Davie’s: The Urinary Tract
[Part 4]
197. You’re scanning a pt & notice that the RT & LT kidneys are attached at their
lower poles. What anomaly is present?
a.
b.
c.
d.
e.
Duplicated collecting system
Supernumerary kidney
Ureterocele
Pelvic kidney
Horseshoe kidney
198. During a routine renal US, you’re suspicious of increased echogenicity of the
kidneys. Which describes normal echogenicity of the renal cortex?
a.
b.
c.
d.
e.
The kidney is normally hyperechoic in comparison to spleen & liver
The kidney echogenicity is always hypoechoic compared to spleen & liver
The normal kidney is never isoechoic with the liver
The echogenicity of the normal kidney is often isoechoic with liver & spleen
The echogenicity of the kidney varies & should not be compared to the liver
199. Which renal mass would most likely cause a speed propagation artifact?
a.
b.
c.
d.
e.
Angiomyolipoma
Renal cell carcinoma
Renal pseudoaneurysm
Transitional cell carcinoma
Adenoma
200. You’re performing a sonogram on a pt with bilaterally small kidneys. What’s the
normal range in size for a kidney?
a.
b.
c.
d.
e.
2-4 cm
4-7 cm
7-9 cm
9-14 cm
13-17 cm
201. During a renal sonogram, you notice a 1.5 cm thickening of the left lateral renal
cortex. This most likely represents:
a.
b.
c.
d.
e.
Column of Bertin
Angiomyolipoma
Dromedary hump
Medullary pyramid
Hilar vessels
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.
b.
c.
d.
e.
Nephrectomy
Renal agenesis
Renal hypoplasia
Renal atrophy
All of the above
203. Which of the 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 is 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 slightly medial compared to the inferior pole.
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
205. You are performing an ultrasound on a patient with suspected renal failure. What lab work
is elevated with renal failure?
A.
B.
C.
D.
E.
Serum creatinine
Urine creatinine
Serum bilirubin
Serum lipase
Alpha-fetoprotein
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 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 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
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.
b.
c.
d.
e.
Ureteral stone
Large uterine fibroid
Ureteropelvic junction obstruction
Acute pyelonephritis
Ovarian mass
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 with 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
209. You have been asked to perform an ultrasound evaluation of a child with
multicystic dysplastic kidney (MCDK). Which of the following is NOT a sign of
this condition?
a.
b.
c.
d.
e.
Multiple variably sized cysts
Nonmedial location of the largest cyst
Dilated ureter
No identifiable renal sinus
Brightly echogenic tissue interfaces between cysts
210. You are performing an ultrasound exam on a patient with crossed renal ectopia.
Which of the following describes your findings?
a.
b.
c.
d.
e.
Both kidneys are on the same side of the abdomen
One of the kidneys is located in the pelvis
One of the kidneys is located in the thoracic cavity
The kidneys are fused together at the upper pole
A small third kidney is located above one of the normal kidneys
211. Which malignant tumor is most common in children aged 2—5?
a.
b.
c.
d.
e.
Renal hamartoma
Wilms tumor
Renal cell carcinoma
Transitional cell carcinoma
Renal lymphoma
212. Which kidney part contains fat, calyces, infundibuli of collecting system & vessels?
a.
b.
c.
d.
e.
Medulla
Cortex
Sinus
Pyramid
Gerota’s fascia
213. During routine surveillance of the urinary bladder, you detect the presence of
periodic ureteral “jets.” This is a sign of:
a.
b.
c.
d.
e.
Ureteral stone
Transitional cell carcinoma
Ureteral spasm
Ureteral compression
Normality
214. What preparation should you require for pts scheduled for renal sonograms?
a.
b.
c.
d.
e.
Fasting for 24 hours prior to examination
Ingestion of 100 mg simethicone 5 minutes before examination
Water enema
Moderate hydration with no other specific preparation
Fatty meal within 30 minutes of examination
215. You’re scanning a 31-y.o pt with HTN & impaired renal function. You detect
enlarged kidneys with cysts too numerous to count. Which is most likely?
a.
b.
c.
d.
e.
Multicystic dysplastic kidney
Medullary cystic disease
Polycystic kidney disease
Parapelvie cysts
Multiple simple cysts
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.
b.
c.
d.
e.
Extension of tumor into the renal vein
Search for liver metastasis
Search for retroperitoneal adenopathy
A and B only
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.
b.
c.
d.
e.
Renal cell carcinoma
Wilms tumor
Renal hamartoma
Angiomyolipoma
Renal lymphoma
218. You are performing an ultrasound on a patient with known horseshoe kidneys.
Where is the isthmus of a horseshoe kidney located?
a.
b.
c.
d.
e.
