Pathology 42% Urinary

D. Note the membranous structure covering the ureteral opening into the bladder. It obstructs normal outflow of the urine into the bladder causing the hydronephrosis. Posterior urethral valves would cause significant urination issues and an over distended bladder with bilateral hydronephrosis. A diverticulum is structural bladder abnormality that presents an out-pouching of the bladder wall

A 12yr old male patient presents for a renal ultrasound. Mild to moderate hydronephrosis is noted in the left kidney. The image displayed is of the patient's left side of the bladder. Which of the following is the most likely diagnosis? A: urethrocele B: posterior urethral valves C: diverticulum D: ureterocele

A. The renal pelvis and calyces are dilated, but the ureter is normal. This indicates an obstruction at the ureteropelvic junction. A parapelvic cyst would not normally cause the calyces to dilate. A UV obstruction and a ureterocele would cause the ureter to dilate with the renal pelvis and calyces. Increased levels of creatinine would indicate renal disease.

A 3yr old patient presents with flank pain and increased serum levels of creatinine. The images of the right kidney are displayed here. The right ureter was not dilated. The left kidney and bladder were normal. These findings are most suggestive of: A: right UPJ obstruction B: right parapelvic cyst C: right UVJ obstruction D: right ureterocele

D. A dromedary hump is a prominent focal bulge on the lateral border of the left kidney. They are normal variants of the renal contour, caused by the splenic impression onto the superolateral left kidney.

A 4yr old presents for a renal ultrasound with a suspected mass on the lateral aspect of the left kidney seen on a KUB x-ray. The ultrasound reveals a foca outward thickening of the normal renal cortex near the mid pole of the kidney. Which of the following best describes the finding? A: duplicated collecting system B: Wilm's tumor C: column of Bertin D: dromedary hump

A. Bilateral enlargement, patient 30-59yrs, and more than 2 cysts per kidney indicates ADPCKD. MCKD is unilateral finding and ACKD demonstrates small kidneys with cyst formation

A 55yr old female presents with mild flank pain. The right kidney measures 13cm and demonstrates 3 cysts. The left kidney measures 13.8cm and demonstrates 2 cysts. Which of the following is the most likely explanation of the findings? A: autosomal dominant polycystic kidney disease B: multicystic kidney disease C: autosomal recessive polycystic kidney disease D: acquired cystic kidney disease

C. The patient symptoms should lead to a diagnosis related to infection related to the recent biopsy. The complex cystic mass demonstrates debris levels and the adiacent tissues are hyperechoic with a loss if definition of the medial aspect of the mid to lower pole.

A 60yr old female patient presents with a recent history of a renal biopsy of the lower pole of the left kidney. Currently, she is suffering from flank pain, fever, nausea and vomiting. The clinical and ultrasound findings are most suggestive of: A: Renal hematoma with thrombus formation B: baring tine bropsused by possible puncture of tine ureter C: Renal abscess with pus accumulation D: A or B, not enough information to differentiate

B. There is mass infiltration into the wall of the urinary bladder. Note the infiltration and loss of definition of the affected wall as compared to the unaffected segments. Thrombus accumulation would be limited to the internal lumen of the bladder. Cystitis most commonly displays as a diffuse thickening of the bladder wall.

A 65yr old male presents with a recent diagnosis of secondary carcinoma of the seminal vesicles. A urinary system ultrasound is ordered. The findings displayed in the image most likely represent which of the following? A: Cystitis, which is a common side effect of the chemotherapy meds B: Primary or Secondary bladder carcinoma C: Thrombus accumulation with gross hematuria, which is a common side effect of the chemotherapy meds D: Bladder calculi and sludge due to malfunction of the seminal vesicles

D. Wilm's tumor AKA nephroblastoma is the most common renal tumor in children. They grow quite large and are usually palpable at the time of diagnosis. The mass formation can lead to blood from the kidney entering the urine as it is formed. A pheochromocytoma is an adrenal tumor not commonly found in children.

A 6yr old female presents with hematuria and a palpable mass in the RUQ. The most likely diagnosis is: A: pheochromocytoma or neuroblastoma B: Wilm's tumor or oncocytoma C: nephroblastoma or staghorn calculus D: nephroblastoma or Wilm's tumor

D. In ADPKD the kidneys are enlarged and would contain 4 or more cysts in each kidney in a patient >60yrs of age. MCKD is a unilateral finding with numerous cysts causing renal enlargement. ACKD occurs with dialysis and the kidneys are small with multiple cyst formation. This patient demonstrates simple cortical cysts in normal sized kidneys.

A 72yr old patient presents for an abdominal ultrasound for epigastric pain. You note a 3cm cyst on the periphery of the right kidney and 3 smaller cortical cysts on the left kidney. The cysts are anechoic with smooth borders. Both kidneys are normal in size and echotexture. These findings are most consistent with: A: autosomal dominant polycystic kidney disease B: multicystic kidney disease C: acquired cystic disease D: simple cortical cysts

B. A large calculus located in the renal pelvis area is called a staghorn calculus. Staghorn calculus formation is a common finding with Xanthogranulomatous Pyelonephritis.

A large calculus located in the renal pelvis area is called: A: Parapelvic stone B: Staghorn calculi C: Gerota calculi D: Parapelvic stone or staghorn calculus

A. Renal cell carcinoma is seen in patients with tuberous sclerosis, autosomal dominant PCKD, acquired cystic disease from dialysis and Von Hippel Linda syndrome. Hematuria is a common symptom of RCC.

