ABDOMINAL SONOGRAPHY Sono2111 - Kidneys & Urinary system

Which of the following is sonography of the kidneys NOT used for ?

a. Assess the size of the kidney, including length, width, and thickness
b. Evaluate the echogenicity of the renal cortex, medulla, and sinus
c. Evaluate the function of the kidneys
d. Differentiate between cystic and solid lesions

C

What is the functional unit of the kidney ?

a. Mesonephros
b. Nephron
c. Hepatocyte
d. Pronephros

B

Approx when do the kidneys begin to function ?

a. 4 weeks
b. 6 weeks
c. 8 weeks
d. 10 weeks

C

8 weeks= kidney functions

What is the normal length of the adult kidney ?

a. 6-8 cm
b. 8-10 cm
c. 10-12 cm
d 12-14 cm

C

Kidneys = 10-12 cm

Which of the following surrounds the kidney and adrenal gland and serves to anchor them to the surrounding structures ?

a. renal capsule
b. Gerota's fascia
c. Adipose capsule
d. Glisson's capsule

B

Which of the following is TRUE regarding the renal vasculature ?

a. The renal arteries arise off of the anterior aspect of the AO

b. The RT renal artery courses anterior to the IVC before entering the renal hilum

c. The LT renal veins crosses posterior to the AO before entering the IVC

d. Because the AO lies to the LT of the midline, the RT renal artery is typically longer than the LT renal artery.

D

What are the extensions of cortex that lie between the renal pyramids called ?

a. Columns of Bertin
b. Cortical columns
c. Fetal lobulation
d. Dromedary hump

A

What is a common renal variation in which a local bulge is seen at the lateral border of the kidney ?

a. Hypertrophied column of Bertin
b. Extrarenal pelvis
c. Fetal lobulation
d. Dromedary hump

D

What is excessive fatty infiltration of the renal pelvis called ?

a. Hypertrophied column of Bertin
b. extrarenal pelvis
c. Renal sinus lipomatosis
d. Nephrocalcinosis

C

Which of the following is NOT a laboratory test used to evaluate renal function ?

a. BUN
b. Creatinine
c. Urinalysis
d. Amylase

D

Amylase = pancreas

An RI in the adult kidney is considered normal if it is below :

a. 1
b. 0.8
c. 0.7
d. 0.5

C

What is the most common congenital anomaly of the genitourinary tract ?

a. Duplicated collecting system
b. Unilateral renal agenesis
c. Bilateral renal agenesis
d. Pelvic kidney

A

You are asked to evaluate a pt with a complaint of a pulsatile midline abdominal mass. Which renal condition may be responsible for this complaint ?

a. Pyelonephritis
b. Pelvic kidney
c. Duplicated collecting system
d. Horseshoe kidney

D

While performing an abdominal sonogram on a 62-yr-old pt, you find a 2-cm cystic area in the lower pole cortex. What is the most likely diagnosis ?

a. Adult polycystic kidney disease
b. Simple renal cyst
c. Von Hippel-Lindau disease
d. Medullary sponge kidney

B

Which of the following is NOT associated with adult polycystic kidney disease ?

a. Bilaterally enlarged kidneys with numerous discrete cysts visible

b. Associated cysts in the liver, panc, and spleen

c. Small echogenic kidneys

d. Cerebral artery aneurysms located within the circle of Willis

C

What is the sonographic appearance of medullary sponge kidney ?

.a Bilaterally enlarged kidneys with numerous large cysts in the region of the pyramids.

b. Small, echogenic kidneys with a loss of corticomedullary junction

c. Normal-sized kidneys with echogenic cortex

d. Normal-sized kidneys with highly echogenic medullary pyramids without associated shadowing

A

What is a cyst that originates in the renal parenchyma and protrudes into the renal sinus called ?

a. Simple cyst
b. Parapelvic cyst
c. Milk of calcium cyst
d. Extrarenal cyst

B

Which of the following is NOT associated with renal cortical cysts ?

a. Tuberous sclerosis
b. Von Hippel-Lindau disease
c. Adult polycystic kidney disease
d. Amyloidosis

D

Which of the following is NOT a benign tumor of the kidney ?

