Renal and Adrenal Pathology

Question 1

Large Adrenocortical Carcinoma’s have a tendency to invade what structures?
Correct answer:

adrenal veins and IVC

pancreas and splenic veins

aorta and kidneys

renal arteries and aorta

Answer 1

adrenal veins and IVC

Question 2

This tumor is rare with a poor prognosis. They can be aggressive and grow larger than 6cm.

adrenocortical carcinoma

pheochromocytoma

adrenal hemorrhage

adrenal neuroblastoma

Answer 2

adrenocortical carcinoma

Question 3

This tumor is associated with Von Hippel Lindau Disease. It secretes catecholamine. What is it?

Adrenal Adenoma

Pheochromocytoma

Adrenal Carcinoma
Adrenal Lymphoma

Answer 3

Pheochromocytoma

Question 4

Which kidney pathology is caused by ischemic necrosis of the cortex with sparing of the medullary pyramids? This condition is rare but does cause acute renal failure. It is associated with burn patients, severe dehydration, and snake bites.

Acute tubular necrosis

Papillary necrosis

Acute cortical necrosis

Acute glomerulonephritis

Answer 4

Acute cortical necrosis

Question 5

_____ is defined as tubulointerstitial inflammation of the kidney. Most commonly, this infection is caused by E coli from the intestinal tract that ascends to the kidney from the bladder.

Emphysematous pyelonephritis

Acute pyelonephritis

Xanthogranulomatous

Papillary necrosis

Answer 5

Acute pyelonephritis

Question 6

This renal pathology is associated with multiple cysts in bilateral kidneys, the most common hereditary renal disorder. It’s usually asymptomatic, but can cause renal failure, hematuria, abdominal pain, and HTN in the patients 50s.

Autosomal dominant polycystic kidney disease

Autosomal recessive polycystic kidney disease

Emphysemtatous pyelonephritis

Acute cortical necrosis

Answer 6

Autosomal dominant polycystic kidney disease

Question 7

A patient comes into the ultrasound department for a renal scan. He has complaints of pain and hematuria. While reviewing the patient’s medical history, the sonographer notes that the patient has been on long-term hemodialysis. Sonographically, the kidneys are small and echogenic. 3-5 cysts are noted with internal echoes. The likely diagnosis is

Angiomyolipoma

Acquired cystic disease

Mycetoma

Emphysematous pyelonephritis

Answer 7

Acquired cystic disease

Question 8

What is the most common cause of acute reversible renal failure?

Acute glomerulonephritis

Acute cortical necrosis
Acute tubular necrosis

Acute pyelonephritis

Answer 8

Acute tubular necrosis

Question 9

This condition likely began in childhood. It can be unilateral or bilateral. When unilateral, the contralateral kidney can be affected. What disease is visualized here?

Chronic pyelonephritis

Pyenephosis

Medullary sponge kidney

Acute pyelonephritis

Answer 9

Chronic pyelonephritis

Question 10

Simple renal cysts occur in approximately 33% of people over ______ years.

50

30

40

60

Answer 10

60

Question 11

What is another name for mycetoma?

Renal cell carcinoma

Fatty tumor

Sludge
Fungus balls

Answer 11

Fungus balls

Question 11

This is the most common congenital urinary tract anomaly, it can be complete or incomplete.

Crossed fused renal ectopia

Renal agensis

Duplex collecting system

Medullary cystic disease

Answer 11

Duplex collecting system

Question 12

This is an uncommon, but life-threatening infection. Symptoms include fever, flank pain, and dehydration. It is characterized by gas formation in the kidney that produces dirty shadowing.

Acute tubular necrosis

Chronic pyelonephritis

Acute glomerulonephritis

Emphysematous pyelonephritis

Answer 12

Emphysematous pyelonephritis

Question 13

_____________ is defined as an inflammation response resulting in glomerular damage caused by systemic disease. Symptoms include HTN, hematuria, and azotemia. Sonographically, the kidneys may be enlarged however will return to normal size with treatment.

