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Davie's abdomen review: part 4 Urinary system

Terms in this set (79)

197. You are scanning a patient and notice that the right and left kidneys are attached at their lower poles. What anomaly is present?
a. duplicated collecting system
b. supernumerary kidney
c. ureterocele
d. pelvic kidney
e. horseshoe kidney
e. horseshoe kidney
198. During a routine renal ultrasound, you are suspicious of increased echogenicity of the kidneys. Which of the following best describes the normal echogenicity of the renal cortex?
a. the kidney is normally hyperechoic in comparison to the spleen and liver
b. the kidney echogenicity is always hypoechoic compared to the spleen and liver
c. the normal kidney is never isoechoic with the liver
d. the normal kidney echogenicity is frequently isoechoic with the liver and spleen
e. the echogenicity of the kidney varies and should not be compared to the liver
d. the normal kidney echogenicity is frequently isoechoic with the liver and spleen
199. Which of the following renal masses would most likely cause a speed propagation artifact?
a. angiomyolipoma
b. renal cell carcinoma
c. renal pseudoaneurysm
d. transitional cell carcinoma
e. adenoma
a. angiomyolipoma
200. You are performing a sonogram on a patient with bilaterally small kidneys. What is the normal range in size for a kidney?
a. 2-4 cm
b. 4-7 cm
c. 7-9 cm
d. 9-14 cm
e 13-17 cm
d. 9-14 cm
201. During a renal sonogram, you notice a 1.5 cm thickening of the left lateral renal cortex. This most likely represents:
a. column of Bertin
b. angiomyolipoma
c. dromedary hump
d. medullary pyramids
e. hilar vessels
c. dromedary hump
202. You have detected compensatory hypertrophy of the right kidney in a 35-year-old male. This finding is associated with which of the following?
a. nephrectomy
b. renal agenesis
c. renal hypoplasia
d. renal atrophy
e. all of the above
e. all of the above
203. Which of following statements is not true regarding normal anatomy of the kidneys?
a. the kidneys are retroperitoneal in location
b. the right kidney is located slightly inferior compared to the left
c. the tail of the pancreas in in contact with the lateral dorsal aspect of the left kidney
d. the superomedial aspect of the right kidney is in contact with the adrenal gland
e. the superior pole of each kidney is lightly medial compared to the inferior pole
c. the tail of the pancreas in in contact with the lateral dorsal aspect of the left kidney
204. What is the normal appearance of the central sinus of the kidney?
a. highly echogenic compared to the renal cortex
b. hypoechoic compared to the renal cortex
c. isoechoic compared to the renal cortex
d. isoechoic to the medullary pyramids
e. hypoechoic compared to the liver
a. highly echogenic compared to the renal cortex
205. You are performing an ultrasound on a patient with suspected renal failure. What lab work is elevated with renal failure?
a. serum creatinine
b. urine creatinine
c. serum bilirubin
d. serum lipase
e. AFP
a. serum creatinine
206. A patient is referred from x-ray with a questionable left renal cyst. What are the sonographic criteria of a simple cyst?
a. anechoic, acoustic enhancement, sharply defined smooth far wall, round or ovoid in shape
b. hyperechoic, acoustic enhancement, sharply defined smooth far wall, round or ovoid shape
c. hypoechoic, acoustic attenuation, sharply defined smooth far wall, round or ovoid in shape
d. isoechoic, acoustic attenuation, sharply defined smooth far wall, round or ovoid shape
e. anechoic, acoustic refraction, sharply defined smooth far wall, round or ovoid shape
a. anechoic, acoustic enhancement, sharply defined smooth far wall, round or ovoid in shape
207. You are performing a renal sonogram and identify hydronephrosis in the right kidney. Which of the following is not a potential cause of hydronephrosis?
a. ureteral stone
b. large uterine fibroid
c. ureteropelvic junction obstruction
d. acute pyelonephritis
e. ovarian mass
d. acute pyelonephritis
208. 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 following sonographic features helps distinguish this from a true pathologic mass?
