Urinary Tract Review
Rejection of a renal transplant is suggested once the resistive index reaches:
0.9
Normal postvoid residual urine volume should not exceed:
20 mL
You are performing a follow-up ultrasound study on a patient with a large left renal cyst. Which of the following most accurately describes the prevalence of renal cysts?
50% of people over age 50
You are performing a sonogram on a patient with bilaterally small kidneys. What is the normal range in size for a kidney?
9 - 14 cm
You detect the presence of free fluid in the space between the liver and right kidney. What is the name of this anatomic location?
Morison's pouch
During a routine renal ultrasound, you are suspicious of increased echogenicity of the kidneys. What describes the normal echogenicity of the renal cortex?
The normal kidney echogenicity is frequently isoechoic with the liver and spleen.
Which of the following statements is NOT true regarding normal anatomy of the kidneys? The kidneys are retroperitoneal in location The right kidney is located slightly inferior compared to the left The tail of the pancreas is in contact with the lateral dorsal aspect of the left kidney The superomedial aspect of the right kidney is in contact with the adrenal gland The superior pole of each kidney is slightly medial compared to the inferior pole
The tail of the pancreas is in contact with the lateral dorsal aspect of the left kidney
Which malignant tumour is most common in children aged 2 - 5?
Wilm's tumor
A hyperechoic focus located in the anteriour renal cortex in an asymptomatic patient most likely represents:
a junctional parenchymal defect
You are performing a Doppler evaluation to rule out renal artery stenosis. You will compute a ratio comparing the velocity in the renal artery to what vessel?
abdominal aorta
You are performing a renal sonogram and identify hydronephrosis in the right kidney. Which of the following is NOT a potential cause of hydronephrosis? ureteral stone large uterine fibroid ureteropelvic junction obstruction acute pyelonephritis ovarian mass
acute pyelonephritis
What is the most common cause of acute renal failure?
acute tubular necrosis (ATN)
What term describes the typical sonographic appearance of the medullary pyramids in the neonate?
anechoic
A patient is referred from x-ray with a questionable left renal cyst. What are the sonographic criteria of a simple cyst?
anechoic acoustic enhancement sharply defined smooth far wall round or ovoid shape
A renal mass that is highly echogenic due to its high-fat content is:
angiomyolipoma
An ultrasound exam reveals a solid, hyperechoic mass in a 46-year-old patient with tuberous sclerosis. This most likely represents:
angiomyolipoma
Which of the following renal masses would most likely cause a speed propagation artifact?
angiomyolipoma
You are performing an ultrasound on a patient with known horseshoe kidneys. Where is the isthmus of a horseshoe kidney located?
anterior to the abdominal aorta
What arteries course on top of the renal pyramids and give rise to the tiny intralobular arteries?
arcuate
You have been asked to identify the ureteral "jets". Where are the ureteral orifices in the urinary bladder?
base of the trigone along posteriour aspect
What describes the normal course of the left renal vein?
between the superiour mesenteric artery and the aorta
You are performing an ultrasound exam on a patient who has been on dialysis for 4 years. Which of the following describes the typical appearance of the kidney in these cases?
bilaterally small, echogenic kidneys with multiple cysts of varying sizes
A 45-year-old female patient arrives for a pelvic ultrasound complaining of urinary frequency. An anechoic structure is identified contiguous with the urinary bladder. The pathology identified is most suspicious for a:
bladder diverticulum
You are performing an ultrasound exam on a patient with crossed renal ectopia. What describes your findings?
both kidneys are on the same side of the abdomen
Fusion of the entire medial aspect of both kidneys is a congenital anomaly termed:
cake kidney
A patient has been referred to the ultrasound department with a history of medullary nephrocalcinosis. What do you expect to see?
calcified pyramids
A catheterized paraplegic patient is scheduled for a retroperitoneum ultrasound. An anechoic structure is identified in the region of the urinary bladder This structure most likely represents a:
catheter balloon
Doppler analysis of intrarenal waveforms performed during renal sonography reveal a resistive index of 1.0. This finding is consistent with:
chronic medical renal disease renal vein thrombosis renal obstruction
During colour Doppler evaluation of the kidney, inadequate fill is seen of the intrarenal vasculature. Which Doppler parameter will you adjust to improve sensitivity to flow?
decrease pulse repetition frequency
What is the purpose of scanning the urinary bladder to identify ureteral "jets" ?
