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URR 47 Flashcards

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1
Q

What two acoustic artifact are associated with renal calculi?
a. posterior shadowing and twinkle artifact
b. posterior shadowing and mirror image artifact
c. side lobe and speed error artifact
d. reverberation and refraction

A

a

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2
Q

Renal vascular calcifications are caused by:
a. systemic hypertension
b. high glucose levels
c. atherosclerosis
d. osteoporosis

A

c

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3
Q

What is the most common solid benign tumor of the kidneys?
a. adenoma
b. angiomyolipoma
c. lipoma
d. oncocytoma

A

b

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4
Q

All of the following are sonographic characteristics of an angiomyolipoma, except:
a. homogeneous mass
b. hyperechoic mass
c. posterior enhancement
d. propagation speed artifact

A

c

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5
Q

What causes propagation sped artifact with an angiomyolipoma?
a. Muscle content of mass
b. calcium content of mass
c. fluid content of mass
d. fat content of mass

A

d

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6
Q

What is the most common cause of ischemia of the renal pyramids?
a. diabetes
b. analgesic abuse
c. systemic hypertension
d. steroid abuse

A

b

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7
Q
A
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8
Q

What benign renal mass presents as a hypoechoic solid mass with varied echogenicity and a central scar?
a. oncocytoma
b. adenoma
c. lipma
d. all the above

A

a

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9
Q

Renal cell carcinoma is also known as ___ or ___

A

hypernephroma
Von Growitz tumor

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10
Q

most common solid renal mass in adults

A

hypernephroma

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11
Q

most common primary malignancy of the kidney

A

renal cell carcinoma

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12
Q

Renal Cell Carcinoma is more common in ____

A

males

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13
Q

Classic triad of RCC symptoms

A

palpable mass
flank pain
hematuria

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14
Q

____ is commonly associated with __ syndrome

A

Von Hippel Lindaur

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14
Q

Most common symptom of RCC

A

hematuria

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15
Q

RCC is associated with ___, ____, and ____

A

tuberous sclerosis
autosomal dominant (PCKD)
acquired cystic diease

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16
Q

Large RCC tumors are treated by:

A

nephrectomy

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17
Q

Radiofrequency ablation can be performed on tumors <__cm

A

5

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18
Q

most common metastatic route for RCC

A

lungs

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19
Q

most commonly presents as solid isoechoic mass; areas of hemorrhage and necrosis with central scar; mass effect

A

RCC

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20
Q

What other structures should be evaluated when suspicion of RCC

A

IVC and renal vein for invasion or thrombus\
liver for mestastasis
retroperitoneal lymph nodes for involvement

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21
Q

Most malignancies are constantly growing and “invading” and this requires:

A

constant flow throughout cardiac cycle

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22
Q

RCC intrantumoral vessels PW Doppler characteristics

A

high velocity flow with increased diastolic flow consistent with a low resistance wavform

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23
Q

rare genetic disorder characterized by visceral cysts, renal and pancreatic cysts, benign masses, and the potential for malignant transformation of the cysts in multiple organ systems

