Ch. 15 urinary review

23. The left kidney is in contact with the: a. spleen, pancreas, and gallbladder. b. spleen, gallbladder, and duodenum. c. pancreas, colon, and porta hepatis. d. spleen, stomach, and pancreas.

ANS: D The left adrenal gland, spleen, stomach, and pancreas lie anterior to the left kidney. The diaphragm, psoas muscle, and quadratus lumborum muscle lie posterior to the left kidney. PTS: 1 REF: p. 376 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

4. The sonographic appearance of tuberous sclerosis may be difficult to differentiate from: a. medullary sponge kidney. b. nephrocalcinosis. c. hydronephrosis. d. autosomal dominant polycystic kidney disease.

ANS: D The sonographic appearance of tuberous sclerosis may be difficult to differentiate from autosomal dominant polycystic kidney disease. PTS: 1 REF: p. 400 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system

41. Which one of the following disorders does not produce a complex sonographic pattern? a. Infected cyst b. Hemorrhagic cyst c. Hematoma d. Congenital simple cyst

ANS: D The sonographic criteria of a simple cyst include anechoic properties (without internal echoes), thin smooth walls, and posterior acoustic enhancement. PTS: 1 REF: p. 398 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system

1. A congenital obstruction found in utero and in infants is called a(n): a. ureteropelvic junction (UPJ) obstruction. b. ureterocele. c. bladder diverticulum. d. posterior urethral valve.

ANS: A A congenital obstruction of the ureteropelvic junction can be seen in utero and in infants. PTS: 1 REF: p. 416 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Sonographic evaluation of the urinary system

2. Parapelvic cysts are located in the: a. renal sinus. b. renal cortex. c. lower pole. d. pararenal space.

ANS: A A parapelvic cyst (renal sinus cyst) is found in the renal sinus but does not communicate with the renal collecting system. PTS: 1 REF: p. 393 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Pathology of the urinary system

8. A cystlike enlargement of the distal end of the ureter is called a: a. ureterocele. b. diverticulum. c. urachal cyst. d. cystitis.

ANS: A A ureterocele is a cyst-like enlargement of the lower end of the ureter. It can be congenital or acquired and may cause obstruction or infection. PTS: 1 REF: p. 391 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Sonographic evaluation of the urinary system

35. A common benign vascular fatty tumor of the kidney is called a(n): a. angiomyolipoma. b. hypernephroma. c. neuroblastoma. d. lymphoma.

ANS: A An angiomyolipoma is the most common benign renal tumor. It is composed of fat, muscle, and blood vessels. PTS: 1 REF: p. 409 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Pathology of the urinary system

34. Dilation of the renal pelvis may be caused by all of the following except: a. oliguria. b. reflux. c. pregnancy. d. distended urinary bladder.

ANS: A Dilation of the renal pelvis may be caused by polyuria, distended bladder, reflux, pregnancy, and atrophy after obstruction. PTS: 1 REF: p. 418 OBJ: Discuss normal physiology of the urinary system. TOP: Sonographic evaluation of the urinary system

30. A potential space located between the liver and right kidney is: a. Morison's pouch. b. Douglas' pouch. c. cul-de-sac. d. Winhauer space.

ANS: A Morison's pouch is located in the right posterior subhepatic space anterior to the right kidney and posterior to the right lobe of the liver. PTS: 1 REF: p. 376 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

25. Outside the renal capsule is the: a. perinephric fat. b. paranephric space. c. renal fascia. d. renal medulla.

ANS: A Outside of the fibrous capsule is a covering of perinephric fat. PTS: 1 REF: p. 376 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

13. A posttransplant perinephric fluid collection includes all of the following except: a. ureterocele. b. hematoma. c. urinoma. d. lymphocele.

ANS: A Perinephric fluid collections include hematoma, abscess, lymphocele, or urinoma. PTS: 1 REF: pp. 420-421 OBJ: Discuss the role and limitations of sonography in postrenal transplant patients. TOP: Box 15-10

31. Renal cell carcinoma commonly invades the IVC via the: a. renal vein. b. renal artery. c. portal vein. d. splenic vein.

ANS: A Renal cell carcinoma may invade the renal vein and IVC with a tumor or thrombosis. PTS: 1 REF: p. 404 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Sonographic evaluation of the urinary system

36. All of the following statements about the kidneys are true except: a. the kidneys are intraperitoneal in location. b. the average adult kidneys measure approximately 9 to 12 cm in length. c. the kidneys move with respiration. d. the anteroposterior thickness of the normal adult kidney is approximately 4 to 5 cm.