a. Hypernephroma
b. Angiomyolipoma
c. Oncocytoma
d. Adenoma

A

A small, well-defined, highly echogenic mass is seen in the renal cortex of a 38-yr-old woman. What is this a characteristic of ?

a. Hypernephroma
b. Oncocytoma
c. Angiomyolipoma
d. Adenoma

C

A 25-yr-old pregnant pt presents in her 3rd trimester with mild RT flank pain. Which of these would you expect to find in this pt ?

a. Multiple angiomyolipomas
b. Large renal cyst
c. Mild-to-moderate hydronephrosis
d. Renal cell carcinoma

C

Which of the following CANNOT cause hydronephrosis ?

a. Hyperplasia of the prostate
b. Ureterocele
c. Fibroid uterus
d. Renal artery stenosis

D

WHat is the medical term for kidney stones ?

a. Nephrolithiasis
b. Cholelithiasis
c. Nephrocalcinosis
d. Fecolithiasis

A

A pt presents with a history of medullary nephrocalcinosis. What is the typical sonographic appearance of medullary nephrocalcinosis ?

a. Bilateral small echogenic kidneys
b. Enlarged kidneys with multiple distinct cystic areas
c. Normal kidney cortex with highly echogenic pyramids bilaterally
d. Bilateral hydronephrosis with thinning of the renal cortex

C

What is a common cause of acute pyelonephritis ?

a. Lower urinary tract infection
b. Renal artery stenosis
c. Renal cell carcinoma
d. Colitis

A

What is the presence of purulent material or pus in the collecting system called ?

a. Hydronephrosis
b. Urosepsis
c. Pyonephrosis
d. Urolithiasis

C

Which of the following is FALSE regarding upper urinary tract infections ?

a. Incomplete bladder emptying or stasis may lead to a UTI
b. Only respiratory infections are more common than UTIs
c. People with diabetes or immunocompromised are more likely to have a UTI
d. The incidence of UTIs is much higher in men

D

What is acute pyelonephritis most commonly caused by :

a. Staphylococcus aureus
b. Escherichia coli
c. Pseudomonas
d. Klebsiella

B - E. coli

A pt is referred for an abdominal sonogram with a history of chronic medical renal disease. What is typical sonographic appearance of the condition ?

a. Bilaterally enlarged hypoechoic kidneys
b. Bilaterally enlarged kidneys with multiple discrete cysts
c. Small hypoechoic kidneys
d. Small echogenic kidneys

D

The urinary system is made up of 2 ___________, 2 __________-, the ____________ ____________ , and the _______________.

Kidneys ; Ureters ; Urinary bladder ; Urethra

During embryological development, three pairs of kidneys are formed at successive intervals : the _______, the ________, and the ________ and _______ ducts.

Pronephros ; Mesonephros ; Metanephros & PAramesonephric ducts

In the male , the ________ duct persists and develops into the male _____________, the ______ _______, and the ejaculatory duct.

In the female, the mesonephric duct develops into the __________ duct, which develops into the _________ and _________.

Mesonephric duct (Wolffian) -> Epididymis , Ductus deferens

Paramesonephric duct ( MUllerian) -> uterus and vagina

At the renal hilus, the renal ______________ and renal _________, _______________, nerves, and the _______________ enter or exit the kidney.

Artery , Vein, Lymphatics ; Ureter

The kidney is surrounded by 3 layers of supportive tissues : the innermost fibrosis __________ _________, which protects against __________ and _____________ ; the middle layer, called the _____________ capsule; and the outermost layer, called __________ fascia .

Fibrous renal capsule ; physical trauma & infection ; Adipose capsule ; Gerota's fascia

The RT kidney is ___________ lower than the LT due to the presence of the ______________. The length of the kidneys should be within ______________ cm of eachother.

2-8 cm ; liver ; 2 cm

The renal _____________ extends from the renal capsule to the bases of the renal __________ and the spaces between them . The renal or _________ pyramids are visualized sonographically as hypoechoic, triangular structures deep to the cortex.

Cortex ; Pyramids ; medullary

In a normal adult , the renal cortex is _____________ or ___________ to the liver parenchyma.

In neonates, the renal cortex is _______ or _____________ to the liver parenchyma.

The cortex in an adult should measure greater than _________ in thickness over the pyramids.