A

Von Hippel Lindau Syndrome

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24
____ has an increased risk for malignant transformation of renal cysts into carcinoma
Von Hippel Lindau
25
Von Hippel Landau Syndrome are commonly associated with ____, ____, ___, ____
renal and pancreatic cysts renal cell carcinomas pheochromocytomas islet cell tumors
26
most common type of lesion in VHL syndrome
pancreatic cysts
27
____ are more common in VHL syndrome the in APKD
multiple pancreatic cysts
28
Von Hippel Lindau Syndrome is also see in patients born with:
biliary atresia
29
transitional cells line the ___, ___, and ___
renal pelvis ureter bladder
30
Transitional cell carcinoma can be found anywhere in the urinary collecting system, but most commonly occurs
bladder
31
If transitional cell carcinoma is found in the kidney, it is usually in the ____
renal pelvis
32
most common symptom of transitional cell carcinoma
painless hematuria
33
hypoechoic mass; originates in the collecting system but can invade parenchyma, preserves outline and contour of kidney, distorts internal architecture; ureteral involvement can lead to hydronephrosis
transitional cell carcinoma
34
Any involvement of the kidneys with lymphoma occurs through the blood or by invasion from a retroperitoneal lymph node mass because:
kidneys contain no lymphatic tissue
35
____ lymphoma can cause bilateral renal masses
Hodkin disease
36
Sonographic signs of lymphoma affecting the kidneys
bilaterally enlarged kidneys lobulated renal contour hypoechoic changes with loss of corticomedullary definition retroperitoneal lymphadenopathy
37
Most common primary cancers to metastasize to the kidneys
lung breast renal cell carcinoma of contralateral kidney
38
can cause the formation of a mass or diffuse infiltration of the kidney; kidney enlarged but maintains its reniform shape
metastasis
39
____ is preferred for evaluating possible renal metastasis
contrast CT
40
Nephroblastoma is also known as:
Wilms tumor
41
most common malignant tumor found by sonography in pediatric patients
Wilms tumor
42
most common renal tumor identified in pediatric patients
Wilms tumor
43
Children with _____ have a significant risk of developing Wilms Tumor
Beckwith Wiedemann Syndrome
44
A Wilms tumor presents between __-__ years old
3 5
45
Clinical symptoms of Wilms tumor
hematuria hypertension fever palpable mass
46
solid mass with varying echogenicity; areas of necrosis or hemorrhage; distorts renal parenchyma and disrupts contour; can invade IVC and renal vein
Wilms tumor
47
Renal Cell Carcinoma (RCC) is: a. the most common solid renal mass in adults b. the most common primary malignancy of the kidney c. more common in males d. all the above
d
48
A palpable mass, flank pain and ___ are the classic triad of RCC symptoms. a. hematuria b. leukocytosis c. leukopenia d. hypercalcemia
a
49
Bilateral and multicentric RCC is associated with: a. multiple endocrine neoplasm syndrome b. Von Hippel Lindau Syndrome c. Tuberous sclerosis d. Autosomal dominant polycystic disease
b
50
What benign renal tumor has a similar sonographic appearance to RCC? a. angiomyolipoma b. papillary necrosis c. lipoma d. oncocytoma
d
51
All the following are common complications of RCC, except: a. liver metastasis b. renal vein invasion c. renal artery stenosis d. retroperitoneal lymphadenopathy
c
52
PW Doppler evaluation of a suspected RCC mass with demonstrate what type of waveform? a. low peak systolic velocity b. low resistance with increased diastolic flow c. high resistance with diastolic flow reversal d. high resistance with biphasic flow
b
53
Transitional cell carcinoma can be found anywhere in the renal: a. arteries b. veins c. cortex d. collecting system
d
54
Which of the following describes transitional cell carcinoma? a. most commonly affects the bladder b. distorts the renal contour c. originates in the renal cortex d. painful hematuria is a common symptoms
a
55
Bilaterally enlarged kidneys with lobulated renal contour and hypoechoic cortical changes would be most suggestive of: a. nephrocalcinosis b. medullary sponge kidney c. lymphoma d. tuberous sclerosis
c
56
Nephroblastoma is associated with what syndrome? a. Beckwith Wiedemann Syndrome b. multiple endocrine neoplasm syndrome c. Sjrogen syndrome d. Meckel Gruber syndrome
a
57
Symptoms of hypertension related to renal artery stenosis
refractory hypertension systemic blood pressure may be at very high levels abdominal bruit elevated creatinine and cholesterol levels unexplained CHF or pulmonary edema
58
hypertension that is unresponsive to medication
Refractory hypertension
59