a. isoechogenicity with the rest of the renal cortex
b. continuity of the renal cortex
c. lack of mass effect or splaying of central renal sinus fat
d. normal vascularity by color Doppler
e. all of the above
e. all of the above
209. You have been asked to perform an ultrasound evaluation of a child with multicystic dysplastic kidney. Which of the following is not a sign of this condition?
a. multiple variably sized cysts
b. nonmedial location of the largest cyst
c. dilated ureter
d. no identifiable renal sinus
e. brightly echogenic tissue interfaces between cysts
c. dilated ureter
210. You are performing an ultrasound exam on a patient with crossed renal ectopia. Which of the following describes your findings?
a. both kidneys are on the same side of the abdomen
b. one of the kidneys is located in the pelvis
c. one of the kidneys is located in the thoracic cavity
d. the kidneys are fused together at the upper pole
e. a small third kidney is located above one of the normal kidneys
a. both kidneys are on the same side of the abdomen
211. Which malignant tumor is most common in children aged 2-5?
a. renal hamartoma
b. Wilm's tumor
c. renal cell carcinoma
d. transitional cell carcinoma
e. renal lymphoma
b. Wilm's tumor
212. Which part of the kidney contains fat, calyces, infundibuli of the collecting system, and vessels?
a. medulla
b. cortex
c. sinus
d. pyramid
e. Gerota's fascia
c. sinus
213. During routine surveillance of the urinary bladder, you detect the presence of periodic ureteral jets. This is a sign of:
a. ureteral stone
b. transitional cell carcinoma
c. ureteral spasm
d. ureteral compression
e. normality
normality
214. What preparation should you require of your patients scheduled for renal sonograms?
a. fasting for 24 hours prior to examination
b. ingestion of 100 mg simethicome 5 minutes before examination
c. water enema
d. moderate hydration with not other specific preparation
e. fatty meal within 30 minutes of examination
d. moderate hydration with not other specific preparation
215. You are scanning a 31-year-old patient with hypertension and impaired renal function. You detect enlarged kidneys with cysts that are too numerous to count. Which of the following is most likely?
a. multicystic dysplastic kidney
b. medullary cystic disease
c. polycystic kidney disease
d. parapelvic cysts
e. multiple simple cysts
c. polycystic kidney disease
216. 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?
a. extension of tumor into the renal vein
b. search for liver metastasis
c. search for retroperitoneal adenopathy
d. a and b only
e. all of the above
e. all of the above
217. An ultrasound exam reveals a solid, hyperechoic mass in a 46-year-old patient with tuberous sclerosis. This most likely represents:
a. renal cell carcinoma
b. Wilm's tumor
c. renal hamartoma
d. angiomyolipoma
e. renal lymphoma
d. angiomyolipoma
218. You are performing an ultrasound on a patient with known horseshoe kidneys. Where is the isthmus of a horseshoe kidney located?
a. in the iliac fossa
b. anterior to the abdominal aorta
c. pouch of Douglas
d. Morrison's pouch
e. posterior to the abdominal aorta
b. anterior to the abdominal aorta
219. What is the ultrasound appearance of ureteropelvic junction obstruction?
a. dilated ureter and collecting system to the level of the urinary bladder
b. pelvicocaliectasis to the level of the junction of the renal pelvis and ureter
c. dilated ureter with normal intrarenal collecting system
d. pelvicaliectasis to the level of the distal ureter
e. ureteropelvic junction obstruction cannot be detected sonographically
b. pelvicocaliectasis to the level of the junction of the renal pelvis and ureter
220. 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?