Hypoechoic or Isoechoic ; Hyperechoic to Isoechoic ; 1 cm

The main function of the kidneys is to remove ____________ from the _______________ and regulate the ______________ and _______________ content of blood.

Waste from blood ; regulate fluid and electrolyte

A urine specimen of urinalysis can be used to detect the presence of ____________, _____________, and ______________, which could indicate _____________ or _______________.

RBCs ; WBCs ; bacteria ; infection or tumor

Bilateral renal agenesis is not compatible with ______________ and can be detected in utero by the absence of a ____________ and __________ or decreased amniotic fluid.

Life ; urinary bladder ; oligohydramnios

In the case of ureteral duplication, the upper pole ureter typically enters in the bladder below the trigone and may be obstructed, leading to ___________ ____________.

Ectopic ureterocele

Complex cysts include ___________ cysts, _________ cysts, and ___________ or ____________ cysts .

Hemorrhagic cyst ; Infected cyst ; Septated or Multilocular cysts

Calcifications in the wall of a cyst may be due to previous _____________ or ______________.

Mural calcifications can also be associated with __________________, so they may need to be evaluated by other means.

Hemorrhage or infection ; malignancy

Milk of calcium may be found in a ___________ or calyceal _________________- and often forms after ___________ or _____________.

cyst or calyceal diverticulum ; inflammation , obstruction or stasis

Tuberous sclerosis is a multisystemic disorder associated with bilateral renal _____________________ and renal _____________.

Angiomyolipomas ; cysts

Von Hippel-Lindau disease is an inherited disorder that can present with multiple renal _____________.

The cysts can contain neoplastic elements that may evolve into _________.

Cysts ; RCC (renal cell carcinoma)

The most common benign kidney tumor is the ____________ and is thought to be the benign counterpart of _____________.

Adenoma ; Renal cell carcinoma

Angiomyolipomas are typically solitary and are more common in ____________.
_____________ angiomyolipomas occur in pt with tuberous sclerosis complex.

Women ; Multiple

Unilateral solitary masses more common in women than men, not associated with tuberous sclerosis

Renal cell carcinoma is also known as _____________ or ____________, and is the most common malignant tumor of the kidney.

Hypernephroma or Adenocarcinoma

Renal cell carcinoma can spread into the perinephric ______________ and renal ___________.

It can also spread to the _____________ kidney

Fat & renal vein ; contralateral kidney

Urothelial tumors include _____________ and __________ and become clinically apparent due to painless _____________.

Transitional cell carcinoma & squamous cell carcinoma ; painless Hematuria

Urothelial = malignant ; tumors of lining of renal pelvis, calyces, ureters, and bladder ; Majority = TCC

TCCs Primary renal pelvis tumor & Most common cancer of ureter.

Hydronephrosis is a urine ____________ of the renal ____________ structures, and __________________.

Hydronephrosis makes kidneys susceptible to _________, ___________, and permanent ____________.

Dilatation ; Renal pelvis & calyceal ; Infundibula

Infection ; stone formation ; permanent damage

CLinical symptoms of urolithiasis include __________ or blood in the urine, ___________ if obstruction occurs, and ___________ as stones are passed.

Stones in the RT ureter may mimic symptoms of _____________.

Hematuria ; Oliguria ; Renal colic ;

Appendicitis

Trauma to the kidneys can occur during blunt of penetrating trauma. A linear absence of echoes is suggestive of a renal ____________.

Focal areas of hemorrhage are typically ___________.

A collection of blood that lies between the cortex and the renal capsule is called a _____________.

Fracture ;

Hypoechoic

Subscapular hematoma

Symptoms of UTI include elevated _____________ and the possibility of the presence of ________________, _____________, and ____________ in the urine.

WBCs (infection) ; blood , pus & bacteria in urine

When evaluating kidneys for medical renal disease, a diffuse __________ in cortical echogenicity is typically seen.

The kidneys become ____________ and the medulla becomes ____________.

Increase

Smaller ; echogenic

_______________ _______________ is a leading cause of chronic renal failure and the cause of diabetic morbidity and mortality.

Diabetic nephropathy

The most common cause of acute renal failure is _____________ _____________ _________.

Renal failure is the inability of the kidneys to remove accumulated _____________ from the blood.