Glomerulonephritis

Cortical necrosis

Pelonephritis

Acute tubular necrosis

Answer 13

Glomerulonephritis

Question 14

The pathology shown here is defined as dilation of the calices that communicate with the central collecting system of the kidney.

Hydronephrosis

Medullary cystic disease

Pyonephrosis

Emphysematous pyelonephrosis

Answer 14

Hydronephrosis

Question 15

This pathology shown here results in dilated collecting tubules and usually occurs in the 3rd to 4th decade of life. It is associated with autosomal recessive polycystic kidney disease and Caroli disease. If stones are present, then hematuria, pain and dysuria may occur.

Medullary sponge kidney

Mycetoma

Angiomyolipoma

Medullary cystic disease

Answer 15

Medullary sponge kidney

Question 15

This pathology will sonographically demonstrate multiple non-communicating cysts, absence of normal renal parenchyma and sinus, and focal echogenic areas. The kidney is usually small and malformed.

Multicystic dysplastic kidney

Crossed fused renal ectopia

Pyonephrosis

Xanthogranulomatous

Answer 15

Multicystic dysplastic kidney

Question 16

The following image was obtained from an ER patient with acute right-side back/flank pain. The lab report on the blood test shows hypercalcemia. The pathology being demonstrated here is __________.

Acute tubular necrosis

Papillary necrosis

Nephrocalcinosis

Chronic pyelonephritis

Answer 16

Nephrocalcinosis

Question 17

This pathology is uncommon. Sonographically, it has a central scar which suggests this pathology. However, the presence of the scar does not rule out it possibly being RCC. In fact, this pathology is indistinguishable from RCC by imaging.
Wilm’s tumor

Mycetoma

Oncocytoma

Angiomyolipoma

Answer 17

Oncocytoma

Question 18

Analgesic abuse, diabetes, UTI, and dehydration are associated causes for which renal pathology? This can be diagnosed clinically with a urine sample.

Papillary necrosis

Acute cortical necrosis

Acute tubular necrosis

Acute glomerulonephritis

Answer 18

Papillary necrosis

Question 19

_________ is defined as purulent material in the collecting system of the kidney and is associated with infection that is secondary to renal obstruction.

Acute tubular necrosis

Acute pyelonephritis

Pyonephrosis

Xanthogranulomatous

Answer 19

Pyonephrosis

Question 20

This renal pathology is associated with Von Hippel-Lindau disease, tuberous sclerosis, acquired cystic kidney disease, and carcinogens. Symptoms include flank pain, a palpable mass, and hematuria.

Mycetoma

Xanthogranulomatous

RCC

Pyonephrosis

Answer 20

RCC

Question 21

The patient you are scanning has recently had a renal transplant. Upon examination, you find an enlarged, hypoechoic kidney with a dilated renal vein that appears to have an absence of venous flow within the kidney. What renal pathology is suggested by these findings?

Renal artery thrombosis

Renal vein thrombosis

Acute cortical necrosis

Acute glomerulonephritis

Answer 21

Renal vein thrombosis

Question 22

Stones can cause irritation to the urinary bladder wall.

True

False

Answer 22

True

Question 23

This neoplasm most commonly occurs in the urinary bladder but can also occur in the ureters or renal pelvis. Urachal cyst RCC Benign prostatic hyperplasia TCC

Answer 23

TCC

Question 24

Where is a transplanted kidney placed in the patient? under the liver in the pelvis in the renal fossa under the spleen

Answer 24

in the pelvis

Question 25

________ is a multi-system disease associated with renal cysts and angiomyolipomas. The classic presentation includes mental retardation, seizures, and adenoma sebaceum. Multiple sclerosis Tuberous sclerosisis Infantile polycystic kidney disease Wilm's tumor

Answer 25

Tuberous sclerosisis

Question 26

The pathology shown in this image is a form of a chronic infection that causes destruction of the renal parenchyma. A large staghorn calculus may be present with this disease. If the calculus is present, the central renal sinus will have shadowing. Xanthogranulomatous pyelonephritis Pyonephrosis Papillary necrosis Chronic pyelonephritis

