Urinary Tract Flashcards by lindsay crouse

Which of the following is a childhood, autoimmune disease that results in the development of purple spots in the skin and possible renal failure?

Henoch-Schoblein purpura
azotemia
von hippel-lindau syndrome
xanthogranulomatous pyelonephritis

Henoch-Schoblein purpura

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what is the functional unit of the kidney?

nephron
medulla
cortex
bowman capsule

nephron

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which would be most indicative of renal artery stenosis?

decreased cortical echogenicity
renal:AO ratio greater than 3.5
enlarged kidney
tardus-parvus waveform upstream to the stenosis

renal:AO ratio greater than 3.5

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the kidneys are:

intraperitoneal organs
retroperitoneal organs
both intraperitoneal & retroperitoneal
neither

retroperitoneal

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the protective capsule of the kidneys is referred to as:

glisson capsule
perirenal capsule
renal capsule
renal cortex

renal capsule

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the vessel located anterior to the abdominal AO and posterior to the SMA is the:

celiac artery
LRA
RRV
LRV

LRV

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which would NOT be a typical clinical feature of renal transplant failure?

oliguria
proteinuria
hypotension
elevated creatinine

hypotension

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enlargement of the unaffected contralateral kidney with unilateral renal agenesis or compromised renal function is referred to as:

dromedary hypertrophy
renal hypoplasia
supernumerary kidney
compensatory hypertrophy

compensatory hypertrophy

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a bulge on the lateral border of the kidney is referred to as:

duplicated kidney
renal hypoplasia
dromedary hump
supernumerary kidney

dromedary hump

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the most common congenital anomaly of the urinary tract is:

horseshoe kidney
duplicated collecting system
renal agenesis
renal hypoplasia

duplicated collecting system

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a renal scar most likely appears as:

a hypoechoic mass in the renal parenchyma

a linear anechoic space in the renal cortex

a hyperechoic, rounded structure within the renal parenchyma that shadows

an echogenic area that extends from the renal sinus through the renal parenchyma

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what is the most common location of an ectopic kidney?

thoracic cavity
pelvis
contralateral fossa
LUQ

pelvis

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all of the following are clinical findings of ARF except:

hematuria
hypertension
oliguria
decreased BUN and creatine

decreased BUN and creatine

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which is true regarding a duplex collecting system with complete urethral duplication?

the upper pole of the kidney suffers from reflux

the lower pole suffers from obstruction because of a varicocele

the upper pole suffers from obstruction because of a ureterocele

the lower pole suffers from reflux and hypertrophy

the upper pole suffers from obstruction because of a ureterocele

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which is the most common cause of CRF?

HTN
diabetes mellitus
ARPKD
acute tubular necrosis

diabetes mellitus

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what renal cystic disease would be most likely caused by, and thus associated with hemodialysis?

MCDK
ADPKD
acquired renal cystic disease
ARPKD

acquired renal cystic disease

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sonographically, compared to normal kidneys, those affected by CRF will appear:

normal in size with a decreased echogenicity

smaller in size and hypoechoic

larger in size and more echogenic

smaller in size and more echogenic

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renal cysts that project out away from the kidneys are termed:

exophytic
perapelvic
cortical
peripelvic

exophytic

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A female presents with a history of leukocytosis, dysuria, lower abdominal pain, and hematuria. Sonographically, the kidneys appear normal, although the bladder wall measures 6mm on the distended state. What is the most likely diagnosis?

glomerulonephritis
xanthogranulomatous pyelonephritis
cystitis
TCC of bladder

cystitis

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the inherited disorder associated with the development of tumors of the CNS and orbits, renal cysts, and adrenal tumors is:

tuberous sclerosis
tuberculosis
von hippel-lindau syndrome
MCDK

von hippel-lindau syndrome

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what is the most likely location of TCC in the kidney?

cortex
medulla
minor calyx
renal pelvis

renal pelvis

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which is the most common cause of ARF?

