlrged & echogenic
40
ARPKD --> assoc w what fetal conditions? (2)
- oligohydramnios
| - pulm hypoplasia
41
Wilms tumor --> arises from what embryologic tissue?
persistent metanephric blastema
42
what conditions have increased risk for Wilms tumor? (4)
- Beckwith-Wiedemann synd
- WAGR synd
- horseshoe kidney
- trisomy 18
43
Beckwith-Wiedemann synd --> synd? (5)
- hemihypertrophy
- macroglossia
- omphalocele
- neonatal hypoglycemia
- childhood malig (ie Wilms tumor, hepatoblastoma)
44
WAGR synd --> synd? (4)
- Wilms tumor
- aniridia
- GU anomaly
- mental retard
45
Wilms tumor --> imaging appearance?
heterogeneous solid renal mass
46
heterogeneous solid renal mass --> pediatric --> ddx? (2) how to differentiate?
- Wilms tumor: 3-5yo
| - mesoblastic nephroma: <1yo
47
what is claw sign?
normal parenchyma surrounding large mass --> indicates that the mass is arising from that organ
48
Wilms tumor --> like to metastasize where? (3)
- liver
- lung
- bone
49
sickle cell --> predisposed to what kind of RCC?
renal medullary CA
50
rhabdoid tumor --> occurs in what organ? (2)
- kidney
| - brain
51
rhabdoid tumor --> imaging appearance?
lrg heterogeneous soft tissue mass --> ill-defined --> infiltrate renal hilum
52
clear cell sarcoma --> like to metastasize where? (1)
bone
53
pediatric --> renal mets --> MC primary? (2)
- neuroblastoma
| - leukemia/lymphoma
54
lymphoma --> renal mets --> imaging appearance? (2)
- mass
| - diffuse infiltration
55
mesoblastic nephroma --> benign or malig?
benign
56
heterogeneous solid renal mass --> may be benign mesoblastic nephroma --> tx? why?
can't differentiate from Wilms tumor --> surgical resection
57
mesoblastic nephroma --> arises from what embryologic tissue?
persistent mesonephric blastema
58
what is nephroblastomatosis?
persistence of metanephric blastema
59
nephroblastomatosis --> imaging appearance?
bilateral enlrged kidneys --> nonenhancing lobular masses/nodules
60
nephroblastomatosis --> precursor to what condition?
Wilms tumor
61
multiple renal angiomyolipomas --> what condition?
tuberous sclerosis
62
renal AML --> what size (cm) has risk of hemorrhage?
>4cm
63
renal AML --> key imaging characteristic?
macroscopic fat
64
persistent metanephric blastema --> can lead to what condition? (3)
- Wilms tumor
- mesoblastic nephroma
- nephroblastomatosis
65
pediatric --> mult solid renal masses --> ddx? (4)
- nephroblastomatosis
- lymphoma
- multifocal pyelonephritis
- multiple infarcts
66
neuroblastoma --> arises from what kind of tissue?
primitive neural crest cell --> sympathetic change
67
neuroblastoma --> MC arises from what organ?
adrenal gland
68
Wilms tumor --> displace or encase vessels?
displace
69
neuroblastoma --> displace or encase vessels?
encase
70
neuroblastoma --> calcifications or no calcifications?
50% have calcifications
71
neuroblastoma --> MRI --> does it demonstrate restricted diffuse? why?
hypercellular --> restricted diffusion
72
what NM scan can be used to evaluate neuroblastoma?
I-123 MIBG scintigraphy
73
metastatic neuroblastoma --> classic presentation?
intracranial subdural mass arising from BM
74
neuroblastoma --> MRI --> often seen invading into what?
neuroforamina & spinal canal
75
neuroblastoma --> mets --> MC organ?
BM
76
imaging features suggestive of neuroblastoma --> what is another differential consideration?
ganglioneuroma
77
ganglioneuroma --> benign or malig?
benign
78
neuroblastoma vs ganglioneuroma --> how to differentiate? (2)
neuroblastoma: very young (2yo) --> MRI restricted diffusion
ganglioneuroma: slightly older (6yo) --> no restricted diffusion
79
neuroblastoma --> benign or malig?
malig
80
adrenal hemorrhage --> US appearance?
hypoechoic avascular suprarenal mass
81
hypoechoic avascular suprarenal mass --> ddx? (2)
- adrenal hemorrhage
| - neuroblastoma
82
hypoechoic avascular suprarenal mass --> adrenal hemorrhage vs neuroblastoma --> how to differentiate? (2)
followup:
- adrenal hemorrhage --> involute
- neuroblastoma --> not involute
83
adrenal cortical CA --> assoc w what condition? (2)
- Beckwith-Wiedemann synd
| - Li-Fraumeni synd
84
urachal anomaly --> possible complication?
adenoCA
85
urachal anomaly --> 4 types?
- patent urachus
- urachal cyst
- urachal sinus
- vesicourachal diverticulum
86
what is duplication cyst?
rare congenital cystic malformation of GI tract
87
rectal duplication cyst --> locaiton?
retrorectal space
88
rectal duplication cyst --> tx? why?
malig potential --> surgical resect
89
what is hydrometrocolpos? can be seen in what pt pop?
neonatal --> fluid-filled vagina + uterus
90
what is hematometrocolpos? can be seen in what pt pop?
puberty --> blood-filled vagina + uterus
91
hydrometrocolpos or hematometrocolpos --> what does it indicate?
outflow tract obstruction (ie. congenital imperforate hymen)
92
mullerian duct cyst --> occur in M or F?
M only
93
mullerian duct cyst --> location?
midline pelvis --> usu prostate
94
midline prostatic cyst --> ddx? (2) how to differentiate? (3)
mullerian duct cyst:
- present 30s-40s yo
- not comm w urethra
- usu larger than utricle cyst --> extend above prostate
prostatic utricle cyst
- 10s-20s yo
- comm w urethra
- small --> not extend above prostate
95
what is prostatic utricle? normal or abnormal?
terminal remnant of Mullerian duct --> normal
96
MC sarcoma of childhood?
rhabdomyosarcoma
97
rhabdomyosarcoma --> MC locations? (2)
- head/neck
| - pelvis
98
8yo --> painless proptosis --> no infx --> dx?
rhabdomyosarcoma
99
US --> unilat empty renal fossa --> ddx? (2)
- renal agenesis
| - cross fused renal ectopia