Answer 26

Xanthogranulomatous pyelonephritis

Question 27

_____________ is defined as an inflammation response resulting in glomerular damage caused by systemic disease. Symptoms include HTN, hematuria, and azotemia. Sonographically, the kidneys may be enlarged however will return to normal size with treatment. Glomerulonephritis Cortical necrosis Pelonephritis Acute tubular necrosis

Answer 27

Glomerulonephritis

Question 28

This patient has Cushing's Syndrome and a hx of steroid use. You find this above the kidney. What is this most likely? Adrenal Neuroblastoma Adrenal Adenoma Polycystic Ovary disease Adrenal Lymphoma

Answer 28

Adrenal Adenoma

Question 29

Does adrenocortical carcinoma have a good prognosis? No Yes

Answer 29

No

Question 30

Fungal balls are hyperechoic and produce a posterior acoustic shadow. True False

Answer 30

False

Question 31

Autosomal recessive polycystic kidney disease is divided into ____ types. 2 3 4 5

Answer 31

4

Question 32

Which of the following characteristics would be considered atypical for a renal cyst and suggest malignancy? irregular walls solid component multiple thick septations all listed none listed

Answer 32

all listed

Question 33

Simple renal cysts occur in approximately 33% of people over ______ years. 50 30 40 60

Answer 33

60

Question 34

Which kidney pathology is caused by ischemic necrosis of the cortex with sparing of the medullary pyramids? This condition is rare, but does cause acute renal failure. It is associated with burn patients, severe dehydration, and snake bites. Acute tubular necrosis Papillary necrosis Acute cortical necrosis Acute glomerulonephritis

Answer 34

Acute cortical necrosis

Question 35

Ischemia of the medullary pyramids is called ___________. Acute tubular necrosis Papillary necrosis Hydronephrosis Pyonephrosis

Answer 35

Papillary necrosis

Question 36

Angiomyolipoma is another name for renal fungal balls. True False

Answer 36

False

Question 37

What pathology is a disorder of calcium metabolism that results in the formation of calcifications in the renal parenchyma? Nephrocalcinosis Papillary necrosis Medullary cystic disease Xanthogranulomatous

Answer 37

Nephrocalcinosis

Question 38

True or False: Multicystic dysplastic kidney disease is typically unilateral. True False

Answer 38

True

Question 39

Analgesic abuse, diabetes, UTI, and dehydration are the associated causes for which renal pathology? Papillary necrosis Acute cortical necrosis Acute tubular necrosis Acute glomerulonephritis

Answer 39

Papillary necrosis

Question 40

_____ is defined as tubulointerstitial inflammation of the kidney. Most commonly, this infection is caused by E coli from the intestinal tract that ascends to the kidney from the bladder. Emphysematous pyelonephritis Acute pyelonephritis Xanthogranulomatous pyelonephritis Papillary necrosis

Answer 40

Acute pyelonephritis

Question 41

Adrenocortical Carcinoma's have a tendency to invade what structures? Renal Arteries and Aorta adrenal veins and IVC Aorta and Kidneys Pancreas and Splenic veins

Answer 41

adrenal veins and IVC

Question 42

Renal transplant is the treatment of choice for chronic renal failure severe enough to warrant dialysis. This treatment occurrence has increased, what has also increased? refusing treatment living donors cadaver donors

Answer 42

living donors

Question 43

What is the most common cause of acute reversible renal failure? Acute glomerulonephritis Acute cortical necrosis Acute tubular necrosis Acute pyelonephritis

Answer 43

Acute tubular necrosis

Question 44

Adrenal mets are the ____ malignant adrenal lesion. 3rd 2nd most common

Answer 44

most common

Question 45

This is a non-hereditary development anomaly that produces small, malformed kidneys with multiple cysts. There is a contralateral UPJ obstruction approx. 30% of the time. What is it? Xanthogranulomatous Emphysematous pyelonephritis RCC Multicystic Dysplastic Kidney