HTN
diabetes
ARPKD
acute tubular necrosis

acute tubular necrosis

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all of the following are characteristics of a complex cyst EXCEPT:

internal echoes
smooth walls
mural nodules
septations

smooth walls

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which would most likely present with a clinical finding of hematuria?

hemorrhagic renal cyst
milk of calcium renal cyst
simple renal cyst
angiomyolipoma

hemorrhagic renal cyst

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which of the following would be considered the most common solid renal mass? renal hematoma angiomyolipoma oncocytoma hypernephroma

angiomyolipoma

infantile polycystic kidney disease may also be referred to as: ARPKD ADPKD MCDK acquired renal cystic disease

ARPKD

which of the following best describes the sonographic appearance of a kidney affected by ARPKD? bilateral enlarged, echogenic kidneys unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossa small, echogenic kidneys numerous, large, complex renal cysts

bilateral enlarged, echogenic kidneys

the systemic disorder associated with epilepsy that leads to the development of solid tumors in various organs, including angiomyolipomas of the kidneys is: tuberous sclerosis tuberculosis von hippel-lindau syndrome MCDK

tuberous sclerosis

what is the most common clinical finding of a simple renal cyst? hematuria quadrant pain elevated BUN asymptomatic

asymptomatic

suspicion of cortical thinning should occur when the renal cortex measures: greater than 2mm less then 1cm greater than 5mm less than 3cm

less than 1cm

which is NOT considered an extrinsic cause of hydronephrosis? ureteral stricture pregnancy neurogenic bladder uterine leiomyoma

ureteral stricture

which would be a common finding in a patient undergoing peritoneal dialysis? hemorrhage ascites RA stenosis RV thrombosis

ascites

the presence of purulent material within the renal collecting system is termed: pylotosis pyelonephritis pyonephrosis emphysematous pyelonephritis

pyonephrosis

the most common cause of fungal urinary tract infections is: candida albicans RCC renal tract obstruction urolithiasis

candida albicans

clinical findings of glomerulonephritis include all of the following EXCEPT: proteinuria throat infection azotemia hypercalcemia

hypercalcemia

which is NOT considered an intrinsic cause of hydronephrosis? ureterocele urethritis urolithiasis ureteropelvic junction obstruction

urethritis

clinical findings of nephrocalcinosis include all of the following EXCEPT: urinary tract infections urinary calculi hyperparathyroidism weight loss

weight loss

which is associated with the development of cysts within the pancreas and liver? ARPKD ADPKD MCDK acquired renal cystic disease

ADPKD

a stone that completely fills the renal pelvis is referred to as: calculus granulosis staghorn calculus twinkle stone nephrocalcinotic calculus

staghorn calculus

what is the most common location for a urolithiasis to become lodged? ureteropelvic junction midureter urethra ureterovesicular junction

ureterovesicular junction

You are scanning a patient and notice that the right and left kidneys are attached at their lower poles. What anomaly is present? duplicated collecting system supernumerary kidney ureterocele pelvic kidney horseshoe kidney

horseshoe kidney

which describes the normal echogenicity of the renal cortex? kidney is normally hyperechoic in comparison to the spleen and liver kidney echogenicity is always hypoechoic compared to the spleen and liver normal kidney is never isoechoic with the liver echogenicity of the normal kidney is frequently isoechoic with the liver and spleen echogenicity of the kidney varies and should not be compared to the liver

echogenicity of the normal kidney is frequently isoechoic with the liver and spleen

which would most likely cause a spleen propagation artifact? angiomyolipoma RCC renal pseudoaneurysm TCC adenoma

angiomyolipoma

You are performing a sonogram on a patient with bilaterally small kidneys. What is the normal range in size for a kidney? 2-4 cm 4-7 cm 9-14 cm 13-17 cm