A male patient presents with a palpable flank mass, pain, hematuria and a history of Von Hippel-Lindau syndrome. The findings on the image are most suggestive of: A: renal cell carcinoma B: focal pyelonephritis C: spontaneous hematoma D: renal adenoma

A. If both kidneys are on one side of the body, one renal fossa will be empty.

A patient is referred for a renal ultrasound due to suspected cross fused renal ectopia. What is the expected ultrasound finding for this condition? A: Both kidneys are located on the same side of the body and fused together at varied locations. B: There is a single kidney located in the midline pelvic region. c: The kidneys are in their normal position but the upper poles of the kidneys are joined across the midline, usually anterior to the mid aorta. D: The kidneys are in their normal position but the lower poles of the kidneys are joined across the midline, usually anterior to the mid aorta.

B. Renal Carbuncle refers to a renal abscess that forms in the parenchyma and is caused by hematogenous spread of staphylococcus aureus. A corticomedullary renal abscess is caused by ascending bacteria in the urinary tract. Dirty shadowing and ring down artifact can be seen if gas is produced by bacteria in the abscess.

A patient presents for a renal ultrasound due to a recent diagnosis of staphylococcus aureus infection, right flank pain and microscopic hematuria. The chart states the referring physician suspects a renal carbuncle has formed. How will this abnormality be identified Sonographically? A: A hyperechoic mass of fibrous tissue replaces the tissues of the renal sinus causing significant outflow obstruction B: 1.5cm complex mass with ring down and dirty shadowing located within the renal parenchyma C: A single large calculus obstructing the renal pelvis with severe hydronephrosis. D: 1.5cm complex mass located within the renal pelvis that is cauisng renal vein thrrombosis

B. The infarct is wedge shaped due to the fanning out of the arterial branches as they near the periphery.

A patient presents for a renal ultrasound to rule out renal artery stenosis. A wedge shaped hypochoic area is noted within the parenchyma of the lower pole of the left kidney and no arcuate flow is detected in the area with color Doppler. The findings are most consistent with: A: acute pyelonephrosis B: renal infarct C: nephrocalcinosis D: medullary sponge kidney

B. An untreated long term bacterial infection of the kidney will cause chronic pyelonephritis. The severe symptoms, unilateral involvement and abnormal size, shape and contour of the kidney should suggest chronic pyelonephritis. Acute glomerulonephritis is usually a bilateral abnormality and the kidney is enlarged. Emphysematous pyelonephritis would cause renal enlargement with possible ring down or dirty shadowing.

A patient presents with a history of high fever, HT, nausea and vomiting. Lab results indicate the presence of white blood cells, pus and bacteria in the urine. A small, shrunken, misshapen left kidney and a normal right kidney are documented on the ultrasound exam. What are these findings most suggestive of? A: acute renal failure B: chronic pyelonephritis C: emphysematous pyelonephritis D: acute glomerulonephritis

D. The neuroblastoma will not distort the renal contour or disrupt the capsule. The nephroblastoma will distort the renal contour and disrupt the capsule.

Which of the following correctly describes how a Sonographer can differentiate a neuroblastoma from a nephroblastoma on an abdominal US? A: The neuroblastoma is highly vascular while the nephroblastoma is mainly necrotic due to limited vascular supply. B: It is not possible to differentiate these two tumors sonographically. c: The nephroblastoma will not distort the renal contour or disrupt the capsule. The neuroblastoma will distort the renal contour and disrupt the capsule. D: The neuroblastoma will not distort the renal contour or disrupt the capsule. The nephroblastoma will distort the renal contour and disrupt the capsule.

B. Lymphoma affects both organs in a pair, both kidneys are enlarged. In ovarian lymphoma, bilateral ovarian masses are present.

Which of the following correctly describes the sonographic appearance of renal lvmphoma? A: bilateral renal atrophy with renal failure B: bilateral renal enlargement C: unilateral renal enlargement D: unilateral renal atrophy

B. ADPKD results in the replacement of the renal cortex with multiple cysts. The number of cysts increases as patient ages and is usually not detected until after age 30 yrs. Renal function can be reduced later in life. ARPKD results in the replacement of the renal cortex by very tiny cysts. Renal function is significantly impaired causing death early on. MCKD most commonly occurs unilaterally. If it is bilateral, the patient will not survive long after birth. Acquired cystic disease occurs in patients undergoing dialysis treatment. The kidneys are decreased in size with sporadic cyst formation.

If the left kidney has the same appearance, the finding are most consistent with: A: autosomal recessive polycystic kidney disease B: autosomal dominant polycystic kidney disease C: acquired cystic disease D: multicystic kidney disease

C. If the patient voids and the hydronephrosis remains, the blockage must be above the level of the bladder. A ureteral obstruction (calculous, retroperitoneal fibrosis) or UPJ obstruction could cause these findings. Posterior urethral valves and other urethral obstructions cause bladder outlet obstruction and bilateral hydronephrosis.

If the patient voids normally and the image remains the same, the findings are most suggestive of: A: renal vein thrombosis B: Urethral obstruction C: ureteral obstruction D: benign prostatic hypertrophy

C. In an otherwise normal kidney, an angiomyolipoma is hyperechoic to the renal cortex and isoechoic to the renal sinus.

In an otherwise normal kidney, an angiomyolipoma is ____________to the renal cortex and __________to the renal sinus. A: isoechoic, hyperechoic B: hyperechoic, hypochoic C: hyperechoic, isoechoic D: hypochoic, isoechoic

D. In cases of moderate to severe medical renal disease the renal parenchyma will be atrophied to <10mm thickness. The kidney increases in echogenicity as it shrinks.

In cases of moderate to severe medical renal disease the renal parenchvma will be__________________. A: hypochoic to the sinus B: isoechoic to the liver C: hypertrophied to >10mm thickness D: atrophied to <10mm thickness

D. Sinus Lipomatosis is a benign accumulation of fat in the renal sinus and replacement or cortical tissue. It is of no pathologic significance. Sonographic characteristics include increased echogenicity of the renal sinus and thinned cortical layer.