most common cause of renal artery stenosis
atherosclerosis
60
renal artery stenosis most commonly occurs where?
proximal segment of artery
61
second most common cause of renal artery stenosis
Fibromuscular dysplasia
62
Renal artery stenosis related to fibromuscular dysplasia most commonly occurs where?
distal 2/3 of artery
63
Kidneys receive ___ blood flow due to renal artery stenosis
less
64
Renal response to reduced systemic blood pressure
activation of the renin-angiotensin aldosterone system
65
What does the renin-angiotensin system do?
raises the blood pressure to try to increase flow to kidneys which results in systemic hypertension
66
Long standing renal artery stenosis can lead to ____ and ___
parenchymal damage renal failure
67
____ is the gold standard in diagnosis of renal artery stenosis, but requires an invasive technique
Angiography
68
NPO status for renal exam
at least 8 hours
69
Risk factors for renal artery stenosis
hypertension diabetes smoking family history obesity high cholesterol age gender history of fibromuscular dysplasia
70
Clinical findings in patients with suspected renal artery stenosis
young patients with significant hypertension patients with malignant hypertension patients with hypertension that is difficult to control with medication history of hypertension and deteriorating renal function patients with renal insufficiency and discrepant kidney size
71
Discrepant kidney size (>___ difference length) can be a sign of stenosis
2 cm
72
When considering the transverse view of the aorta as a clock face, the ___ originates between 9 and 11 o clock and the _____ originated between 3 and 4 oclock
right renal artery left renal artery
73
Doppler velocities can be artifactually diminished in patients with ____ and ___
decreased cardiac output cardiac disease
74
____ ratio is used to assess stenosis
Renal/Aortic
75
The ____ of the renal artery is divided by the ____ of the aorta to get the renal/aortic ratio
peak systolic velocity peak systolic velocity
76
RAR <___ is considered normal
3.5
77
used Doppler to evaluate the entire length of the main renal artery
Direct evaluation
78
Direct evaluation uses __ degree Doppler angle to assess main renal artery
60
79
Using direct evaluation, obtain velocity information every __-__ mm along length of artery
2 3
80
When using direct evaluation, obtain the aortic waveform at the level of:
renal artery origins
81
___ and ___ are used to assess renal artery stenosis with direct evaluation
velocity RAR
82
Arcuate arteries can be difficult to assess with Doppler due to the blood flow moving ____ to the ultrasound beam
perpendicular
83
Interlobular arteries course ____ to the renal capsule and provide more accurate flow assessment
perpendicular
84
Indirect evaluation of the ____ at the upper, mid, and lower poles is required
parenchymal
85
Indirect evaluation uses __ degree or less Doppler angle
20
86
With indirect evaluation, ___ is used to assess renal artery stenosis
Waveform shape
87
With indirect evaluation, ___ and ___ are used to assess stenosis
resistive index acceleration time
88
Doppler criteria >60% stenosis - at the stenosis
PSV >2.0 m/s RAR >3.5
89
Doppler criteria >60% stenosis - parenchymal evaluation
RI <0.5 dampened systolic peaks with maintained diastolic flow Increased acceleration time = slower systolic upstroke; AT >0.07 Tardus Parvus Waveform - absence of early systolic peak and prolonged acceleration time
90
A normal renal artery waveform demonstrates _____
early systolic peak
91
Renal artery stenosis will cause the ESP to ____ and the waveform will be ____
disappear more rounded
92
Intrarenal arteries demonstrate damping with an acceleration time >0.07s when stenosis is present ____
proximally
93
absence of early systolic peak and prolonged acceleration time
Tardus Parvus waveform
94
late peaking and low velocity flow
tardus parvus waveform
95
There will be damped velocities ___ to the site of stenosis
distal
96
Treatment for renal artery stenosis
stent placement
97
absence of a visible main renal artery; kidney size <9cm in length; either absence of blood flow or very low amplitude flow; damped intrarenal flow signals; increased echogenicity of the affected kidney; compensatory hypertrophy of the contralateral kidney
renal artery occlusion
98
thrombus or embolus; acute onset of malignant hypertension, hematuria; prerenal acute renal failure
acute occlusion of the renal artery
99
multiple renal infarcts; absence of arterial flow within kidney; enlarged kidney (chronic = small)
acute occlusion of renal artery

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