Azotemia is an overload of ______________ ___________, such as ________ _________ ____________, __________ ___________, and __________ _____________ in the blood.

Acute tubular necrosis

Metabolites

Nitrogenous waste ; bun urea nitrogen ; uric acid ; & serum creatinine

What is the term for where the ureter and renal pelvis meet up ?

Ureteralpelvic junction (UPJ)

True or false :

The renal vein is anterior while the renal artery is posterior.

TRUE

What are the 3 narrowing sites ?

Pelviureteric junction
Crossing pelvic brim
Traversing the bladder wall

Are the pyramid in the renal sinus ?

NO ; they are in the medulla

What is the purpose of the hormone renin that is secreted from the kidneys ?

Regulate BP

What is gross hematuria ?

BLood in urine that is able to be seen with the naked eye

Microscopic hematuria is seen under microscope

What is the term for an increased in cells so the renal pyramids can become bigger ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Ectrarenal pelvis
g. Duplication
f. Renal Agenesis
g. Renal hypoplasia
h. Renal ectopia
i. Horseshoe kidney
j. Cross-fused kidney

A

Which is an extended tissue usually pm the LT lateral portion of kidney ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Ectrarenal pelvis
g. Duplication
f. Renal Agenesis
g. Renal hypoplasia
h. Renal ectopia
i. Horseshoe kidney
j. Cross-fused kidney

D

Which is when the kidney has a piece missing because the kidney did not form 100% and is the triangular echogenic region on kidneys ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Ectrarenal pelvis
g. Duplication
f. Renal Agenesis
g. Renal hypoplasia
h. Renal ectopia
i. Horseshoe kidney
j. Cross-fused kidney

B

Which is an increase in fat at the sinus creating the sinus to become more echogenic than usual ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
f. Renal Agenesis
g. Renal hypoplasia
h. Renal ectopia
i. Horseshoe kidney
j. Cross-fused kidney

E

Which is a cystic dilatation of the ureter at the distal portion of kidney ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
h. Renal Agenesis
i. Renal hypoplasia
j. Renal ectopia
k. Horseshoe kidney
l. Cross-fused kidney

F

Which is when there are 2 of everything ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
h. Renal Agenesis
i. Renal hypoplasia
j. Renal ectopia
k. Horseshoe kidney
l. Cross-fused kidney

G

Incomplete = 1 ureter enters ectopically in Superior pole -> creates hydronephrosis -> leades to hydroureter making urine back up into bladder -> creates Ureterocele : cystic dilatation at bladder entrances

Complete = 2 ureters -> 1 in upper pole , 1 in lower pole

WHat is the term for reduced number of renal lobules and calyces?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
h. Renal Agenesis
i. Renal hypoplasia
j. Renal ectopia
k. Horseshoe kidney
l. Cross-fused kidney

i

Which is when the kidneys lie just above the pelvic brim or more common in the pelvis ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
h. Renal Agenesis
i. Renal hypoplasia
j. Renal ectopia
k. Horseshoe kidney
l. Cross-fused kidney

j

WHat is produced when there is a fusion of the upper or lower kidney poles during fetal development ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
h. Renal Agenesis
i. Renal hypoplasia
j. Renal ectopia
k. Horseshoe kidney
l. Cross-fused kidney

K

HIgher risk for UTIs

What is the term for when the lower pole of one kidney is connected to the upper pole of the other kidney ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Dromedary hump
e. Sinus lipomatosis
f. Extrarenal pelvis
g. Duplication
h. Renal Agenesis
i. Renal hypoplasia
j. Renal ectopia
k. Horseshoe kidney
L. Cross-fused kidney

L

WHat is the term for when both kidneys are fused together medially ?

a. Hypertrophied column of Bertin
b. Junctional parenchymal defect
c. Fetal lobulation
d. Cake

D

True or false :

If polycystic kidney disease is found in utero, it is not compatible with life.

TRUE

WHat is the most common palpable mass in neonates ?

Multicystic Dysplastic kidney

Which of the following pathologies does NOT have an increase risk of renal cell carcinoma ?

a. Von Hippel-Landau disease
b. MEdullary sponge kidney
Adult polycystic kidney disease
d. Tuberous sclerosis

B