determine if a ureter is obstructed
You have been asked to perform an ultrasound evaluation of a child with mylticystic dysplastic kidney (MCDK). Which of the following is NOT a sign of this condition? multiple variably sized cysts nonmedial location of the largest cyst dilated ureter no identifiable renal sinus brightly echogenic tissue interfaces between cysts
dilated ureter
During a renal sonogram, you notice a 1.5 cm thickening of the left lateral renal cortex. This most likely represents:
dromedary hump
You are scanning a patient post biopsy and discover a cystic mass in the kidney. What should you do?
evaluate the cyst with colour Doppler
Which of the following would be most helpful in delineating ureteral "jets"?
examine the urinary bladder with colour Doppler
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 the renal vein search for liver metastasis search for retroperitoneal adenopathy
You are performing a Doppler study of a renal transplant to rule out stenosis of the renal artery. The renal artery is usually anastomosed to which artery?
external iliac artery
You are scanning a patient with autosomal dominant polycystic kidney disease. Which of the following is NOT true regarding this disease? liver cysts may be present in up to 30% of patients high blood pressure 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
Which of the following renal structures is composed of blood vessels or nerve fibers?
glomerulus
You detect a discrete echogenic focus without shadowing in the left kidney and suspect the presence of a renal calculus. What is most helpful in improving visualization of posteriour acoustic shadowing?
higher-frequency transducer
What is the normal appearance of the central sinus of the kidney?
highly echogenic compared to the renal cortex
A patient has been referred from CT with a history of nephrocalcinosis. What is the ultrasound appearance of this entity?
highly echogenic renal pyramids with or without posterior acoustic shadowing
You are scanning a patient and notice that the right and left kidneys are attached at the their lower poles. What anomaly is present?
horseshoe kidney
What condition is most likely to mimic a duplicated urinary system?
hypertrophied column of Bertin
You are performing a follow-up study on a patient with a renal transplant. What changes normally occur in renal transplants compared to the immediate postoperative study?
hypertrophy
Which intrarenal arteries course alongside the renal pyramids?
interlobar
You have been asked to evaluate an atypical renal cyst seen on CT. What feature is indicative of an atypical cyst?
internal septations wall calcification internal echoes irregular walls
A questionable mass is seen between the renal pyramids on the right kidney. You suspect this is a Column of Bertin "pseudomass." Which of the folling sonographic features helps distinguish this from a true pathologic 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 colour Doppler
The renal arteries arise from which aspect of the abdominal aorta?
lateral
The left renal artery is normally located immediately posterior to:
left renal vein
What condition is associated with a decrease in blood urea nitrogen (BUN)?
liver failure (also associated with pregnancy)
What describes the normal waveform of the main renal artery?
low resistance
A patient has been referred to your lab for a Doppler study of the kidneys. What type of waveform do you expect to see in the normal main renal artery?
low resistance with forward flow throughout the cardiac cycle
You are scanning a patient with right flank pain and known polycystic kidney disease. You suspect the presence of hemorrhage within one of the renal cysts. What is the sonographic appearance of this finding?
low-level echoes within the cyst
Which of the following structures are contained in the renal sinus?
lymphatics, peripelvic fat, major calyces
During 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
What preparation should you require of your patients scheduled for renal sonograms?
moderate hydration with no other specific preparation
Which of the following is usually diagnosed in early childhood or in utero?
multicystic dysplastic kidney
You are performing a follow-up study on a patient diagnosed with emphysematous pyelonephritis. What best describes the sonographic appearance of this condition?
multiple echogenic foci within the renal sinus or parenchyma with "dirty" posteriour acoustic shadows
You are scanning a patient with suspected lymphoma of the kidney. Which ultrasound appearance is associated with lymphoma?
multiple, bilateral, hypoechoic masses in enlarged kidneys
You are scanning a patient with known bladder outlet obstruction and note thickening of the urinary bladder wall. What is the most likely etiology of the wall thickening?
muscular hypertrophy
You have detected compensatory hypertrophy of the right kidney in a 35-year-old male. This finding is associated with which of the following?
nephrectomyrenal agenesis, renal hypoplasia, renal atrophy
What structure is considered the basic functional unit of the kidney?
nephron
What is the accepted treatment for a simple renal cyst?
no further evaluation required
A patient has been referred to your ultrasound lab with a history of acute pyelonephritis. What is the most common ultrasound appearance of this condition?