Increased renal fat in the renal sinus with a thinned cortex indicates: A: Chronic renal failure B: Acute tubular necrosis C: Angiomyolipomatosis D: Sinus lipomatosis

B. Acute tubular necrosis, acute renal failure and renal vein thrombosis reflect kidneys that cannot properly filter blood and cortical tissue resistance is increased. No intrarenal arterial flow will be detected in the kidney with an acute renal arterial occlusion. Diastolic flow should be moderate in renal allografts (low resistance).

Increased resistive index in the renal parenchymal arteries is an expected finding with: A: infrarenal aortic aneurysms B: acute tubular necrosis and renal vein thrombosis C: acute renal artery occlusion and acute renal failure D: renal allografts placed less than 1 week ago

A. Multicystic kidney disease is a result of an insult to the kidney during embryonic development, usually related to UP obstruction.

Multicystic dysplastic kidneys are usually the result of: A: an obstruction of the ureteropelvic junction in utero B: autosomal dominant genetic disorder C: chronic urinary tract infections as a child D: autosomal recessive genetic disorder

A. As a kidney decreases in function, the organ atrophies. The cortex thins and becomes denser leading to an increase in cortical echogenicity.

Sonographic signs of chronic renal failure include a/an __________in size and a/an__________in echogenicity. A: decrease, increase B: decrease, decrease C: increase, increase D: increase, decrease

B. Nephrocalcinosis is the formation of multiple calcifications/stones within the pyramids of a medullary sponge kidney. The reduced function of the medullary sponge kidney is thought to be the cause of the formation of the stones.

The attached image demonstrates which abnormality, commonly associated with medullary sponge kidneys? A: Nephrolithiasis B: Nephrocalcinosis C: Granuloma formation D: Pyelonephritis

D. The round structure with the echogenic rim represents the balloon that is inflated on the end of a Foley catheter.

The attached image demonstrates: A: Ureterocele n the urinary bladder B: echinococcal cyst in the urinary bladder C: sludge ball on the urinary bladder D: foley catheter in the bladder

C. The image demonstrates a large bladder thrombus. Urinary catheters can irritate the bladder walls and cause bleeding that may lead to this type of thrombus formation. Trauma and the passage of renal stones can also cause bleeding/thrombus formation.

The findings on the image are most consistent with a patient history of: A: Gandaursyndromeant po yeystic kidney disease or Vonttlipper B: renal vein thrombosis or acute tubular necrosis c: ureherer ca cun or recent history of urinary bladder D: ureterocele or obstruction of the ureteropelvic junction

B. A duplicated collecting system refers to two separate collecting systems and ureters. Typically, one ureter drains the upper pole and one ureter drains the rest of the kidney. Hydronephrosis occurring in the upper OR lower pole is an indication of complete duplicated collecting system. Upper pole hydronephrosis is a common finding with a complete duplication. The ureter draining the upper pole of the kidney is more commonly affected by an abnormal distal ureter connection. Ureterocele is a common complication of the distal insertion site of the upper pole ureter. Reflux is common in the lower pole ureter.

The findings on the image are most suggestive of: A: column of Bertin B: duplicated collecting system C: junctional parenchymal defect D: cross fused renal ectopia

B. A splenorenal shunt is demonstrated on the images. Portal HTN increases pressure in the portal system and collaterals form. A collateral connection between the splenic and left renal veins is a splenorenal shunt. It is a common finding with portal HTN

The findings on the image of the left flank are caused by: A: ureteral obstruction B: portal HTN C: pancreatitis D: polycystic kidney disease

C. The image demonstrates chronic renal disease. Renal artery stenosis causes renal failure over time due to the chronic ischemia. An acute obstruction would cause renal enlargement and decreased echogenicity.

The findings on the image of the right flank are commonly associated with: A: nephrocalcinosis B: acute renal artery occlusion C: renal artery stenosis D: autosomal recessive polycystic kidney disease

D. The image demonstrates hydronephrosis that is limited to the upper pole. This is a classic sign of a duplicated collecting system. Ureteroceles are a common finding with upper pole hydronephrosis in a duplicated collecting system.

The image demonstrates ______________, which is commonly associated with_____________. A: ureteropelvic obstruction, staghorn calculus B: staghorn calculus, hydronephrosis C: parapelvic cyst, bladder diverticulum D: duplicated collecting system, ureterocele

B. The most common cause of acute renal failure is acute tubular necrosis and the most common cause of chronic rena failure is diabetes mellitus.

The most common cause of acute renal failure is___________ and the most common cause of chronic renal failure is__________. A: renal artery stenosis, renal vein thrombosis B: acute tubular necrosis, diabetes mellitus C: acute tubular necrosis, renal artery stenosis D: trauma, renal vein thrombosis

B. The most common location of a renal calculus causing obstruction is in the distal ureter at the junction with the bladder.

The most common location for a urinary obstruction caused by a renal calculus is in the__________________. A: trigone of the bladder B: distal ureter C: distal urethra D: proximal ureter

A. The kidneys are formed in the pelvic region and during fetal development they migrate superiorly to their positions on either side of the spine. The most common location for an ectopic kidney is in the pelvic region on the side of the body with the empty renal fossa.

The most common place for an ectopic kidney to be located is: A: right or left lower quadrant, slightly off midline B: mid-epigastric region posterior to bowel C: connected to the lower pole of the opposite kidney D: adjacent to the opposite kidney in the same quadrant

A. A column of Bertin is a strip of renal cortex that extends into the renal sinus. If the column of tissue reaches the cortex of the opposing side of the kidney, a duplicated collecting system is usually present.

The purple arrow on the image indicates which of the following? A: A normal variant in renal formation usually related to a duplicated collecting system B: Two kidneys fused at the mid poles. The arrow is pointing to the point of connection and the shared parenchymal tissue. C: A malignant mass of tissue separating the sinus into 2 portions. D: A normal variant in renal parenchymal formation called a dromedary hump.