9-14cm

During a renal sonogram, you notice a 1.5cm thickening of the left lateral renal cortex. This most likely represents: column of bertin angiomyolipoma dromedary hump medullary pyramid hilar vessels

dromedary hump

You have detected compensatory hypertrophy of the right kidney in a 35 year old male. This finding is associated with: nephrectomy renal agenesis renal hypoplasia renal atrophy all of the above

all of the above

which of the following statements is NOT true regarding normal anatomy of the kidneys? kidneys are retroperitoneal in location right kidney is located slightly inferior compared to the left tail of the pancreas is in contact with the lateral dorsal aspect of the left kidney superomedial aspect of the right kidney is in contact with the adrenal gland superior pole of each kidney is slightly medial compared to the inferior pole

tail of the pancreas is NOT in contact with the lateral dorsal aspect of the left kidney

what is the normal appearance of the central sinus of the kidney? highly echogenic compared to the renal cortex hypoechoic compared to the renal cortex isoechoic compared to the renal cortex isoechoic to the medullary pyramids hypoechoic compared to the liver

highly echogenic compared to the renal cortex

what lab work is elevated with renal failure? serum creatinine urine creatinine serum bilirubin serum lipase AFP

serum creatinine

what are the sonographic criteria of a simple cyst? anechoic, acoustic enhancement, sharply defined smooth far wall, round or ovoid shape hyperechoic, acoustic enhancement, sharply defined smooth far wall, round or ovoid shape hypoechoic, acoustic attenuation, sharply defined smooth far wall, round or ovoid shape isoechoic, acoustic attenuation, sharply defined smooth far wall, round or ovoid shape anechoic, acoustic refraction, sharply defined smooth far wall, round or ovoid

anechoic, acoustic enhancement, sharply defined smooth far wall, round or ovoid shape

which is NOT a potential cause of hydronephrosis? ureteral stone large uterine fibroid ureteropelvic junction obstruction acute pyelonephritis ovarian mass

acute pyelonephritis

A questionable mass is seen between the renal pyramids on the right kidney. You suspect this is a column of Bertin "pseudomass." Which sonographic features help distinguish this from a true pathological mass? isoechogenicity with the rest of the renal cortex continuity with the renal cortex lack of mass effect or splaying of central renal sinus fat normal vascularity by color doppler all of the above

all of the above

which is NOT a sign of MCDK? multiple variable sized cysts nonmedial location of the largest cyst dilated ureter no identifiable renal sinus brightly echogenic tissue interfaces between cysts

dilated ureter

You are performing an ultrasound exam on a patient with crossed renal ectopic. Which of the following describes your findings? both kidneys are on the same side of the abdomen one of the kidneys is located in the pelvis one of the kidneys is located in the thoracic cavity the kidneys are fused together at the upper pole a small third kidney is located above one of the normal kidneys

both kidneys are on the same side of the abdomen

which malignant tumor is most common in children ages 2 to 5 years old? renal hamartoma Wilm's tumor RCC TCC renal lymphoma

Wilm's tumor

which part of the kidney contains fat, calyces, infundibuli of the collecting system, and vessels? medulla cortex sinus pyramid Gerota's fossa

sinus

During routine surveillance of the urinary bladder, you detect the presence of periodic ureteral "jets." This is a sign of: ureteral stone TCC ureteral spasm ureteral compression normality

normality

what preparation should you require of your patients scheduled for renal sonograms? fasting for 24 hours prior to exam ingestion of 100mg simethicone 5mins before exam water enema moderate hydration with no other specific prep fatty meal within 30mins of exam

moderate hydration with no other specific prep

You are scanning a 31 year old patient with HTN and impaired renal function. You detect enlarged kidneys with cysts that are too numerous to count. Which of the following is most likely? MCDK medullary cystic disease PKD parapelvic cysts multiple simple cysts

PKD

You have detected a solid mass in the right kidney of a 47 year old male. You should tailor your exam to evaluate which of the following? extension of tumor into renal vein search for liver metastasis search for retroperitoneal adenopathy A and B only all of the above

all of the above

An ultrasound exam reveals a solid, hyperechoic mass in a 46 year old patient with tuberous sclerosis. This most likely represents: RCC Wilm's tumor renal hamartoma angiomyolipoma renal lymphoma

angiomyolipoma

where is the isthmus of a horseshoe kidney located? in the iliac fossa anterior to the abdominal AO pouch of douglas morison's pouch posterior to the abdominal AO

anterior to the abdominal AO

what is the ultrasound appearance of ureteropelvic junction obstruction? dilated ureter and collecting system to the level of the urinary bladder pelvicaliectasis to the level of the junction of the renal pelvis and ureter dilated ureter with normal intrarenal collecting system pelvicaliectasis to the level of the distal ureter ureteropelvic junction obstruction cannot be detected sonographically

