Radiology

Question 1

two modalities for visualising ureteric calculi

Answer 1

1. KUB XR

2. non-contrast enhanced CT

Question 2

which modality is first line for imaging ureteric calculi?

Answer 2

non-contrast enhanced CT

also shows complications and alternative diagnoses (appendicitis, hernia)

Question 3

when should non-contrast enhanced CT be avoided for imaging ureteric calculi?

Answer 3

pregnant

young females

Question 4

management of ureteric calculi

Answer 4

IM diclofenac

Question 5

causes of macroscopic haematuria

Answer 5

calculi
infection
tumour
trauma
clotting disorders

Question 6

investigations in >50s for macroscopic haematuria

Answer 6

1. CT urography

2. cystoscopy

Question 7

describe CT urography

Answer 7

scan then add contrast which is excreted over 15 minutes

Question 8

what does CT urography detect?

Answer 8

renal parenchyma and urothelial tumours

typically used for upper tracts

Question 9

what does a cystoscopy examine?

Answer 9

bladder and urethra

allows ureteroscopy or ablation of tumours

Question 10

why is investigations for macroscopic haematuria different if <50?

Answer 10

incidence of tumours is low so CT radiation unjustified

Question 11

methods used to investigate macroscopic haematuria in <50s?

Answer 11

USS
cystoscopy
CTU

Question 12

what does USS show?

Answer 12

calculi

renal parenchymal tumours

Question 13

what can cystoscopy diagnose?

Answer 13

bladder TCC
bladder calculi
tumours
urethritis/prostatitis

Question 14

when is CTU used in macroscopic haematuria of the <50s?

Answer 14

when other tests are norma

Question 15

when is MR urography useful?

Answer 15

contrast allergy
renal impairment
pregnant

Question 16

four phases of CT with contrast

Answer 16

1. pre-contrast (best to depict calculi)
2. corticomedullary
3. nephrogenic
4. excretory

Question 17

what is the corticomedullary phase of CT with contrast?

Answer 17

cortical enhancement 25-70 seconds after IV injection

Question 18

what is nephrogenic phase of CT with contrast?

Answer 18

80-180 seconds where the renal medulla enhances

Question 19

what is the excretory phase of CT with contrast?

Answer 19

5-15 minutes there is opacification of renal collecting systems

Question 20

what is the risk of using contrast in renal CT scan?

Answer 20

contrast-induced nephropathy (ATN)

Question 21

what is contrast-induced nephropathy?

Answer 21

impairment of renal function within 3 days of CT contrast

Question 22

management of contrast-induced nephropathy

Answer 22

follow hydration protocols (saline before and after using NaHCO3 rather than NaCl)

check renal function before CT

Question 23

imaging option in pre-renal impairment

Answer 23

MR angiography for RAS

Question 24

imaging in renal impairment

Answer 24

USS to guide biopsy

Question 25

imaging in post-renal impairment

Answer 25

USS to exclude hydronephrosis | may require CT

Question 26

imaging for painful scrotum or swelling

Answer 26

USS

Question 27

diagnosis of epidiymo-orchitis on USS

Answer 27

hypervascular

Question 28

testicular torsion diagnosis on USS

Answer 28

avascular

Question 29

what is hysterosalpingogram (HSG) used for?

Answer 29

infertility investigation into tubal patency | uterine anomalies

Question 30

two types of bladder rupture

Answer 30

1. extraperitoneal (conservative management) | 2. intraperitoneal (surgery)

Question 31

imaging modalities used for bladder rupture

Answer 31

cystography | CT cystography as contrast leaks through

Question 32

causes of urethral disruption

Answer 32

anterior pelvic fracture/dislocation | straddle injury

Question 33

management of urethral disruption

Answer 33

if suspicious DO NOT catheterise

Question 34

non-vascular interventional radiology

Answer 34

relief of obstruction (nephrostomy- catheter and stent) drainage of abscess or cyst biopsy of renal masses guided ablation of renal tumours (RFA, cryoablation)

Question 35

vascular interventional radiology

Answer 35

``` control bleeding (embolisation) varicocoele embolisation ```

Question 36

risk to the kidneys when using MRI?

Answer 36

nephrogenic systemic fibrosis caused by exposure to gadolinium

Question 37

presentation of nephrogenic systemic fibrosis

Answer 37

skin erythema pruritis pain can cause joint contractures, respiratory insufficiency and muscular atrophy