A. In a patient with horseshoe kidney, the kidneys are fused at their lower poles, across the midline of the body. An ectopic kidney usually involves the abnormal placement of a single kidney in the pelvic region. Agenesis of the kidney is the absence of the formation of a kidney. A duplicated collecting system involves a congenital duplication of the renal pelvis/calyces and possibly ureters.

The renal anomaly where the kidneys do not separate completely during embryonic development is called: A: Horseshoe kidney B: Ectopic kidney C: Duplicated collecting system D: Renal agenesis

B. The debris and dirty shadowing correlate with an infection causing pus accumulation (Pyonephrosis). The gas produced by the bacteria in the infection causes the dirty posterior shadowing. A staghorn calculus would be highly reflective and exhibit clean posterior shadowing. Hydronephrosis is defined as a backup of urine into the renal pelvis and calyces which would appear anechoic.

The renal collecting system is dilated and contains mildly echogenic material with dirty shadowing posteriorly. This most likely represents: A: Pyelonephritis B: Pyonephrosis C: Staghorn calculus D: Hydronephrosis

C. The term allograft refers to a transplanted organ.

The term allograft refers to: A: the native organ that will be replaced by a transplanted organ B: the bypass graft used in arterial revascularization of an organ C: the transplanted organ D: an external portal shunt

A. Urinary bladder tumor invasion is most commonly caused by uterine cancer in females and by prostate cancer in males.. Tumor invasion occurs when a primary cancer crosses tissue planes into adjacent organs or vessels.

Tumor invasion into the urinary bladder is most commonly caused by___________in females and by ___________in males. A: uterine cancer, prostate cancer B: colon cancer, prostate cancer C: uterine cancer, colon cancer D: ovarian cancer, testicular cancer

B. The most common cause for an abdominal mass in a newborn is MCKD

What is the most common cause for an abdominal mass in a newborn? A: hemangioma B: multicystic kidney disease C: hepatoblastoma D: renal cell carcinoma

D. Duplicated collecting system is the most common congenital anomaly of the urinary system.

What is the most common congenital anomaly of the urinary system? A: dromedary hump B: ectopic kidney C: pancake kidney D: duplicated collecting system

B. Renal cell carcinoma is the most common primary renal malignancy.

What is the most common primary renal malignancy? A. Wilm's tumor B. Renal cell carcinoma C. Transitional cell carcinoma D. Cystadenocarcinoma

A. Renal papillary necrosis refers to ischemic necrosis of the renal papilla. The necrosis leads to the presence of sloughed papilla in the urine. It is most commonly caused by analgesic abuse.

What renal abnormality is suspected when sloughed papilla are identified in the urine? A: papillary necrosis B: hydronephrosis C: nephrocalcinosis D: acute pyelonephritis

A. Upper pole hydronephrosis is a common finding with a complete duplication. The ureter draining the upper pole of the kidney is more commonly affected by an abnormal distal ureter connection. Ureterocele is a common complication of the distal insertion site of the upper pole ureter. Reflux is common in the lower pole ureter.

What two bladder abnormalities are most commonly associated with a duplicated collecting system? A: ureterocele and vesicoureteral reflux B: neurogenic bladder and posterior urethral valves C: vesicoureteral reflux and bladder diverticulum D: ureterocele and bladder diverticulum

D. Intracranial "berry" aneurysms are an associated abnormality with autosomal dominant PCKD.

What type of aneurysm is most commonly asscociated with autosomal dominant polycystic kidney disease? A. Saccular B. Fusiform C.Pseudoaneurysm D. Berry

C. A duplicated collecting system indicates there are two ureters draining urine from the kidney. If one ureter becomes obstructed, only the portion of the kidney that is drained by that ureter wil become dilated with hydronephrosis.

Which congenital anomaly is associated with hydronephrosis of the upper OR lower pole of the kidney? A: UPJ obstruction B: posterior urethral valves C: duplicated collecting system D: column of Bertin

D. Ureterocele formation is commonly associated with a complete duplicated collecting system. A complete duplication indicates two renal pelvi and two ureters. The upper pole ureter usually has an abnormal distal insertion site (ureterocele). An incomplete duplication would demonstrate 2 renal pelvi and a single ureter.

Which congenital renal anomaly is commonly associated with ureterocele formation? A: renal agenesis B: dromedary hump C: horseshoe kidney D: duplicated collecting system

B. The resistive index should normally be below 0.7 in a renal allograft. If the RI reaches 0.8-1.0 transplant failure is suspected.

Which of the following Doppler criteria is used to evaluate the parenchymal flow in a renal allograft? A: renal aortic ratio B: resistive index C: SD ratio D: peak systolic velocity

D. Horseshoe kidneys refer to the attachment of the kidneys across the midline of the body, usually the lower poles. Hydronephrosis is common due to abnormal structure of collecting system and course and location of ureter. Calculi and pyelocaliectasis are also

Which of the following are commonly associated findings with horseshoe kidneys? A: emphysematous pyelonephritis and ureterocele B: renal cell carcinoma and oncocytoma C: bilateral renal atrophy and echogenic cortex D: calculi and hydronephrosis

A. Chronic renal hydronephrosis can result in renal failure. The kidney function will decrease and the blood pressure will rise to try to increase the filtration rate. A chronic obstruction usually leads to infection and can develop in to sepsis.

Which of the following are complications associated with chronic hydronephrosis? A: systemic HTN and renal failure B: neurogenic bladder and medullary sponge kidney C: portal thrombosis and pulmonary embolism D: urinoma and hematoma

B. Nephrocalcinosis refers to the deposition of calcium salts in the parenchyma of the kidney. It will present Sonographically as hyperechoic renal pyramids that may shadow.

Which of the following best describes the ultrasound appearance of nephrocalcinosis? A: Three or more renal calculi identified in each pole of the kidney B: Hyperechoic renal pyramids that may shadow C: Multiple linear calcifications within the renal parenchyma D: A large calculus within the renal pelvis causing hydronephrosis

B. Lithotripsy is used to shatter kidney stones into "manageable" sized pieces to allow the patient to pass them normally.