ANS: A The kidneys are located in the retroperitoneal cavity. PTS: 1 REF: p. 376 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

39. Which one of the following statements about the kidneys is false? a. The kidneys are rigidly fixed on the abdominal wall. b. The kidneys consist of an internal medullary and external cortical substance. c. The kidneys rest on the psoas and quadratus lumborum muscles. d. Renal pyramids are found within the medullary region.

ANS: A The kidneys are located in the retroperitoneum, not on the abdominal wall or rigidly fixed. PTS: 1 REF: p. 376 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Sonographic evaluation of the urinary system

40. The most common location of renal ectopia is the: a. pelvis. b. intrathoracic. c. epigastric region. d. retroperitoneum.

ANS: A The pelvic kidney, also called the sacral kidney, is the most common renal ectopia and should not be misdiagnosed as a pelvic tumor. PTS: 1 REF: p. 388 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Sonographic evaluation of the urinary system

10. A cortical bulge in the lateral border of the kidney is called a(n): a. junctional parenchymal defect. b. dromedary hump. c. extrarenal pelvis. d. column of Bertin.

ANS: B A dromedary hump is a cortical bulge in the lateral border of the kidney and is more common in the left kidney. PTS: 1 REF: p. 385 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Sonographic evaluation of the urinary system

16. A common finding in people over 50 years of age is: a. renal calculi. b. renal cyst. c. multicystic disease. d. hypernephroma.

ANS: B Approximately 50% of patients over the age of 50 years have a simple renal cyst. PTS: 1 REF: p. 393 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system

19. Ureteral jets are not visualized in patients with: a. renal cell carcinoma. b. obstruction. c. duplex collecting system. d. acute focal bacterial nephritis.

ANS: B Complete obstruction demonstrates an absence of the respective ureteral jet; partial obstruction may show a low-level jet on the side of the obstruction or an asymmetry of the ureteral jets or both. PTS: 1 REF: p. 418 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Pathology of the urinary system

42. The normal bladder wall should be smooth and thin and measure between ____________ millimeters (mm). a. 2 to 4 b. 3 to 6 c. 5 to 7 d. 5 to 10

ANS: B Depending on the level of bladder distention, the normal bladder wall may measure 3 to 6 mm. PTS: 1 REF: p. 392 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Sonographic evaluation of the urinary system

33. An extremely large echogenic renal sinus that appears to engulf the entire renal parenchymal outline suggests: a. hydronephrosis. b. lipomatosis. c. hypernephroma. d. nephrocalcinosis.

ANS: B In sinus lipomatosis, the abundant fibrous tissue may cause enlargement of the sinus region with an increase in echogenicity. PTS: 1 REF: p. 385 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Sonographic evaluation of the urinary system

20. The process of disposing metabolic wastes is called: a. urea. b. excretion. c. deamination. d. urination.

ANS: B Metabolic wastes must be excreted quickly to prevent toxic concentrations of homeostasis (maintenance of normal body physiologic stability). PTS: 1 REF: p. 378 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

32. Pyonephrosis refers to the presence of: a. blood in a dilated collecting system. b. pus in a dilated collecting system. c. urine in a dilated collecting system. d. a perinephric abscess.

ANS: B Pyonephrosis occurs when pus is found in the obstructed renal system. PTS: 1 REF: p. 420 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Pathology of the urinary system

14. A renal sonogram is performed. The finding of hypoechoic areas adjacent to the renal sinus is most consistent with: a. bifid renal pelvis. b. medullary pyramids. c. column of Bertin. d. junctional parenchymal defect.

ANS: B The renal medulla consists of hypoechoic pyramids disbursed in uniform distribution and separated by bands of intervening parenchyma that extend toward the renal sinus. PTS: 1 REF: p. 384 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Sonographic evaluation of the urinary system

7. The most echogenic portion(s) of the kidney is(are) the: a. cortex. b. sinus. c. medullary pyramids. d. parenchyma.

ANS: B The renal sinus is the most echogenic portion of the normal kidney. It includes the calyces, renal pelvis, renal vessels, fat, nerves, and lymphatic channels. PTS: 1 REF: p. 379 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Sonographic evaluation of the urinary system

24. The right kidney is in contact with the: a. spleen, colon, and adrenal gland. b. liver, colon, and adrenal gland. c. liver, pancreas, and gallbladder. d. liver, gallbladder, and splenic flexure.