In the iliac fossa
Anterior to the abdominal aorta
Pouch of Douglas
Morison’s pouch
Posterior to the abdominal aorta
219. What is the ultrasound appearance of ureteropelvic junction obstruction?
a.
b.
c.
d.
Dilated ureter and collecting system to the level of the urinary bladder
Pelvicaliectasls to the level of the junction of the renal pelvis and ureter
Dilated ureter with normal intrarenal collecting system
Pelvicaliectasis to the level of the distal r reter
e. Ureteropelvic junction obstruction cannot be detected sonographically
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.
b.
c.
d.
e.
Normal appearance
Irregular renal surface contour
Mottled appearance of both kidneys
Focal hypoechoic masses throughout the kidney
Gas within the renal parenchyma
221. A renal mass that is highly echogenic due to its high-fat content is:
a.
b.
c.
d.
e.
Renal cell carcinoma
Wilms tumor
Renal hamartoma
Angiomyolipoma
Renal lymphoma
222. 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?
a.
b.
c.
d.
e.
High resistance with prominent systolic flow and little diastolic flow
Continuous with little differentiation between systole and diastole
High impedance with no diastolic component
Low resistance with forward flow throughout the cardiac cycle
Prominent early systolic peak with retrograde flow in early diastole
223. 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?
a.
b.
c.
d.
e.
Muscular hypertrophy
Endometriosis
Hematoma
Renal cell carcinoma
Oncocytoma
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
225. A patient has been referred from CT with a history of nephrocalcinosis. What’s the
ultrasound appearance of this entity?
a. Normal sized kidney with focal, wedge-shaped, hypoechoic mass
b. Multiple hypoechoic masses throughout the kidney
c. Echogenic kidney with calcified capsule
d. Highly echogenic renal pyramids c̅ or s̅ posterior acoustic shadowing
e. Cystic masses containing tiny echogenic foci situated throughout the kidney
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.
b.
c.
d.
e.
Overdistention of the urinary bladder
Parapelvic cysts
Prominent hilar vessels
Large extrarenal pelvis
All of the above
227. During a routine abdomen & pelvic ultrasound study, you detect a small round,
cystic structure projecting into the urinary bladder. This most likely represents:
a.
b.
c.
d.
e.
Urinoma
Ureterocele
Transitional cell carcinoma
Papillary necrosis
Extrarenal pelvis
228. You’re scanning a 69 y.o male with hematuria. Your ultrasound findings include
RT-sided hydronephrosis & a mass within the urinary bladder. Which of the
following tumors most commonly occurs within the urinary bladder?
a.
b.
c.
d.
e.
Transitional cell carcinoma
Renal cell carcinoma
Renal lymphoma
Renal hamartoma
Oncocytoma
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.
b.
c.
d.
e.
Lymphocele
Urinoma
Ureterocele
Hematoma
Abscess
230. Which intrarenal arteries course alongside the renal pyramids?
a.
b.
c.
d.
e.
Segmental
Interlobar
Arcuate
Intralobular
Vasa recta
231. Which of the following describes the normal course of the left renal vein?
a.
b.
c.
d.
e.
Retroaortic
Between the superior mesenteric artery and the aorta
Anterior to the superior mesenteric artery and inferior vena cava
Posterior to the inferior vena cava
Between the superior mesenteric artery and the splenic vein
232. Which of the following describes the normal course of the right reHal artery?
a.
b.
c.
d.
e.
Retroaortic
Between the superior mesenteric artery and the aorta
Anterior to the superior mesenteric artery and inferior vena cava
Posterior to the inferior vena cava
Between the superior mesenteric artery and the splenic vein
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.
b.
c.
d.
e.
<3 mm
3—6 mm
6—9 mm
ñl0 mm
The renal cortex cannot be measured sonographically.
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.
b.
c.
d.
e.
Ureteral calculi
Pelvic mass
Aortic aneurysm
A and B
All of the above
235. What is the purpose of scanning the urinary bladder to identify ureteral “jets”?
a.
b.
c.
d.
e.
Rule out the presence of urinoma
Determine if a ureter is obstructed
Determine if bladder outlet obstruction is present
Search for bladder carcinoma
Identify the urethra
236. You are scanning a patient with suspected lymphoma of the kidney. Which
ultrasound appearance is associated with renal lymphoma?
a.
b.
c.
d.
e.
Small, echogenic kidneys with hyperdense pyramids
Cystic masses of varying sizes throughout both kidneys
Multiple, bilateral, hypoechoic masses in enlarged kidneys
Single, large, hyperechoic mass
Unilateral wedge-shaped hypoeclioic mass
237. What arterioles course on top of renal pyramids & give rise to the tiny
intralobular arteries?
a.
b.
c.
d.
e.