Which of the following can be treated using lithotripsy techniques? A: renal artery stenosis B: staghorn calculus C: Budd Chiari Syndrome D: lymphoma

D. Xanthogranulomatous Pyelonephritis is most commonly a unilateral finding. Recurrent infections cause chronic obstruction to renal urine output. Stone formation is a commonly associated finding with most presenting with staghorn calculus formation. Females and diabetic patients have higher risk of developing this abnormality.

Which of the following correctly describes Xanthogranulomatous Pyelonephritis? A: caused by recurrent severe dehydration B: most commonly bilateral and fatal C: prevalent in males and HIV patients D: most cases demonstrate a staghorn calculus and thinned renal cortex

B. 30% patients have duplicated or accessory renal arteries. The largest artery is the main renal artery and accessory arteries are smaller in caliber. They usually originate 1-2cm inferior to the main renal artery, but can also originate from the SMA or common iliac arteries. Some accessory arteries may not enter the hilum, but course directly to the upper or lower pole. Lumbar arteries can be confused with accessory renal arteries, but they have very high resistance flow patterns which are unlike the low resistance flow pattern in the renal artery. Accessory renal vessels must be documented prior to renal resection or transplantation.

Accessory renal arteries: A: usually originate from the contralateral renal artery B: must be documented prior to renal resection or transplantation C: demonstrate the same flow pattern as lumbar arteries D: always enter the hilum adjacent to the main renal artery

B. Prerenal failure - hypotension, volume depletion, heart failure, acute occlusion of the renal artery Intrinsic (infrarenal) renal failure - acute tubular necrosis, nephritic syndrome, interstitial nephritis, autoimmune diseases Postrenal failure - bilateral renal obstruction

Acute occlusion of the main renal artery can cause_____________ acute renal failure. A: postrenal B: prerenal C: intrinsic D: extrinsic

A. Angiomyolipomas and lipomas are both tumors that would appear hyperechoic to the cortex. An oncocytoma has varied echogenicity with a central scar related to necrosis.

An asymptomatic patient presents for a renal US for size evaluation due to chronic systemic HTN. The right kidney demonstrates a 1cm rounded hyperechoic mass within the renal cortex. There is no posterior enhancement or shadowing noted with the mass. Which of the following can be used to describe the US findings? A: angiomyolipoma or lipoma B: adenoma or fibroma C: oncocytoma D: hepatoma

A. A milk of calcium cyst contains debris that layers in the dependent portion of the cyst. The cyst contains a colloidal suspension of calcium salts (carbonate, phosphate and oxalate). If there is a lot of calcium in the debris, it can be very echogenic and cause shadowing. They are usually asymptomatic and an incidental finding.

An ultrasound exam demonstrates a 1.8cm renal cyst in the upper pole of the left kidney with debris that layers in the dependent portion of the cyst when the patient changes position. These findings are most suggestive of: A: milk of calcium cyst B: porcelain cyst C: renal abscess D: infected cyst

C. Renal papillary necrosis refers to ischemic necrosis of the renal papilla. The necrosis leads to the presence of sloughed papilla in the urine. It is most commonly caused by analgesic abuse.

Analgesic abuse is the most common cause of what renal abnormality? A: nephrocalcinosis B: acute renal failure C: papillary necrosis D: glomerulonephritis

C. Tuberous sclerosis is commonly associated with the formation of angiomyolipomas in the kidneys.

Apatient presents for a renal ultrasound due to a history of tuberous sclerosis. What is the doctor looking for? A: hydronephrosis B: renal artery stenosis C: angiomyolipomas D: renal failure

B. Nephroblastoma (Wilms Tumor) is the most common malignant tumor found by sonography in pediatric patients. It is the most common renal tumor identified in pediatric patients. Children with Beckwith Wiedemann Syndrome have a significant risk of developing nephroblastoma.

Children with Beckwith Wiedemann Syndrome have a significant risk of developing: A: hyperparathyroidism B: nephroblastoma C: cholelithiasis D: portal HTN

A. A low RI value, less than 0.5, in the kidney indicates reduced inflow. A low PSV with moderate diastolic flow indicates a proximal stenosis in the renal artery. Renal disease causes increased resistance to renal inflow and an Rl higher than 0.7.

If Doppler evaluation of the parenchymal artery of a kidney demonstrates a resistive index of 0.45, the findings are considered: A: suspicious for proximal renal artery stenosis B: normal C: suspicious for acute renal failure D: suspicious for chronic renal failure

D. A sudden increase in systemic BP with no response to medication is usually associated with renovascular HT caused by renal artery stenosis.

If a patient complains of a recent onset of uncontrollable systemic HTN with average BP readings exceeding 170/90mmHg, what vascular cause should be suspected? A: portal HTN B: hepatic congestion C: subclavian stenosis D: renal artery stenosis

D. The presence of ureteral jets in the bladder can help exclude complete ureteral obstruction in a pregnant patient with hdronephrosis. An IP or CT exam is not recommended on a pregnant patient due to radiation exposure and contrast risks.

If a pregnant patient has unilateral hydronephrosis, what is the preferred method to rule out an obstructive ureteral calculus as the cause? A: Obstructive ureteral calculi cannot be evaluated in a pregnant patient. An intravenous pyelogram is required. B: Obstructive ureteral calculi cannot be evaluated in a pregnant patient. An CT abdomen and pelvis exam with contrast is required. C: Ask patient to empty bladder and apply color Doppler to locate a stone with twinkling artifact D: Apply color Doppler to identify the ureteral jets

C. The image demonstrates a large bladder thrombus. A neurogenic bladder requires frequent catheterization. Urinary catheters can irritate the bladder walls and cause bleeding that may lead to this type of thrombus formation. Changing the patient position will demonstrate that the mass is mobile, not affixed to the wall. Tumor formation would disrupt and invade the wall. The bladder wall is smooth in this patient.