Answer 45

Multicystic Dysplastic Kidney

Question 46

Bladder _________ are herniations of the bladder mucosa through the bladder wall muscles. ureterocele diverticula papilloma urinoma

Answer 46

diverticula

Question 47

Sonographically, stones have echogenic appearance and produce ________. posterior enhancement comet-tail reverberation posterior shadowing

Answer 47

posterior shadowing

Question 48

The sonographic appearance of a simple cyst includes round or oval shape, absence of internal echoes, sharply defined thin wall, and _________. posterior acoustic shadowing posterior acoustic enhancement comet-tail reverberation thick septations

Answer 48

posterior acoustic enhancement

Question 49

This renal disease can lead to sepsis and shock if left untreated. Debris-fluid levels maybe be visualized. What disease is this? Emphysematous pyelonephritis Pyonephrosis RCC Acute pyelonephritis

Answer 49

Pyonephrosis

Question 50

This disease is transmitted as an autosomal dominant gene. Renal cysts are found in 76% of patients. 75-90% of patients with this disease will have renal cell carcinoma. CT/MRI is actually better for detecting this disease. Medullary sponge kidney Mycetoma Von Hippel-Lindau disease Acute tubular necrosis

Answer 50

Von Hippel-Lindau disease

Question 51

This pathology is predominantly seen in middle-aged women. It is a benign renal tumor composed of fat. Its echogenicity is equal to or greater than that of the renal sinus. The lesion will be asymptomatic, unless it grows too large and causes complications. Acute tubular necrosis Xanthogranulomatous Papillary necrosis Angiomyolipoma

Answer 51

Angiomyolipoma

Question 52

This condition may be unilateral or bilateral, 3:1 male, and is related to malformation of the ureteral bud. If the condition exists bilaterally, it will be incompatible with life. Renal agenesis Crossed ectopic kidneys Adenomas Hypertrophied column of Bertin

Answer 52

Renal agenesis

Question 53

________ is the most common solid renal mass in adults. Angiomyolipoma Mycetoma RCC TCC

Answer 53

RCC

Question 54

With renal agenesis, both the kidney and the adrenal gland are absent on the affected side. True False

Answer 54

False

Question 55

The ________ type of infantile polycystic kidney disease will present with massive renal enlargement, oligohydraminos, and hypoplastic lungs. Death usually occurs. perinatal neonatal infantile juvenile

Answer 55

perinatal

Question 56

This pathology shown here results in dilated collecting tubules and usually occurs in the 3rd to 4th decade of life. It is associated with autosomal recessive polycystic kidney disease and Caroli disease. If stones are present, then hematuria, pain and dysuria may occur. Medullary sponge kidney Mycetoma Angiomyolipoma Medullary cystic disease

Answer 56

Medullary sponge kidney

Question 57

________ is a multi-system disease associated with renal cysts and angiomyolipomas. The classic presentation includes mental retardation, seizures, and adenoma sebaceum. Multiple sclerosis Tuberous sclerosisis Infantile polycystic kidney disease Wilm's tumor

Answer 57

Tuberous sclerosisis

Question 58

A mass or focal thickening of the bladder wall should raise suspicion of _________. malignancy ureterocele stone hematoma

Answer 58

malignancy

Question 59

True or False: Renal mets often come from primary tumor sites in the lungs, breast, or RCC of the contralateral kidney. True False

Answer 59

True

Question 60

________ is defined as diffuse bladder wall thickening. Cystitis Papilloma TCC Bladder diverticula

Answer 60

Cystitis

Question 61

_________ occurs when the developing kidneys fuse in the pelvis and one kidney ascends to its normal position, pulling the other kidney with it across the midline. They are often attached upper pole to lower pole. Renal agenesis Adult polycystic kidney disease Infantile polycystic kidney disease Crossed fused ectopia