pelvicaliectasis to the level of the junction of the renal pelvis and ureter

what is the most common ultrasound appearance of acute pyelonephritis? normal appearance irregular renal surface contour mottled appearance of both kidneys focal hypoechoic masses throughout the kidney gas within the renal parenchyma

normal appearance

a renal mass that is highly echogenic due to its high-fat content is: RCC wilm's tumor renal harmatoma angiomyolipoma renal lymphoma

angiomyolipoma

what type of waveform do you expect to see in the normal main RA? high resistance with prominent systolic flow and little diastolic flow continuous with little differentiation between systole and diastole high impedance with no diastolic component low resistance with forward flow throughout the cardiac cycle prominent early systolic peak with retrograde flow in early distole

low resistance with forward flow throughout the cardiac cycle

what is the most likely etiology of the bladder wall thickening? muscular hypertrophy endometriosis hematoma RCC oncocytoma

muscular hypertrophy

A patient with a history of chronic medial renal disease has been referred for abdominal ultrasound. Which of the following describes the renal appearance you expect to see? enlarged hypoechoic kidneys small hyperechoic kidneys normal appearance of kidneys small hypoechoic kidneys normal sized kidneys with calcified collecting system

small hyperechoic kidneys

what is the ultrasound appearance of nephrocalcinosis? normal sized kidneys with focal, wedge-shaped, hypoechoic mass multiple hypoechoic masses throughout the kidney echogenic kidney with calcified capsule highly echogenic renal pyramids with or without posterior acoustic shadowing cystic masses containing tiny echogenic foci situated throughout the kidney

highly echogenic renal pyramids with or without posterior acoustic shadowing

which is a cause of false-positive determination of hydronephrosis? overdistention of the bladder parapelvic cysts prominent hilar vessels large extrarenal pelvis all of the above

all of the above

During a routine abdomen and pelvic ultrasound study, you detect a small round, cystic structure projecting into the urinary bladder. This most likely represents: urinoma ureterocele TCC papillary necrosis extrarebal pelvis

ureterocele

You are scanning a 69 year old male with hematuria. Your ultrasound findings include right sided hydronephrosis and a mass within the urinary bladder. Which most commonly occurs within the urinary bladder? TCC RCC renal lymphoma renal hamartoma oncocytoma

TCC

During a sonographic evaluation of a 2 week old renal transplant, you detect a fluid collection with septations and internal debris adjacent to the kidney. This most likely represents: lymphocele urinoma ureterocele hematoma abscess

lymphocele

which intrarenal arteries course alongside the renal pyramids? segmental interlobar arcuate intralobular vasa recta

interlobar

which describes the normal course of the LRV? retroaortic between the SMA and AO anterior to the SMA and IVC posterior to the IVC between the SMA and splenic vein

between the SMA and AO

what is the normal diameter of the renal cortex? < 3mm 3-6mm 6-9mm > or = 10mm cannot be measured sonographically

> or = 10mm

Ultrasound imaging reveals left sided hydronephrosis in a 38 year old woman with vague abdominal pain. You should tailor your exam to rule out: ureteral calculi pelvic mass A and B all of the above

all of the above

what is the purpose of scanning the urinary bladder to identify ureteral "jets"? rule out the presence of urinoma determine if a ureter is obstructed determine if bladder outlet obstruction is present search for bladder carcinoma identify the urethra

determine if a ureter is obstructed

which ultrasound appearance is associated with renal lymphoma? small, echogenic kidneys with hyper dense pyramids cystic masses of varying sizes throughout both kidneys multiple, bilateral, hypoechoic masses in enlarged kidneys single, large, hyperechoic mass unilateral wedge-shaped hypoechoic mass

multiple, bilateral, hypoechoic masses in enlarged kidneys

what arteries course on top of the renal pyramids and give rise to the tiny intralobular arteries? segmental interlobar arcuate vasa recta capsular

arcuate

You detect a discrete echogenic focus without shadowing in the left kidney and suspect the presence of a renal calculus. Which of the following is most helpful in improving visualization of posterior acoustic shadowing? high frequency transducer lower frequency transducer smaller aperture transducer increased frame rate increased dynamic range