A patient presents with a history of neurogenic bladder and recent onset of mild hematuria. Which of the following statements is true regarding the findings on the image? A: The mass appears to be a remnant of the catheter balloon that was thought to be removed one week ago. B: The hypochoic mass is most likely malignant due to the significant infiltration of the bladder wall. C: It is necessary to change the patient position while scanning to determine mass mobility. D: If the hypochoic mass is mobile, it is most likely a calculus.

D. The symptoms and urinalysis are related to an infection in the urinary system. The image demonstrates a focal mass of renal cortex with mild heterogeneity. Focal pyelonephritis is identified at the mid pole of the right kidney. Note the loss of definition of the corticomedullary boundary.

A patient presents with flank pain, fever and nausea for 2 days. Urinalysis shows RBC and WBC present in the sample. Which of the following would be the most likely diagnosis made from the renal ultrasound images provided from this patient's exam? A: Renal Adenoma B: Diffuse Pyelonephritis C: Renal Cell Carcinoma D: Focal Pyelonephritis

C. The renal allograft is usually connected to the external iliac artery and vein. Blood moves from the external iliac artery to the renal artery of the transplant.

A renal transplant is usually positioned in the right lower quadrant with an arterial connection with what native artery? A: internal iliac B: aorta C: external iliac D: inferior mesenteric artery

D. Tardus Parvus waveform - absence of earl systolic peak and prolonged acceleration time. If identified in in the native arcuate arteries, significant renal artery stenosis is present.

A tardus parvus wavefrom is described as? A. Pronounced of early systolic peak and prolonged acceleration time. B. Reduced systolic velocity with diastolic flow reversal C. Resistive index of 1.0 or greater. D. Absence of early systolic peak and prolonged acceleration time.

A. Transitional Cell Carcinoma forms in transitional cells that line the renal pelvis, ureters and bladder. It is the most common bladder neoplasm. The most common symptom is painless macroscopic hematuria. Mass or focal wall thickening of the bladder are strong indicators of TCC. Sonographic characteristics include solitary or multiple hypochoic mass formation with potential invasion into surrounding tissues. Unilateral hydronephrosis can be present with single ureter involvement. Bilateral hydronephrosis can be present with bilateral ureteral or urethral involvement.

Which of the following correctly describes transitional cell carcinoma? A: Most commonly presents as diffuse bladder wall thickening with multiple masses within the wall B: Most common mass encountered on the adrenal gland C: Always causes bilateral hydronephrosis D: Urinary incontinence is the most common symptom

A. Distal to a significant stenosis the flow will be damped and is called tardus parvus. A tardus parvus waveform refers to the absence of early systolic peak and prolonged acceleration time. Tardus Parvus means "late and low" with late peaking and low

Which of the following describes a tardus parvus waveform? A: low velocity with late systolic peak B: high velocity with sharp peak C: low velocity with diastolic flow reversal D: high velocity with diastolic flow reversal

B. Renal cell carcinoma is seen in patients with tuberous sclerosis, autosomal dominant PCKD, acquired cystic disease from dialysis and Von Hippel Lindau syndrome. Patients with autosomal recessive PCKD usually die early in life.

Which of the following has the lowest risk of developing renal cell carcinoma? A: patients with acquired cystic disease B: patients with autosomal recessive PCKD C: patients on long term dialysis D: patients with tuberous sclerosis

D. Acute tubular necrosis commonly presents as enlarged kidney with prominent pyramids. The parenchymal vessels will demonstrate increased resistance and resistive index = decreased diastolic flow.

Which of the following is a Sonographic characteristic of acute tubular necrosis? A: increased diastolic flow in the arcuate arteries B: cortical thickness <1 cm C: atrophied kidney D: prominent renal pyramids

B. In a transverse view the normal kidney demonstrates cortical tissue surrounding the upper and lower poles, while the mid pole demonstrates the renal pelvis with a lack of cortical tissue in the area of the renal pelvis. When documenting a duplicated collecting system with ultrasound, obtain transverse images demonstrating the upper pole with a hilum, the mid pole with circumferential cortex (no hilum), and the lower pole with a hilum. Color Doppler can assist in demonstrating vessels entering the upper and lower pole hilar areas, but not at the expected mid pole area.

Which of the following is an expected Sonographic finding with complete duplication of the collecting system of the kidney? A: circumferential cortex at the upper, mid and lower poles B: circumferential cortex at the mid pole C: circumferential cortex at the lower pole D: circumferential cortex at the upper pole

A. Acute pyelonephritis is most commonly diagnosed clinically with lab testing and is treated with antibiotics. It is Most commonly caused by an ascending UTI. Diffuse involvement can demonstrate loss of distinction of the renal sinus echoes in affected kidney/segment. Focal involvement will demonstrate a hypochoic wedge shaped segment of parenchyma

Which of the following is correct regarding acute pyelonephritis? A: Usually treated with antibiotics B: Critical finding that requires immediate nephrectomy to prevent sepsis C: Diffuse involvement will demonstrate prominent distinction of the renal sinus echoes in affected kidney/segment D: Focal involvement will demonstrate a hyperechoic ovoid segment of parenchyma

A. Non-shadowing renal masses include mycetoma, lipoma, and angiomyolipoma. Papillary necrosis leads to echogenic material and calcifications with shadowing within the collecting system (sloughed papilla).

Which of the following is most likely to produce posterior shadowing? A: sloughed papilla B: angiomyolipoma C: mycetoma D: renal lipoma

C. Acute tubular necrosis is the most common cause of acute renal failure in an allograft.

Which of the following is the most common cause of acute renal failure in an allograft? A: renal artery stenosis B: multicystic kidney disease C: acute tubular necrosis D: polycystic disease

A. Oncocytomas are most commonly benign tumors that occur later in life. They cannot be distinguished from renal cell carcinoma without a biopsy. Both RCC and oncocytomas can demonstrate a central scar.