ANS: B The right adrenal gland and second part of the duodenum lie anterior to the right kidney. The diaphragm, psoas muscle, and quadratus lumborum muscle lie posterior to the right kidney. PTS: 1 REF: p. 376 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

28. The vessel seen posterior to the IVC on the sagittal scan represents the: a. right adrenal artery. b. right renal artery. c. left renal artery. d. left renal vein.

ANS: B The right renal artery is seen as a circular structure coursing posterior to the IVC in the sagittal plane. PTS: 1 REF: p. 381 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

22. The kidneys are located in the: a. peritoneal cavity. b. retroperitoneal cavity. c. perirenal cavity. d. perirenal space.

ANS: B The urinary system is located in the retroperitoneal cavity. PTS: 1 REF: p. 375 | p. 376 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Sonographic evaluation of the urinary system

43. Which one of the following describes a bladder diverticulum? a. Cystic enlargement of the bladder orifice b. Echogenic mass of the bladder wall c. Herniation of the bladder wall d. Focal thickening of the bladder wall

ANS: C A bladder diverticulum is defined as a herniation of the bladder wall. PTS: 1 REF: p. 427 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system

44. In the adult, a postvoid residual of less than _____ ml of urine is considered normal. a. 35 b. 50 c. 20 d. 25

ANS: C A postvoid residual of less than 20 ml of urine is considered normal in the adult. PTS: 1 REF: p. 393 OBJ: Discuss normal physiology of the urinary system. TOP: Sonographic evaluation of the urinary system

11. A dilated renal pelvis without ureteral dilation is observed in patients with: a. hydronephrosis. b. posterior urethral valve obstruction. c. ureteropelvic junction obstruction. d. ureterocele.

ANS: C Dilation of the kidney or ureter or both occurs superior to the obstruction. PTS: 1 REF: p. 416 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Sonographic evaluation of the urinary system

17. Identify the type of hydronephrosis demonstrating dilatation of the renal pelvis with thinning of the renal cortex. a. Grade 0 b. Grade 3 c. Grade 4 d. Grade 6

ANS: C Grade 4 hydronephrosis is characterized by prominent dilation of the collecting system, thinning of the renal parenchyma, and a lack of differentiation between the collecting system and the renal parenchyma. PTS: 1 REF: p. 416 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system

21. Which one of the following is present in urine whenever extensive damage or destruction of the functioning erythrocytes occurs? a. Protein b. Creatinine c. Hemoglobin d. Albumin

ANS: C Hemoglobin is present in urine whenever extensive damage or destruction of the functioning erythrocytes occurs. This condition injures the kidney and can cause acute renal failure. PTS: 1 REF: p. 378 OBJ: Describe the clinical signs and symptoms of urinary tract problems and the laboratory tests that are used to evaluate them. TOP: Physiology and laboratory data of the urinary system

37. Hydronephrosis may be best demonstrated sonographically by which one of the following patterns? a. Distorted shape of the kidney outline b. Multiple cystic masses throughout the renal parenchyma c. Fluid-filled pelvocaliceal collecting system d. Hyperechoic pelvocaliceal collecting system

ANS: C Hydronephrosis demonstrates a fluid-filled renal collecting system. PTS: 1 REF: p. 397 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system

9. Which one of the following describes the sonographic appearance of chronic pyelonephritis? a. Echogenic cortex b. Hypoechoic enlarged kidney c. Inability to distinguish the cortex from the medullary regions d. Echogenic foci in the medullary regions

ANS: C In chronic renal disease, including chronic pyelonephritis, the kidneys appear diffusely enlarged with a loss of normal anatomy. PTS: 1 REF: p. 422 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Pathology of the urinary system

5. In cases of nephrocalcinosis, calcium deposits are usually located in the: a. cortex. b. renal sinus. c. medulla. d. renal hilum.

ANS: C Nephrocalcinosis, or parenchymal calcification, involves diffuse foci of calcium deposits, usually located in the medulla but infrequently seen in the renal cortex. Both kidneys are affected. PTS: 1 REF: pp. 421-422 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Sonographic evaluation of the urinary system

18. Renal vein thrombosis may be visualized in patients with: a. pyelonephritis. b. renal calculi. c. renal cell carcinoma. d. angiomyolipoma.