Segmental
Interlobar
Arcuate
Vasa recta
Capsular
238. You detect a discrete echogenic focus without shadowing in the left kidney and
suspect the presence of a renal calculus. Which of the following is most helpful in
improving visualization of posterior acoustic shadowing?
a.
b.
c.
d.
e.
Higher-frequency transducer
Lower-frequency transducer
Smaller-aperture transducer
Increased frame rate
Increased dynamic range
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. Morison’s pouch
c. Cul-de-sae
d. Space of Disse
e. Foramen of Winslow
240. What is the indication for a Doppler renal study to rule out renal artery stenosis?
a.
b.
c.
d.
e.
Hematuria
Increased serum creatinine
Leukocytosis and fever
Uncontrolled hypertension
Anemia, progressive azotemia, and polyuria
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.
b.
c.
d.
Abdominal aorta
Superior mesenteric artery
Common hepatic artery
Celiac trunk
e. Inferior mesenteric artery
242. 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?
a.
b.
c.
d.
e.
< 1% people over age 50
15% of people o ei age 50
30% of people over age 50
50% of people over age 50
100% people over age 50
243. You’re scanning a pt with autosomal dominant polycystic kidney disease.
Which of the following statements is NOT true regarding this disease?
a.
b.
c.
d.
e.
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.
244. Which of the following is usually diagnosed in early childhood or in utero?
a.
b.
c.
d.
e.
Autosomal dominant polycystic disease
Multicystic dysplastic kidney
Acquired cystic kidney disease
Parapelvic cysts
A&B
245. Doppler analysis of intrarenal waveforms performed during renal
sonography reveals a RI index of 1.0. This finding is consistent with:
a.
b.
c.
d.
e.
Normality
Chronic medical renal disease
Renal vein thrombosis
Renal obstruction
B, C & D
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 bicomuate uterus.
d. Scan the patient in an upright position.
e. Perform a complete Doppler study of the solitary kidney.
247. Which of the following would be most helpful in delineating ureteral “jets”?
a.
b.
c.
d.
e.
Have the patient perform a Valsalva maneuver.
Scan the patient in both inspiration and expiration.
Examine the urinary bladder with color Doppler.
Increase the transducer frequency.
Give the patient a fatty meal.
248. You’re scanning a pt post-bx & discover a cystic mass in kidney. What should you do?
a.
b.
c.
d.
e.
Nothing; cystic masses are very common.
Evaluate the cyst with color Doppler.
Have the patient return in 2 weeks for a follow-up study.
Scan the patient in a prone position.
Compress the mass with probe pressure.
249. Which of the following results from an ascending urinary tract infection?
a.
b.
c.
d.
e.
Horseshoe kidney
Acute tubular necrosis
Glomerulonephritis
Pyelonephritis
Nephrocalcinosis
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.
b.
c.
d.
e.
Celiac trunk
Superior mesenteric artery
Splenic vein
Inferior mesenteric artery
Common hepatic artery
251. You’re scanning pt with RT flank pain & known polycystic kidney disease &
suspect hemorrhage presence within 1 of renal cysts. Sono appearance of finding?
a.
b.
c.
d.
e.
Ultrasound cannot be used to detect hemorrhage within a renal cyst.
Low-level echoes within the cyst
Multiple bright foci with posterior acoustic shadowing distal to the cyst
Solid appearing nodule with increased attenuation
All of the above
252. Pt’s referred to your US lab for eval of new renal transplant. Where do you look?
a. Morison’s pouch
b. Left upper quadrant
c. Pouch of Douglas
d. Right lower quadrant
e. Right upper quadrant
253. Ultrasound findings in a patient with hypertension include a left kidney measuring
6.8 cm & a right kidney measuring 11.7 cm. Which of the following is most
consistent with these findings?
A.
B.
C.
D.
E.
Acute pyelonephritis in the left kidney
Acute glomerulonephritis in the right kidney
Occlusion of the left main renal artery
Amyloidosis of the right kidney
Renal agenesis
254. What Doppler parameter should you measure to look for rejection in a
renal transplant?
a.
b.
c.
d.
e.
Pulsatility index
Resistive index
Renal-aortic ratio
Systolic-diastolic ratio
Acceleration index
255. You detect irregular thickening of the bladder wall in a 53-year-old male with
hydronephrosis and a dilated ureter. Which of the following would you
suspect?
a.
b.
c.
d.
e.
Renal cell carcinoma
Ureterocele
Bladder outlet obstruction
Transitional cell carcinoma
Endometriosis
256. Which statement below would help you in identification of the right renal vein?
a.
b.
c.
d.
The right renal vein lies inferior and posterior to the renal artery.
The right renal vein courses underneath the IVC.
The right renal vein courses anterior to the abdominal aorta.