a. normal appearance
b. irregular renal surface contour
c. mottled appearance of both kidneys
d. focal hypoechoic masses throughout the kidney
e. gas within the renal parenchyma
a. normal appearance
221. A renal mass that is highly echogenic due to it's high fat content is:
a. renal cell carcinoma
b. Wilm's tumor
c. renal hamartoma
d. angiomyolipoma
e. renal lymphoma
d. angiomyolipoma
222. A patient has been referred to your lab for a Doppler analysis of the kidneys. What type of waveform do you expect to see in the normal main renal artery?
a. high resistance with prominent systolic flow and little diastolic flow
b. continuous with little differentiation between systole and diastole
c. high impedance with no diastolic component
d. low resistance with forward flow through the cardiac cycle
e. prominent early systolic peak with retrograde flow in early diastole
d. low resistance with forward flow through the cardiac cycle
223. You are scanning a patient with known bladder outlet obstruction and note a thickening of the urinary bladder. What is the most likely etiology of the wall thickening?
a. muscular atrophy
b. endometriosis
c. hematoma
d. renal cell carcinoma
e. oncocytoma
a. muscular atrophy
224. A patient with a history of chronic medical renal disease has been referred for abdominal ultrasound. Which of the following describes the renal appearance you expect to see?
a. enlarged hypoechoic kidneys
b. small hyperechoic kidneys
c. normal appearance of kidneys
d. small hypoechoic kidneys
e. normal sized kidneys with calcified collecting system
b. small hyperechoic kidneys
225. A patient has been referred from CT with a history of nephrocalcinosis. What is the ultrasound appearance of this entity?
a. normal sized kidneys with focal, wedge shaped, hypoechoic mass
b. multiple hypoechoic masses throughout the kidney
c. echogenic kidney with calcified capsule
d. highly echogenic renal pyramids with or without posterior acoustic shadowing
e. cystic masses containing tiny echogenic foci situated throughout the kidney
d. highly echogenic renal pyramids with or without posterior acoustic shadowing
226. You suspect hydronephrosis in a 42-year old female who complains of vague abdominal discomfort. Which of the following is a cause of false-positive determination of hydronephrosis?
a. overdistension of the urinary bladder
b. parapelvic cysts
c. prominent hilar vessels
d. large extrarenal pelvis
e. all of the above
e. all of the above
227. During a routine abdomen and pelvic ultrasound study, you detect a small round, cystic structure projecting into the urinary bladder. This most likely represents:
a. urinoma
b. ureterocele
c. transitional cell carcinoma
d. papillary carcinoma
e. extrarenal pelvis
b. ureterocele
228. 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 of the following tumors most commonly occurs within the urinary bladder?
a. transitional cell carcinoma
b. renal cell carcinoma
c. renal lymphoma
d. renal hamartoma
e. oncocytoma
a. transitional cell carcinoma
229. 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:
a. lymphocele
b. urinoma
c. ureterocele
d. hematoma
e. abscess
a. lymphocele
230. Which intrarenal arteries course alongside of the renal pyramids?
a. segmental
b. interlobar
c. arcuate
d. intralobular
e. vasa recta
b. interlobar
231. Which of the following describes the normal course of the left renal vein?
a. retroaortic
b. between the SMA and aorta
c. anterior to the SMA and IVC
d. posterior to the IVC
e. between the SMA and splenic vein
b. between the SMA and aorta
232. Which of the following describes the normal course of the right renal artery?
a. retroaortic
b. between the SMA and aorta
c. anterior to the SMA and IVC
d. posterior to the IVC
e. between the SMA and splenic vein
d. posterior to the IVC
233. 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?
a. <3 mm
b. 3-6 mm
c. 6-9 mm
d. >10 mm
e. the renal cortex cannot be measured sonographically
d. >10 mm
234. 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?
a. ureteral calculi
b. pelvic mass
c. aortic aneurysm
d. a and b
e. all of the above
e. all of the above
235. What is the purpose of scanning the urinary bladder to identify ureteral jets?
a. rule out the presence of urinoma
b. determine if a ureter is obstructed
c. determine if bladder outlet obstruction is present
d. search for bladder carcinoma
e. identify the urethra
b. determine if a ureter is obstructed
236. You are scanning a patient with suspected lymphoma of the kidney. Which ultrasound appearance is associated with renal lymphoma?
