Radiology

Question 1

causes of renal colic

Answer 1

calculi
pyelonephritis
gynaecological disease

Question 2

what are calculi made of?

Answer 2

most are calcium dense

some are urate

Question 3

imaging for calculi

Answer 3

KUB XR

non-contrast enhanced CT (CT stone search)= GOLD standard

Question 4

what extra does non-contrast enhanced CT show in calculi diagnosis?

Answer 4

signs of obstruction e.g. perinephric stranding and hydroureteronephrosis

Question 5

what does non-contrast enhanced CT struggle to differentiate?

Answer 5

calculi and phleboliths

Question 6

when should CT be avoided?

Answer 6

pregnancy

non-pregnant young females

Question 7

management of calculi

Answer 7

IM diclofenac

Question 8

causes of macroscopic haematuria

Answer 8

calculi
infection
tumour
urethritis/prostatitis
trauma
clotting disorder

Question 9

investigations of macroscopic haematuria in over 50

Answer 9

CT urography (CTU)= upper tracts
cystoscopy= lower tracts

Question 10

describe CT urography

Answer 10

first scan without contrast then administer IV which is excreted by the kidneys over 15 minutes

detects renal parenchymal and urothelial tumours

Question 11

describe cystoscopy

Answer 11

bladder and urethra

option for ureteroscopy and ablate tumours in patients unfit for nephrourecterectomy

Question 12

what is different in investigation of macroscopic haematuria in under 50

Answer 12

incidence of tumours low in this age group so CT radiation dose unjustified

Question 13

investigations for macroscopic haematuria for under 50

Answer 13

US
cystoscopy
CTU (only if other tests normal)

Question 14

what does MR urography not require?

Answer 14

contrast and does not use radiation

Question 15

when is MR urography useful in macroscopic haemturia?

Answer 15

contrast allergy
renal impairment
pregnancy

Question 16

phases of using CT with contrast

Answer 16

• pre-contrast= best to depict calculi
• corticomedullary= cortex 25-70seconds
• nephrogenic= 80-180 seconds medulla
• excretory= 5-15 minutes collecting system

Question 17

risk when using CT with contrast?

Answer 17

CT-contrast induced nephropathy within 3 days in absence of alternative aetiology

Question 18

risk factors for CT-contrast induced nephropathy

Answer 18

renal impairment (DM)
dehydration
CHF
LV ejection fraction <40%
acute MI (within 24 hours)
nephrotoxic drugs

Question 19

how to reduce risk of CT-contrast nephropathy

Answer 19

• eGFR >60
• hydration protocols (saline NaHCO3 before and after scan)
• check renal function before

Question 20

imaging in pre-renal

Answer 20

MR angiography for RAS

Question 21

imaging in renal

Answer 21

US to guide biopsy

Question 22

imaging in post-renal

Answer 22

US to exclude hydronephrosis (may require CT)

Question 23

imaging for painful scrotum?

Answer 23

USS

Question 24

Epididymo-orchitis presentation on USS

Answer 24

hypervascular

Question 25

testicular torsion appearance on USS

Answer 25

avascular

Question 26

scrotal swelling imaging

Answer 26

USS (if prostate cancer can use MRI)

Question 27

what is used to assess fertility (tubal patency) and uterine anomalies?

Answer 27

hysterosalpingogram

Question 28

imaging for urinary tract trauma

Answer 28

CT | USS

Question 29

diagnosis of bladder rupture

Answer 29

cystography or CT cystography

Question 30

types of bladder rupture

Answer 30

extraperitoneal (conservative) | intraperitoneal (surgery)

Question 31

causes of urethral disruption

Answer 31

anterior pelvic fracture /dislocation | straddle injury

Question 32

when do you not attempt catheterisation?

Answer 32

suspicion of urethral disruption

Question 33

presentation of urethral disruption

Answer 33

meatal bleeding | can't pass urine

Question 34

what is used to assess stricture formation in urethral trauma?

Answer 34

urethrography

Question 35

non-vascular interventional radiology

Answer 35

nephrostomy- catheter and stent drainage biopsy guided ablation of tumours (RFA, cryoablation)

Question 36

vascular interventional radiology

Answer 36

embolisation | stenting

Question 37

risk in kidneys when using MRI

Answer 37

nephrogenic systemic fibrosis

Question 38

cause of nephrogenic systemic fibrosis

Answer 38

exposure to gadolinium contrast in MRI

Question 39

presentation of nephrogenic systemic fibrosis

Answer 39

``` skin erythema pruritis pain joint contractures, respiratory insufficiency and muscular atrophy skin thickens and appears wood-like ```

Question 40

what increases risk of nephrogenic fibrosis?

Answer 40

renal impairment