normal appearance
During routine surveillance of the urinary bladder, you detect the presence of periodic ureteral "jets." This is a sign of:
normality
Ultrasound findings in a patient with hypertension include a left kidney measuring 6.8 cm and a right kidney measuring 11.7 cm. What is most consistent with these findings?
occlusion of the left main renal artery
You suspect hydronephrosis in a 42-year-old femal who complains of vague abdominal discomfort. Which of the following is a cause of false-positive determination of hydronephrosis?
overdistention of the urinary bladder parapelvic cysts prominent hilar vessels large extrarenal pelvis
A patient has been referred for Doppler interrogation of the kidney. Which view provides the best colour Doppler evaluation of the intrarenal vasculature?
patient in posteriour oblique position, coronal view through posteriour axillary line
What is the ultrasound appearance of ureteropelvic junction obstruction?
pelvicaliectasis to the level of the junction of the renal pelvis and ureter
A patient has been referred for ultrasound evaluation of the left kidney following an automobile accident. What is the sonographic appearance of a subcapsular hematoma?
perirenal fluid collection that flattens the underlying renal contour
You are scanning a 31-year-old patient with hypertension and impaired renal function. You detect enlarged kidneys with ysts that are too numerous to count. What is most likely?
polycystic kidney disease
The quadratus lumborum is a muscle located in the:
posteriour abdominal wall
What describes the normal course of the right renal vein?
posteriour to the inferiour vena cava
What patient position is typically used for renal biopsy procedures?
prone
A 43-year-old female patient presents to the ultrasound department complaining of right flank pain and dysuria. A generalized swelling of the kidney is demonstrated. The medullary pyramids appear well defined. This is most suspicious for:
pyelonephritis
Which of the following results from an ascending urinary tract infection?
pyelonephritis
A patient is referred for ultrasound evaluation to rule out the presence of renal malignancy. What is the most common solid renal mass in the adult?
renal cell carcinoma
What renal tumour is most common?
renal cell carcinoma
A patient complaining of sharp, severe flank pain radiating to the groin is describing:
renal colic
What Doppler parameter should you measure to look for rejection in a renal transplant?
resistivity index
You are scanning the urinary bladder and notice multiple artifactual bands in the near field at the anteriour bladder wall. What is the source of these echoes?
reverberation artifact
A patient has been referred to your ultrasound lab for evaluation of a new renal transplant. Where should you look?
right lower quadrant
During performance of a renal sonogram, you identify only one kidney. What should you do?
scan in the pelvis area to rule out the presence of a pelvic kidney
You are performing an ultrasound on a patient with suspected renal failure. What lab work is elevated with renal failure?
serum creatinine
The most common renal neoplasm identified in patient over the age of 55 years is a:
simple cyst
Which part of the kidney contains fat, calyces, infundibuli of the collecting system and vessels?
sinus
A patient with a history of chronic medical renal disease has been referred for abdominal ultrasound. What describes the renal appearance you expect to see?
small hyperechoic kidneys
The renal arteries arise from the aorta closest to the origin of which artery?
superior mesenteric artery
You are having difficulty identifying the renal arteries in a patient referred for questionable renal artery stenosis. Which vessel is most helpful as a landmark for the location of the renal arteries?
superiour mesenteric artery
Functions of the kidneys include all of the following EXCEPT: regulation of acid-base balance urine production regulation of electrolyte balance synthesis of amino acids production of erythroprotein
synthesis of amino acids
What will help you in identification of the right renal artery?
the right renal vein lies anteriour to the renal artery
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 tumor most commonly occurs within the urinary bladder?
transitional cell carcinoma
You detect irregular thickening of the bladder wall in a 53-year-old male with hydronephrosis and a dilated ureter. What would you suspect?
transitional cell carcinoma
What muscle is located lateral to each kidney?
transversus abdominus
What is the indication for a Doppler renal study to rule out renal artery stenosis?
uncontrolled hypertension
Ultrasound imaging reveals left-sided hydronephrosis in a 38-year-old woman with vague abdominal pain. You should tailor your exam to rule out which of the following?
ureteral calculi pelvic mass aortic aneurysm
During a routine abdomen and pelvic ultrasound study, you detect a small round, cystic structure projecting into the urinary bladder. This most likely represents:
ureterocele
The most common etiology for hydronephrosis is:
urinary tract obstruction
Which of the following is not a part of the urinary tract?
uterus
You are scanning a patient with a history of renal infections. You suspect thinning of the renal cortex. What is the normal diameter of the renal cortex?
≥10 mm