a. small, echogenic kidneys with hyperdense pyramids
b. cystic masses of varying sizes throughout both kidneys
c. multiple, bilateral, hypoechoic masses in enlarged kidneys
d. single, large, hyperechoic mass
e. unilateral wedge-shaped hypoechoic mass
c. multiple, bilateral, hypoechoic masses in enlarged kidneys
237. What arteries course on top of the renal pyramids and give rise to the tiny intralobular arteries?
a. segmental
b. interlobar
c. arcuate
d. vasa recta
e. capsular
c. arcuate
238. You detect a discrete echogenic focus without shadowing in the left kidney and suspect the presence of renal calculus. Which of the following is most helpful in improving visualization of posterior acoustic shadowing?
a. higher-frequency transducer
b. lower-frequency transducer
c. smaller-aperture transducer
d. increased frame rate
e. increased dynamic range
a. higher-frequency transducer
239. You detect the presence of free fluid in the space between the liver and right kidney. What is the name for this anatomic location?
a. pouch of Douglas
b. Morrison's pouch
c. Cul-de-sac
d. space of Disse
e. Foramen of winslow
b. Morrison's pouch
240. What is the indication for a Doppler renal study to rule out renal artery stenosis?
a. hematuria
b. increased serum creatinine
c. leukocytosis and fever
d. uncontrolled hypertension
e. anemia, progressive azotemia and polyuria
d. uncontrolled hypertension
241. 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?
a. abdominal aorta
b. superior mesenteric artery
c. common hepatic artery
d. celiac trunk
e. inferior mesenteric artery
a. abdominal aorta
242. You are performing a follow-up ultrasound study on a patient with a large left renal cyst. Which of the following most accurately describe the prevalence of renal cysts?
a. <1% people over age 50
b. 15% of people over age 50
c. 30% of people over age 50
d. 50% of people over age 50
e. 100% of people over age 50
d. 50% of people over age 50
243. You are scanning a patient with autosomal dominant polycystic kidney disease. Which of the following statements is not true regarding this disease?
a. liver cysts may be present in up to 30% of patients
b. high blood pressure is common
c. cysts may be complicated by bleeding or infection
d. frequently only one kidney is involved
e. progressive renal failure is common
d. frequently only one kidney is involved
244. Which of the following is usually diagnosed in early childhood or in utero?
a. autosomal dominant polycystic disease
b. multicystic dysplasic kidney
c. acquired cystic kidney disease
d. parapelvic cysts
e. a and b
b. multicystic dysplasic kidney
245. Doppler analysis of intrarenal waveforms performed during renal sonography reveal a resistive index of 1.0. This finding is consistent with:
a. normality
b. chronic medical renal disease
c. renal vein thrombosis
d. renal obstruction
e. b, c, and d
c. renal vein thrombosis
246. During performance of a renal sonogram, you identify only one kidney. What should you do?
a. inform the patient of your finding and advise a thorough medical exam to detect other anatomic anomalies