Which of the following is true regarding a renal oncocytoma? A: may have a central scar similar to renal cell carcinoma B: usually occur in pediatric patients C: usually malignant and very aggressive D: easily differentiated from renal cell carcinoma by the presence of a central scar within the tumor

B. Acute glomerulonephritis causes inflammation of the glomeruli. It results in bilateral renal enlargement with increased cortical echogenicity and prominent pyramids.

Which of the following lists the most common ultrasound findings with acute glomerulonephritis? A: Unilateral renal enlargement with decreased cortical echogenicity B: bilateral renal enlargement with increased cortical echogenicity C: small, smooth echogenic kidneys D: bilateral microcyst formation that causes increased cortical echogenicity

C. Lack of fetal urine production in utero is the first sign that infantile PCKD is present.

Which of the following renal disorders is usually detected in utero due to oligohydramnios? A: duplicated collecting system B: multicystic dysplastic kidney disease C: autosomal recessive polycystic kidney disease D: horseshoe kidney

D. Both abnormalities will demonstrate normal renal size with a focal, indistinct, hypoechoic wedge shaped segment of parenchyma.

Which of the following renal pathologies will appear the same sonographically as focal acute pyelonephritis? A: pyonephritis B: angiomyolipoma C: renal adenoma D: renal infarct

A. Transitional cells line the renal pelvis, ureter and bladder. Transitional cell carcinoma would not be identified in the renal cortex. It is most commonly found in the bladder. If found in the kidney, it is usually identified in the renal pelvis. The other choices originate in the parenchymal tissue in a more superficial location.

Which of the following renal tumors is a hypochoic mass most commonly found in the renal pelvis? A: transitional cell carcinoma B: oncocytoma C: renal cell carcinoma D: adenoma

B. Acute renal vein thrombosis will demonstrate increased kidney size, hypochoic renal cortex, decreased corticomedullary differentiation, mottled echogenicity, dilated renal vein and no intrarenal venous flow. There is also increased resistance in renal arteries due to the outflow obstruction in the venous system.

Which of the following sonographic characteristics is an expected finding in a patient with acute renal vein thrombosis? A: increased diastolic flow in the renal arteries B: enlarged kidney with mottled echogenicity C: high velocity, continuous venous flow within the kidney D: prominent corticomedullary definition

A. Renal vein thrombosis will demonstrate increased kidney size, hypochoic renal cortex, decreased corticomedullary differentiation, mottled echogenicity, dilated renal vein, no intrarenal venous flow, and increased resistance in renal arteries. Diastolic flow reversal is a sign of high resistance.

Which of the following sonographic characteristics is most suggestive of acute renal vein thrombosis? A: diastolic flow reversal in the renal arteries B: atrophied kidney with mottled echogenicity C: hyperarterial flow within the kidney D: increased corticomedullary definition

B. The mass represents an angiomyolipoma, which is a benign fatty tumor.

Which of the following statements best describes the findings on the image ? A. A large renal calculus is present in the lower pole of the kidney B. A hyperechoic, rounded mass is present in the lower pole of the kidney. C.A hypoecoic , rounded mass is present in the lower pole of the kidney. D. The lower pole of the kidney demonstrates the classic appearance of an infarct.

B. Using the transverse image, note the position of the mass closer to the renal hilum = medial. Note the position of the mass closer to the top of the image = anterior

Which of the following statements best describes the findings on the image? A: A hyperechoic, rounded mass is attached to the posterior, medial aspect of the mid pole of the kidney. B: A hyperechoic, rounded mass is attached to the anterior, medial aspect of the mid pole of the kidney. c: A hyperechoic, rounded mass is attached to the posterior, lateral aspect of the mid pole of the kidney. D: A hyperechoic, rounded mass is attached to the anterior, lateral aspect of the mid pole of the kidney.

B. Renal artery stenosis > 60% is indicated when the PSV is greater than 2.0m/s and the renal aortic ratio is over 3.5. A 60% stenosis is considered significant and treatment is required. There are no other diagnostic criteria used to stage RAS at 75% and 85% stenosis

Which of the following statements is true regarding the Doppler tracing from the renal artery? A: Normal flow pattern and velocity are demonstrated but an incorrect Doppler angle is used to assess the flow causing aliasing to occur B: Accords a RAS diagnostic criteria, Stenosis = 60% iS C: The renal to aortic ratio is most likely below 3.5 D: Normal flow pattern and velocity are demonstrated

A. The images demonstrate cross fused renal ectopia. Note that both kidneys are primarily on the right side of the body and adjacent to the liver. Horseshoe kidneys and cross fused renal ectopia are congenital malformations that involve malpositioning of the kidneys. A horseshoe kidney indicates kidneys that are tilted medially and fused across the midline of the body with a midline isthmus of parenchvmal tissue that passes anterior to the aorta. Cross fused renal ectopia is indicated when both kidneys are fused and identified primarily on the same side of the body. These abnormalities occur during the formation and migration of the kidneys in utero. The overall renal function is usually not affected.

Which of the following statements is true regarding the displayed images from a renal ultrasound exam? A: The left kidney is fused to the right kidney on the right side of the body. B: Renal function will be increased due to the fusion of the kidney C: The images represent the surgical connection of the kidneys in an effort to increase renal function. D: A duplicated collecting system is present.

A. The image demonstrates autosomal dominant PCKD. It requires only one parent to have the defective gene and is characterized by the formation of multiple visible cortical cysts. The affected parent has the same disorder and it spans generations. Autosomal dominant PCKD can lead to a decrease in renal function over time that could cause renal failure later in life. The liver, pancreas and ovaries are also affected. In some cases the spleen demonstrates cystic formation but it is much less common. Autosomal recessive polycystic disease requires two abnormal genes in a pair to develop and it is always fatal early in life. The parent does not usually have the disorder. The functional renal tissue is completely replaced by micro-cysts causing complete malfunction of both of the kidneys in utero and then after birth.