The right renal vein divides into a circumaortic ring before draining into
the IVC.
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.
b.
c.
d.
e.
Each lateral edge
Superior and anterior border
Base of the trigone along the posterior aspect
Inferior and anterior to the trigone
At the bladder base, inferior at the apex of the trigone
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 liver
c. Patient prone, oblique view through back musculature
d. Patient in posterior oblique position, coronal view through posterior axillary line
e. Patient upright, anterior view through liver
259. During color Doppler evaluation of kidney, inadequate fill of intrarenal vasculature is
seen. What Doppler parameter will you make to improve sensitivity to flow? AIT—SIC
a.
b.
c.
d.
e.
Decrease pulse repetition frequency
Increase wall filter
Decrease packet size
Decrease color gain
Decrease color resolution setting
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.
b.
c.
d.
e.
Acoustic speekle
Reverberation artifact
Comet-tail artifact
Mirror-image artifact
Mulitpath 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.
b.
c.
d.
e.
Internal septations
Wall calcification
Internal echoes
Irregular walls
All of the above
262. What is the accepted treatment for a simple renal cyst?
a.
b.
c.
d.
e.
Surgical removal
Aspiration
Fine needle biopsy
Core biopsy
No further evaluation required
263. You’re performing an ultrasound exam on a pt who has been on dialysis for 4 yrs.
Which of the following describes the typical appearance of kidney in these cases?
a.
b.
c.
d.
e.
Bilateral renal enlargement with increased echogenicity
Bilateral small, echogenic kidneys with multiple cysts of varying sizes
Bilateral small, hypoechoi c kidneys with increased corticomedullary distinction
Normal appearing kidneys bilaterally
All of the above sonographic appearances are common in this scenario.
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.
b.
c.
d.
e.
Oncocytoma
Transitional cell carcinoma
Angiomyolipoma
Renal cell carcinoma
Adenoma
265. You’re performing a F/U study on a pt diagnosed with emphysematous
pyelonephritis. Which best describes sono appearance of this condition?
a. Multiple echogenic foci within the renal sinus or parenchyma with “dirty”
posterior acoustic shadows
b. Multiple clear hyperechoic foci c̅ discrete, distinct posterior acoustic shadows
c. Multiple indistinct, hazy foci within renal sinus with posterior acoustic
enhancement
d. Large area of posterior acoustic shadowing not related to any defined echoes
e. Focal, wedge-shaped hypoechoic masses with posterior acoustic enhancement
throughout the kidney
266. Which of the following is NOT a part of the urinary tract?
a.
b.
c.
d.
e.
Kidneys
Ureters
Uterus
Urinary bladder
Urethra
267. Which of the following describes the normal waveform of the main renal artery?
a.
b.
c.
d.
e.
Triphasic
High resistance
Low resistance
Phasic
Bidirectional
268. Renal arteries arise from AO closest to origin of which of the following arteries?
a. Superior mesenteric artery
b. Celiac trunk
c. Inferior mesenteric artery
d. Common iliac arteries
e. Common hepatic
269. LRA is normally located immediately posterior to which of the following?
a.
b.
c.
d.
e.
Left renal vein
Portal vein
Common hepatic artery
Splenic artery
None of the above
270. Of the following renal tumors, which is most common?
a.
b.
c.
d.
e.
Transitional cell carcinoma
Renal cell carcinoma
Oncocytoma
Primary renal lymphoma
Angiomyolipoma
271. A patient has been referred to the ultrasound department with a history of medullary
nephrocalcinosis. What do you expect to see?
a.
b.
c.
d.
e.
A calcified renal capsule
A calcified ureter
A calcified urinary bladder
Calcified pyramids
All of the above
272. A pt has been referred for ultrasound evaluation of LT kidney following an MVA. What’s
the sonographic appearance of a subcapsular hematoma?
a.
b.
c.
d.
e.
Free fluid in Morison’s pouch
Perirenal fluid collection that flattens the underlying renal contour
A linear defect that extends throughout the kidney
An intrarenal fluid collection within the renal collecting system
A subcapsular hematoma will not be visible by ultrasound
273. What is the most common cause of acute renal failure?
a.
b.
c.
d.
e.
Acute tubular necrosis (ATN)
Renal vein thrombosis
Glomerulonepliritis
Amyloidosis
Diabetes mellitus
274. You’re performing F/U study on pt with renal transplant. Which of following ▵’s
normally occurs in renal transplants compared to immediate post-op study?
a. Hypertrophy
b. Increased echogenicity
c. Hydronephrosis
d. Shrinkage
e. Calcified pyramids
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.
b.
c.
d.
e.
Internal iliac artery
External iliac artery
Common iliac artery
Abdominal aorta
Inferior mesenteric artery