ANS: C Renal cell carcinoma may demonstrate renal vein thrombosis or tumor extension into the renal vein and inferior vena cava (IVC). PTS: 1 REF: pp. 395-407 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Box 15-5

27. The left renal vein courses: a. posterior to the IVC. b. anterior to the IVC. c. anterior to the aorta. d. anterior to the superior mesenteric artery.

ANS: C The left renal vein flows from the renal sinus, anterior to the aorta, and posterior to the superior mesenteric artery to join the IVC. PTS: 1 REF: p. 377 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

3. The most common solid renal mass found in childhood is: a. renal cell carcinoma. b. angiomyolipoma. c. Wilms' tumor. d. Von Hippel-Lindau tumor.

ANS: C The nephroblastoma or Wilms' tumor is the most common solid renal mass of childhood, peaking at 2 years of age. Wilms' tumor can reoccur. PTS: 1 REF: p. 407 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Pathology of the urinary system

29. Which of the following is an indirect, sonographic sign of renal function? a. Obstructive uropathy b. Cyst formation c. Ureteral jets d. Angiomyolipoma

ANS: C The way to confirm a complete collecting system is to demonstrate two ureteral jets entering the bladder on the same side. Identify ureteral jets as flashes of Doppler color entering the bladder from the lateral posterior border and coursing superior and medial. PTS: 1 REF: p. 388 OBJ: Discuss the normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy of the urinary system

6. Fusion of the lower pole of the kidneys is called a: a. cross-renal ectopia. b. pelvic kidney. c. supernumerary kidney. d. horseshoe kidney.

ANS: D A horseshoe kidney typically demonstrates fusion of the lower poles. It is commonly associated with improper ascent and malrotation. Inferior poles lie medial, with the isthmus crossing anterior to the aorta. PTS: 1 REF: p. 389 OBJ: Discuss normal anatomic location, function, and sonographic appearance of the urinary system organs. TOP: Anatomy and physiology

26. A triangular-shaped defect located anteriorly in the upper pole of the kidney most likely represents a(n): a. renal tumor. b. artifact from rib. c. IVC compression. d. junctional parenchymal defect.

ANS: D A junctional parenchymal defect is a triangular-shaped echogenic area in the upper pole of the renal parenchyma. PTS: 1 REF: p. 385 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Sonographic evaluation of the urinary system

45. Choose the cause of renal artery stenosis that accounts for two thirds of all cases in young patients. a. Hydronephrosis b. Parapelvic cyst c. Atherosclerosis d. Fibromuscular dysplasia

ANS: D Fibromuscular dysplasia accounts for approximately two thirds of renal artery stenosis cases in young patients. Atherosclerosis is associated with hypertension, which is more common in older patients, and accounts for one third of cases of RAS. PTS: 1 REF: p. 422 OBJ: Define and discuss the pathologies discussed in this chapter. TOP: Pathology of the urinary system

15. Papillary necrosis may develop within ________ after renal transplantation. a. 4 to 8 weeks b. 12 to 18 hours c. days to years d. weeks or months

ANS: D Necrosis may develop within weeks or months after renal transplantation, especially in patients previously treated for rejection and those with cadaveric kidney. PTS: 1 REF: p. 412 OBJ: Discuss the role and limitations of sonography in postrenal transplant patients. TOP: Pathology of the urinary system

12. Which one of the following clinical findings is the most likely reason for a renal artery Doppler examination? a. Hypertension b. Oliguria c. Hematuria d. Severe flank pain

ANS: D Renal artery stenosis (RAS) is the most common correctable cause of hypertension. PTS: 1 REF: p. 422 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Sonographic evaluation of the urinary system

38. Autosomal dominant polycystic kidney disease may be characterized by all of the following statements except: a. the disease is latent until the fourth or fifth decade of life. b. the severity of the disease varies, depending on the genotype. c. the disease may be associated with cysts in the liver, pancreas, and spleen. d. the kidneys are small and extremely echogenic.

ANS: D The kidneys become enlarged with multiple cysts. PTS: 1 REF: p. 401 OBJ: Identify and define the sonographic appearance of pathologies included in this chapter. TOP: Pathology of the urinary system