Which of the following statements is true regarding the form of polycystic kidney disease demonstrated on the image displayed from a 32yr old male patient? A: One parent has the disorder and it spans generations. B: the most commonly associated organ with additional cyst formation is the spleen. C: This form of PCKD is usually fatal early in life. D: it requires two defective genes in a pair to cause this type of PCKD.

B. Note the dilated calyces with thickened walls and debris, consistent with an infection. Fever and increased WBC count will occur with most infections.

Which of the following statements is true regarding the image displayed? A: The BUN and creatinine serum levels will be decreased due to decreased renal function. B: The patient will present with a fever and increased WBC count. C: A staghorn calculus is seen in the central pelvis of the kidney causing the hydronephrosis. D: The renal cortex is thinned and increased in echogenicity.

B. It appears that a duplicated collecting system is usually present. An IVP will demonstrate the duplicated collecting structures. Angiography would demonstrate the vasculature only.

Which of the following will better evaluate the anomaly on the image? A: KUB x-ray B: Intravenous pyelogram C: Core needle biopsy D: serum BUN and creatinine levels

B. No intrarenal arterial flow will be detected in the kidney with an acute renal arterial occlusion. No arterial flow would offer a RI value of 0. Acute tubular necrosis, acute renal failure and renal vein thrombosis reflect kidneys that cannot properly filter blood and cortical tissue resistance is increased. As cortical resistance increases, the RI value increases.

Which of the following will demonstrate the lowest resistive index value? A: acute renal failure B: acute renal artery occlusion C: acute tubular necrosis D: renal vein thrombosis

C. Oncocytoma would normally present as a hypochoic renal mass. A milk of calcium cyst would appear as a anechoic cystic mass with echogenic debris. The other choices will appear as a hyperechoic mass.

Which of the following would normally present as a hypochoic renal mass? A: Mycetoma B: Angiomyolipoma C: Oncocytoma D: Milk of calcium cyst

D. Average adult renal length 9-12 cm, width 4-6 cm and AP 3-4 cm. The length measurements of the adult kidneys should be within 2cm of each other. In this case the right kidney is small and the left kidney is normal in size. Stenosis of the right renal artery can cause renal ischemia and atrophy. The other choices would result in a unilateral or bilateral renal enlargement.

Which of the following would result in a 7cm right kidney and a 9.8cm left kidney in an average sized patient? A: acute thrombosis of the right renal vein B: renal lymphoma C: autosomal dominant polycystic kidney disease D: right renal artery stenosis

D. Ureteroceles are thin membranes that cover the junction of the ureter and bladder. Posterior urethral valves are abnormal structures in the urethral tube causing a backlog of urine starting in the bladder and extending to the kidneys. Polyps would appear as folds of the bladder lining extending into the bladder lumen causing an irregular contour to the bladder wall.

While scanning the urinary bladder using color Doppler, the left urinary it is detected but is partially obstructed by a thin membrane that balloons into the bladder lumen. What is the finding displayed? A: UPJ obstruction B: urethrocele C: posterior urethral valves D: ureterocele

C. Mesoblastic nephroma is the most common renal tumor in neonates, while nephroblastoma is the most common renal tumor in pediatric patients.

_____________is the mostcommon renal tumor in neonates, while ________________ is the most common renal tumor in pediatric patients. A: Nephroblastoma, Mesoblastic nephroma B: Mesoblastic nephroma, Angiomyolipoma C: Mesoblastic nephroma, Nephroblastoma D: Nephroblastoma, Neuroblastoma

A. Ultrasound appearance of a junctional parenchymal defect is a triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney.

How does a junctional parenchymal defect appear on ultrasound examination? A: Triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney B: Prominent renal cortical parenchyma located between 2 medullary pyramids C: Thicker cortex on the lateral aspect of the left kidney D: Narrowing or obstruction of the junction of the renal pelvis and ureter

A. Significant hydronephrosis can lead to increased resistance and resistive index in the parenchymal vessels of the renal cortex.

How does significant hydronephrosis affect the blood flow in the renal cortex? A: increases the resistive index in the parenchymal arteries B: increases diastolic flow C: decreases the resistive index in the parenchymal arteries D: increases systolic flow

D. Stone formation, mass formation and pregnancy can all lead to hydronephrosis due to mechanical obstruction or the mass effect with extrinsic pressure.

Extrinsic compression, pregnancy, stone and mass formation are all causes of what urinary abnormality? A: renal artery stenosis B: renal carbuncle C: medullary sponge kidney D: hydronephrosis

D. FNH, oncocytoma, and RCC usually present as a solid mass with a central hypochoic area termed a central scar. FNH is also described as demonstrating a stellate vascular pattern that radiates from the central area, similar to the spokes on a wheel.

Oncocytoma, renal cell carcinoma, and focal nodular hyperplasia share what sonographic characteristic? A: thick septations within the mass B: invasion of vasculature C: posterior enhancement D: central scar

A. RCC is also known as a hypernephroma or Von Growitz tumor. Wilm's tumor AKA Nephroblastoma is the most common pediatric renal malignancy.

Renal cell carcinoma is also called: A: Hypernephroma B: Wilm's Tumor C: Nephroblastoma D: Transitional Cell carcinoma

C. Diffuse bladder wall calcification is commonly associated with schistosomiasis and chronic cystitis.

Schistosomiasis and chronic cystitis are commonly associated with what Sonographic findings in the urinary bladder? A: Bladder wall atrophy due to reduced arterial supply B: Ureterocele formation C: Diffuse bladder wall calcification D: The bladder lumen is filled with numerous non-shadowing stones