higher frequency transducer

You detect the presence of free fluid in the space between the liver and right kidney. What is the name for this anatomic location? pouch of douglas morison's pouch cul-de-sac space of disse forman if winslow

morison's pouch

what is the indication for a doppler renal study to rule out RA stenosis? hematuria increased serum creatinine leukocytosis and fever uncontrolled HTN anemia, progressive azotemia, and polyuria

uncontrolled HTN

You are performing a doppler evaluation to rule out RA stenosis. You will compute a ratio comparing the velocity in the RA to what vessel? abdominal AO SMA CHA celiac trunk IMA

abdominal AO

You are performing a follow up ultrasound study on a patient with a large left renal cyst. Which most accurately describes the prevalence of renal cysts? <1% of people over age 50 15% of people over age 50 30% of people over age 50 50% of people over age 50 100% of people over age 50

50% of people over age 50

which is NOT true regarding ADPKD? liver cysts may be present in up to 30% of patients high BP is common cysts may be complicated by bleeding or infection frequently only one kidney is involved progressive renal failure is common

frequently only one kidney is involved is NOT true

which is usually diagnosed in early childhood or in utero? ADPKD MCDK acquired cystic kidney disease parapelvic cysts A and B

MCDK

Doppler analysis of intrarenal waveforms performed during renal sonography reveals a RI of 1.0. This finding is consistent with: A. normality B. chronic medial renal disease C. RV thrombosis D. renal obstruction B,C, and D

B, C, and D

During a renal exam, you identify only one kidney. What should you do? inform the patient if your finding and advise a thorough medical exam to detect other abnormalities scan in the pelvis area to rule out the presence of a pelvic kidney perform an endovaginal exam to look for bicornuate uterus scan the patient in an upright position perform a compete dopple study of the solitary lidneh

scan in the pelvis area to rule out the presence of a pelvic kidney

which would be most helpful in delineating ureteral "jets"? have the patient perform a valsalva maneuver scan the patient in both inspiration and expiration examine the urinary bladder with color doppler increase the transducer frequency give the patient a fatty meal

examine the urinary bladder with color doppler

You are scanning a patient post biopsy and discover a cystic mass in the kidney. What should you do? nothing, cystic masses are very common evaluate the cyst with color doppler have the patient return in 2 weeks for a follow up study scan the patient in a prone position compress the mass with probe pressure

evaluate the cyst with color doppler

which results from an ascending urinary tract infection? horseshoe kidney acute tubular necrosis glomerulonephritis pyelonephritis nephrocalcinosis

pyelonephritis

You are having difficulty identifying the renal arteries in a patient referred for questionable RA stenosis. Which vessel below is most helpful as a landmark for the location of the RAs? celiac trunk SMA splenic vein IMA common HA

SMA

You are scanning a patient with right flank pain and known PKD. You suspect the presence of hemorrhage within one of the renal cysts. What is the sonographic appearance of this finding? ultrasound cannot be used to detect hemorrhage within a renal cyst low-level echoes within the cyst multiple bright foci with posterior acoustic shadowing distal to the cyst solid appearing nodule with increased attenuation all of the above

low-level echoes within the cyst

A patient has been referred to your ultrasound lab for evaluation of a new renal transplant. Where should you look? morison's pouch LUQ pouch of douglas RLQ RUQ

RLQ

Ultrasound findings in a patient with HTN include a left kidney measuring 6.8cm and a right kidney measuring 11.7cm. Which is most consistent with these findings? acute pyelonephritis in the left kidney acute glomerulonephritis in the right kidney occlusion of the left main renal artery amyloidosis of the right kidney renal agenesis

occlusion of the left main renal artery

what doppler parameter should you measure to look for rejection in a renal transplant? pulsatility index resistive index renal-aortic ratio systolic-diastolic ratio acceleration index

resistive index

You detect irregular thickening of the bladder wall in a 53 year old male with hydronephrosis and a dilated ureter. Which would you suspect? RCC ureterocele bladder outlet obstruction TCC endometriosis