Answer 61

Crossed fused ectopia

Question 62

What is another name for mycetoma? Renal cell carcinoma Fatty tumor Sludge Fungus balls

Answer 62

Fungus balls

Question 63

________ is a walled off collection of extravasated urine that develops after surgery, trauma, or urinary obstruction. It is usually located around the kidney in the perinephric space. Hematoma Urinoma Lymphoma Diverticulum

Answer 63

Urinoma

Question 64

A patient presents to the department with fever and left flank pain. The lab report for the patient's urine sample states leukocytosis, bacteriuria, and pyuria. Ultrasound exam reveals renal enlargement and hypoechoic parenchyma. What pathology is most likely present? Medullary cystic disease Acute pyelonephritis Emphysematous pyelonephritis Mycetoma

Answer 64

Acute pyelonephritis

Question 65

Stones can cause irritation to the urinary bladder wall. True False

Answer 65

True

Question 66

The patient you are scanning has recently had a renal transplant. Upon examination, you find an enlarged, hypoechoic kidney with a dilated renal vein that appears to have a thrombus. Color doppler reveals an absence of venous flow within the kidney. What renal pathology is suggested by these findings? Renal artery thrombosis Renal vein thrombosis Acute cortical necrosis Acute glomerulonephritis

Answer 66

Renal vein thrombosis

Question 67

This pathology will sonographically demonstrate multiple non-communicating cysts, absence of normal renal parenchyma and sinus, and focal echogenic areas. The kidney is usually small and malformed. Multicystic dysplastic kidney Crossed fused renal ectopia Pyonephrosis Xanthogranulomatous

Answer 67

Multicystic dysplastic kidney

Question 68

This is an uncommon, but life-threatening infection. Symptoms include fever, flank pain, and dehydration. It is characterized by gas formation in the kidney that produces comet-tail artifact. Acute tubular necrosis Chronic pyelonephritis Acute glomerulonephritis Emphysematous pyelonephritis

Answer 68

Emphysematous pyelonephritis

Question 69

Stones can only cause an obstruction if they are located in the kidney. True False

Answer 69

False

Question 70

Which adrenal tumor is associated with the speed propagation artifact? Neuroblastoma Pheochromocytoma Adrenal Adenom Myelolipoma

Answer 70

Myelolipoma

Question 71

Of the options below, which are malignant adrenal masses? adrenal adenoma lymphoma pheochromocytoma adrenocortical carcinoma

Answer 71

adrenocortical carcinoma lymphoma

Question 72

Stones can only appear in the bladder. They are never seen in the kidneys. True False

Answer 72

False

Question 73

Adrenal adenomas can be: A. functioning B. nonfunctioning C. non-Specific D. specific A & B C & D

Answer 73

A & B

Question 74

_________ is defined as purulent material in the collecting system of the kidney and is associated with infection that is secondary to renal obstruction. Acute tubular necrosis Acute pyelonephritis Pyonephrosis Xanthogranulomatous

Answer 74

Pyonephrosis

Question 75

This tumor is associated with Von Hippel Lindau Disease. It secretes Catecholamines. What is it? Adrenal Lymphoma Adrenal Adenoma Adrenal Carcinoma Pheochromocytoma

Answer 75

Pheochromocytoma

Question 76

This disease is an autosomal dominant condition that usually presents itself in a patients 30s or 40s. Sonographically, the kidneys appear small and echogenic with medullary cysts. ADPKD Acquired cystic disease RCC Medullary cystic disease

Answer 76

Medullary cystic disease

Question 77

What is often present that can be a cause of hydronephrosis? a parasite a bacterial infection an obstruction a fungal infection

Answer 77

an obstruction

Question 78

________ is the most common fungal agent that affects the urinary tract. Candida Albicans Herpes Staphylococcus Schistosomiasis

Answer 78

Candida Albicans

Question 79

_______ appear as a cyst-like enlargement of the lower end of the ureter as it projects out into the bladder lumen. Diverticula Urachal cyst Papilloma Ureterocele