b. scan in the pelvis area to rule out the presence of a pelvic kidney
c. perform an endovaginal exam to look for bicornuate uterus
d. scan the patient in an upright position
e. perform a complete Doppler study of the solitary kidney
b. scan in the pelvis area to rule out the presence of a pelvic kidney
247. Which of the following would be most helpful in delineating ureteral jets?
a. have the patient perform valsalva maneuver
b. scan patient in both inspiration and expiration
c. examine the urinary bladder with color Doppler
d. increase the transducer frequency
e. give the patient a fatty meal
c. examine the urinary bladder with color Doppler
248. You are scanning a patient post biopsy and discover a cystic mass in the kidney. What should you do?
a. nothing, cystic masses are very common
b. evaluate the cyst with color Doppler
c. have the patient return in 2 weeks for a follow-up study
d. scan the patient in a prone position
e. compress the mass with probe pressure
b. evaluate the cyst with color Doppler
249. Which of the following results from an ascending urinary tract infection?
a. horseshoe kidney
b. acute tubular necrosis
c. glomerulonephritis
d. pyelonephritis
e. nephrocalcinosis
d. pyelonephritis
250. You are having difficulty identifying the renal arteries in a patient referred for questionable renal artery stenosis. Which vessel below is most helpful as a landmark for the location of the renal arteries?
a. celiac trunk
b. SMA
c. splenic vein
d. IMA
e. common hepatic artery
b. SMA
251.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 ultrasound appearance of this finding?
a. ultrasound cannot be used to detect hemorrhage within a renal cyst
b. low-level echoes within the cyst
c. multiple bright foci with posterior acoustic shadowing distal to the cyst
d. solid appearing nodule with increased attenuation
e. all of the above
b. low-level echoes within the cyst
252. A patient has been referred to your ultrasound lab for evaluation of a new renal transplant. Where should you look?
a. Morrison's pouch
b. left upper quadrant
c. pouch of Douglas
d. right lower quadrant
e. right upper quadrant
d. right lower quadrant
253. Ultrasound findings in a patient with hypertension include a left kidney measuring 6.8 cm and right kidney measuring 11.7 cm. Which of the following is most consistent with these findings?
a. acute pyelonephritis in the left kidney
b. acute glomerulonephritis
c. occlusion of the left main renal artery
d. amyloidosis of the right kidney
c. occlusion of the left main renal artery
254. What Doppler parameter should you measure to look for rejection in a renal transplant?
a. pulsatility index
b. resistivity index
c. RAR
d. systolic-diastolic ratio
e. acceleration index
b. resistivity index
255. You detect irregular thickening of the bladder all in a 53-year-old male with hydronephrosis and a dilated ureter. Which of the following would you suspect?
a. renal cell carcinoma
b. ureterocele
c. bladder outlet obstruction
d. transitional cell carcinoma
e. endometriosis
d. transitional cell carcinoma
256. Which statement below would help you in identification of the right renal vein?
a. the right renal vein lies inferior and posterior to the renal artery
b. the right renal vein courses underneath the IVC
c. the right renal vein courses anterior to the abdominal aorta
d. the right renal vein divides into circumaortic ring before draining into the IVC
e. the right renal vein lies anterior to the renal artery
e. the right renal vein lies anterior to the renal artery
257. You have been asked to identify the ureteral jets. Where are the ureteral orifices in the urinary bladder?
a. each lateral edge
b. superior and anterior border
c. base of the trigone along posterior aspect
d. inferior and anterior to the trigone
e. at the bladder base, inferiorly at the apex of the trigone
c. base of the trigone along posterior aspect
258. A patient has been referred for Doppler interrogation of the kidney. Which view provides the best color Doppler evaluation of the intrarenal vasculature?
a. patient supine, anterior view through liver
b. patient supine, coronal view through the liver
c. patient prone, oblique view through back musculature
d. patient in posterior oblique position, coronal view through the posterior axillary line
e. patient upright, anterior view through the liver
d. patient in posterior oblique position, coronal view through the posterior axillary line
259. During color Doppler evaluation of the kidney, inadequate fill is seen of the intrarenal vasculature. Which Doppler parameter will you adjust to improve sensitivity to flow?
a. decrease pulse repetition frequency
b. increase wall filter
c. decrease packet size
d. decrease color gain
e. decrease color resolution setting
a. decrease pulse repetition frequency
260. You are scanning the urinary bladder and notice multiple artifactual bands in the near field at the anterior bladder wall. What is the source of these echoes?