TCC

which would help in identification of the RRV? RRV lies inferior and posterior to the RA RRV courses underneath the IVC RRV courses anterior to the abdominal AO RRV divides into a circumaortic ring before draining into the IVC RRV lies anterior to the RA

RRV lies anterior to the RA

where are the ureteral orfices in the urinary bladder? each lateral edge superior and anterior border base of the trigone along the posterior aspect inferior and anterior to the trigone at the bladder base, inferior at the apex of the trigone

base of the trigone along the posterior aspect

which view provides the best color doppler evaluation of the intrarenal vasculature? patient supine, anterior view through liver patient supine, coronal view through liver patient prone, oblique view through back musculature patient in posterior oblique position, coronal view through posterior axillary line patient upright, anterior view through liver

patient in posterior oblique position, coronal view through posterior axillary line

During color doppler evaluation of the kidney, inadequate fill of the intrarenal vasculature is seen. What doppler parameter will you make to improve sensitivity to flow? decrease PRF increase wall filter decrease packet size decrease color gain decrease color resolution setting

decrease PRF

You are scanning the bladder and notice multiple artifactual bands in the near field at the anterior bladder wall. What is the source of these echoes? acoustic speckle reverberation artifact comet tail artifact mirror image artifact multi path artifact

reverberation artifact

what feature is indicative of an atypical cyst? internal septations wall calcification internal echoes irregular walls all of the above

all of the above

what is the accepted treatment for a simple renal cyst? surgical removal aspiration fine needle biopsy core biopsy no further evaluation required

no further evaluation required

You are performing an ultrasound exam on a patient who has been on dialysis for 4 years. Which describes the typical appearance of the kidney in these cases? bilateral renal enlargement with increased echogenicity bilateral small, echogenic kidneys with multiple cysts of varying sizes bilateral small, hypoechoic kidneys with increased corticomedullary distinction normal appearing kidneys bilaterally all of the above sonographic appearances are common in this scenario

bilateral small, echogenic kidneys with multiple cysts of varying sizes

A patient is referred for ultrasound evaluation to take out the presence of renal malignancy. What is the most common renal malignancy in adults? oncocytoma TCC angiomyolipoma RCC adenoma

RCC

You are performing a follow up study on a patient diagnosed with emphysematous pyelonephritis. Which best describes the sonographic appearance of this condition? multiple echogenic foci within the renal sinus or parenchyma with "dirty" posterior acoustic shadows multiple distinct hyperechoic foci with discrete, well-defined posterior acoustic shadows multiple indistinct, hazy foci within the renal sinus with posterior acoustic enhancement large area of posterior acoustic shadowing which is not associated with any defined echoes focal, wedge-shaped hypoechoic masses with posterior acoustic enhancement throughout the kidney

multiple echogenic foci within the renal sinus or parenchyma with "dirty" posterior acoustic shadows

which describes the normal waveform of the main RA? triphasic high resistance low resistance phasic bidirectional

low resistance

the renal arteries arise from the AO closest to the origin of which arteries? SMA celiac trunk IMA common iliac arteries common hepatic

SMA

the LRA is normally located immediately posterior to which of the following? LRV PV common hepatic artery splenic artery none of the above

LRV

A patient has been referred to the ultrasound department with a history of medullary nephrocalcinosis. What do you expect to see? a calcified renal capsule a calcified ureter a calcified urinary bladder calcified pyramids all of the above

calcified pyramids

what is the sonographic appearance of a subcapsular hematoma? free fluid in morison's pouch perirenal fluid collection that flattens the underlying renal contour a linear defect that extends throughout the kidney an intrarenal fluid collection within the renal collecting system a subcapsular hematoma will not be visible by ultrasound

perirenal fluid collection that flattens the underlying renal contour

which normally occurs in renal transplants compared to the immediate postoperative study? hypertrophy increased echogenicity hydronephrosis shrinkage calcified pyramids

hypertrophy after transplant, the renal allograft volume may increase 5-15% in the first two weeks

You are performing a doppler study of a renal transplant to rule out stenosis of the RA. The RA is usually anatomosed to which artery? internal iliac artery external iliac artery common iliac artery abdominal AO IMA

external iliac artery

Urinary Tract Flashcards

(115 cards)