Answer 79

Ureterocele

Question 80

Your ultrasound patient presents with flank pain. Sonographically, the right kidney appears normal but with a focal hypoechoic area, and color doppler reveals absence of intrarenal arterial flow in this area. The patient most likely has ______. Renal artery occlusion Renal vein thrombosis Acute glomerulonephritis Hydronephrosis

Answer 80

Renal artery occlusion

Question 81

Pheochromocytomas secrete what? Nor-epinephrine Alk Phos Catecholamines Creatinine

Answer 81

Catecholamines

Question 82

___________ are usually associated with duplex kidney and complete ureteral duplication. This can result in the obstruction of the collecting system resulting in recurrent UTI. Papilloma Ureteroceles Bladder diverticula Urachal cyst

Answer 82

Ureteroceles

Question 83

Can adrenal masses be differentiated with ultrasound alone? True False

Answer 83

False

Question 84

This renal pathology is associated with Von Hippel-Lindau disease, tuberous sclerosis, acquired cystic kidney disease, and carcinogens. Symptoms include flank pain, a palpable mass, and hematuria. Mycetoma Xanthogranulomatous RCC Pyonephrosis

Answer 84

RCC

Question 85

Stones are commonly found in the bladder. This is because the stones have moved there from the kidneys or because the stones formed in the bladder as a result of urinary stasis. True False

Answer 85

True

Question 86

This pathology is uncommon. Sonographically, it has a central scar which suggests this pathology. However, the presence of the scar does not rule out RCC. In fact, this pathology is indistinguishable from RCC by imaging. Wilm's tumor Mycetoma Oncocytoma Angiomyolipoma

Answer 86

Oncocytoma

Question 87

Which of the following describes the possible sonographic appearance of RCC? select all that apply. hypoechoic hyperechoic isoechoic may contain calcifications

Answer 87

hypoechoic hyperechoic isoechoic may contain calcifications

Question 88

This is the most common congenital urinary tract anomaly, it can be complete or incomplete. Crossed fused renal ectopia Renal agensis Duplex collecting system Medullary cystic disease

Answer 88

Duplex collecting system

Question 89

Adrenal involvement with this is common and usually bilateral. Non-Hodgkin is the most common cell type. What is the condition? Adenoma Neuroblastoma Adrenal Mets Lymphoma

Answer 89

Lymphoma

Question 90

This neoplasm most commonly occurs in the urinary bladder but can also occur in the ureters or renal pelvis. Urachal cyst RCC Benign prostatic hyperplasia TCC

Answer 90

TCC

Question 91

A patient comes into the ultrasound department for a renal scan. He has complaints of pain and hematuria. While reviewing the patient's medical history, the sonographer notes that the patient has been on long-term hemodialysis. Sonographically, the kidneys are small and echogenic. 3-5 cysts are noted with internal echoes. The likely diagnosis is Angiomyolipoma Acquired cystic disease Mycetoma Emphysematous pyelonephritis

Answer 91

Acquired cystic disease

Question 92

This tumor is rare with a poor prognosis. They can be aggressive and grow larger than 6cm. adrenal hemorrhage adrenocortical carcinoma pheochromocytoma adrenal neuroblastoma

Answer 92

adrenocortical carcinoma

Question 92

Which kidney is displaced by an adrenal tumor? Contralateral Ipsilateral

Answer 92

Ipsilateral

Question 93

RCC often spreads from the kidney to which nearby structures? renal artery and Aorta colon and IVC: renal vein and IVC adrenal glands and Aorta

Answer 93

renal vein and IVC

Question 94

This renal pathology is associated with multiple cysts in bilateral kidneys, the most common hereditary renal disorder. It's usually asymptomatic, but can cause renal failure, hematuria, abdominal pain, and HTN in the patients 50s. Autosomal dominant polycystic kidney disease Autosomal recessive polycystic kidney disease Emphysemtatous pyelonephritis Acute cortical necrosis

Answer 94

Autosomal dominant polycystic kidney disease