a. acoustic speckle
b. reverberation artifact
c. comet tail artifact
d. mirror image artifact
e. multipath artifact
b. reverberation artifact
261. You have been asked to evaluate an atypical renal cyst seen on CT. What feature below is indicative of an atypical cyst?
a, internal sepations
b. wall calcifications
c. internal echoes
d. irregular walls
e. all of the above
e. all of the above
262. What is the accepted treatment for a simple renal cyst?
a. surgical removal
b. aspiration
c. fine needle biopsy
d. core biopsy
e. no further evaluation required
e. no further evaluation required
263. 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?
a. bilateral renal enlargement with increased echogenicity
b. bilaterally small, echogenic kidneys with multiple cysts of varying sizes
c. bilateral small, hypoechoic kidneys with increased corticomedullary distinction
d. normal appearing kidneys bilaterally
e. all of the above sonographic appearances are common in this scenario
b. bilaterally small, echogenic kidneys with multiple cysts of varying sizes
264. 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?
a. oncocytoma
b. transitional cell carcinoma
c. angiomyolipoma
d. renal cell carcinoma
e. adenoma
d. renal cell carcinoma
265. You are performing a follow-up study on a patient diagnosed with emphysematous pyelonephritis. Which of the following best describes the sonographic appearance of this condition?
a. multiple echogenic foci within the renal sinus or parenchyma with dirty posterior acoustic shadows
b. multiple distinct hyperechoic foci with discrete, well-defined posterior acoustic shadows
c. multiple indistinct, hazy foci within the renal sinus with posterior acoustic enhancement
d. large area of posterior acoustic shadowing which is not associated with any defined echoes
e. focal, wedge-shaped hypoechoic masses with posterior acoustic enhancement through the kidney
a. multiple echogenic foci within the renal sinus or parenchyma with dirty posterior acoustic shadows
266. Which of the following is not a part of the urinary tract?
a. kidneys
b. ureters
c. uterus
d. urinary bladder
e. urethera
c. uterus
267. Which of the following describes the normal waveform of the main renal artery?
a. triphasic
b. high resistance
c. low resistance
d. phasic
e. bidirectional
c. low resistance
268. The renal arteries arise from the aorta closest to the origin of which of the following arteries?
a. SMA
b. celiac trunk
c. IMA
d. common iliac arteries
e. common hepatic
a. SMA
269. The left renal artery is normally located immediately posterior to which of the following?
a. left renal vein
b. portal vein
c. common hepatic artery
d. splenic artery
e. none of the above
a. left renal vein
270. Which of the following renal tumors is more common?
a. transitional cell carcinoma
b. renal cell carcinoma
c. oncocytoma
d. primary renal lymphoma
e. angiomyolipoma
b. renal cell carcinoma
271. A patient is referred to the ultrasound department with a history of medullary nephrocalcinosis. What do you expect to see?
a. a calcified renal capsule
b. a calcified ureter
c. a calcified urinary bladder
d. calcified pyramids
e. all of the above
d. calcified pyramids
272. 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?
a. free fluid in Morrison's pouch
b. perirenal fluid collection that flattens the underlying renal contour
c. a linear defect that extends throughout the kidney
d. an intrarenal fluid collection within the renal collecting system
e. a subcapsular hematoma will not be visible by ultrasound
b. perirenal fluid collection that flattens the underlying renal contour
273. What is the most common cause of acute renal failure?
a. acute tubular necrosis
b. renal vein thrombosis
c. glomerulonephritis
d. amyloidosis
e. diabetes mellitus
a. acute tubular necrosis
274. You are performing a follow-up study on a patient with a renal transplant. Which of the following changes normally occurs in renal transplants compared to the immediate postoperative study?
a. hypertrophy
b. increased echogenicity
c. hydronephrosis
d. shrinkage
e. calcified pyramids
a. hypertrophy
275. 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?
a. internal iliac artery
b. external iliac artery
c. common iliac artery
d. abdominal aorta
e. inferior mesenteric artery
b. external iliac artery
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