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175 Cards in this Set
- Front
- Back
what organ make up the urinary system?
|
kidneys
ureters bladder urethra |
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Where is a renal cyst most commonly located?
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In the renal cortex
|
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where are three places you can develop renal cysts
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cortical
peripheral central/parapelvic |
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Where is a parapelvic cyst located?
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within the renal sinus
|
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What should you do to prove the cyst is a parapelvic cyst and not hydronephrosis?
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be sure it is not connected to the collecting system
|
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Are parapelvic cysts usually symptomatic or asymtomatic?
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asymptomatic
|
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What is Adult Polycystic Kidney Disease (APKD)
|
multi cystic
genitic disorder, bilateral, kidney enlargement can cause cysts in other organs |
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What are primary complications of APKD?
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renal failure
hypertension hemorrhagic cyst ureteric obstruction |
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what is the most common cause of renal failure
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APKD
|
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what do Kidneys excrete?
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nitrogenous waste
|
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What is u/s appearance of kidneys with APKD
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bilaterally enlarged kidneys
multiple cysts (bilateral) corticomedulary differentiation |
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what are three common symtoms of APKD?
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Hematuria
hypertension abdominal flank pain |
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What is another name for infantile Polycystic Kidney Disease?
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autosomal recessive Polycystic Kidney disease
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What is another name for Adult Polycystic Kidney disease
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Autosomal dominant PKD
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Is IPKD seen in utero?
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no, the cysts are too small
|
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What are characteristics of IPKD?
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bilaterally enlarged kidneys
causes renal insufficiency lung hypoplasia |
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What is adult multicystic kidney disease?
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multiple cysts of varying sizes, typically occuring unilaterally
|
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What is the difference between AMKD and APKD?
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AMKD is unilateral and APKD is bilateral
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what are most cases of AMKD caused by?
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urinary tract obstruction
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with adult MKD will the kidney be enlarged?
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can be normal or grossly enlarged to to compensation
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What is the US appearance of Adult MKD?
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Non communicating cysts
absense of normal renal parenchyma cyst wall calcification |
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What is a medullary sponge kidney
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bilateral, cystic dilitation of the collecting ducts, small cysts measuring <2cm.
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Would the medullary sponge kidney have normal renal function?
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yes
|
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What is nephracalcin?
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calcium deposits within the renal parenchyma
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where can nephracalcin deposits occur?
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within the cortex or medulla or both
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would you have shadowing from a nephracalcin?
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no, calcifications may be too small
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What is another name for nephrolithiasis?
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kidney stone
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What is nephrolithiasis?
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stone formation anywhere with in the collecting system
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Is Nephrolithiasis unilateral or bilateral
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either
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Is nephrolithiasis more common in males or females
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males
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What is the average size of a kidney stone?
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2-3 mm
|
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What is a staghorn Calculi
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large central renal stone
|
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What are the symptoms of nephrolithiasis
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renal colic (pain)
Hematuria pyerurea |
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What is the US appearance of Nephrolithiasis
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echogenic focus with shadow
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would you always see a stone in the ureter?
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no, could be impossible to see due to size, location and overlying bowel gas.
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What is Hydronephrosis
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dilitation of the renal collecting system due to the obstruction of the outflow of urine
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Where are three locations that obstruction can occur with hydronephrosis?
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ureter
bladder urethra |
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When is it normal to have hydronephrosis?
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in Rt. Kid during pregnancy
|
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what are some causes of hydronephrosis
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reflux from full bladder (goes away when bladder is empty)
|
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What are some aquired organic causes of hydronephrosis
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stones, prostate enlargement, tumor, inflammation, blood clots, full bladder
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what are some intrinsic causes of hydronephrosis
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calculus, blood clots, tumors, strictures, pyelnephritis
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what are some congenital causes of hydronephrosis
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puv, upj, bladder neck obstruction
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Why does the appearance of hydronephrosis vary?
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it is due to the dilitation and renal output of composition of collecting
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If the hydronephrosis is very severe what will you not be able to see
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you cannot see the renal cortex
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What are three grades of hydro nephrosis?
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mild
moderate severe |
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What is grade I hydro?
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Mild hydro with slight dilitation of the collecting system
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What is grade II hydro?
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further dilitation seen creating a cauliflower shape to the renal pelvis
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what is grade III hydro?
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gross dilitation producing one large sonolucent mass seen with kidney. You will note cortical thinning due to compression
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What is pyelonephritis also known as?
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Kidney infection
|
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what is the most common disease of the urinary tract?
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pyelonephritis
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How does pyelonephritis typically occur
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usually happens from an ascending UTI
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what does ascending UTI mean
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a UTI occuring in the bladder, urethra
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Is Pyelonephritis bilateral or unilateral
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unilateral
|
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with acute pyelonephritis what is the echogenicity of the kidney
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hypoechoic
|
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as the pyelonephritis continues and becomes chronic what is the echogenicity
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hyperechoic
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Who is most likely to get pyelonephritis?
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females 15-35yrs old
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What are the clinical signs of pyelonephritis
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flank pain, fever/chills, dysuria, pyuria, leukocytosis
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What is Xantho-granuloma-tous pyelonephritis
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chronic pyelonephritis w/ obstruction
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What are some characteristics of xanthogranulomatous pyelonephritis
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long standing calculi
inflammatory masses within kidney that can mimic renal CA |
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what do patients with xantho granulomatous pyeloephritis usually present with
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UTI
|
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What is pyonephritis?
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obstructed and infected collecting system displaying echogenic pus (composed of hydronephrosis)
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What is glomerulonephritis
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inflammation and necrosis of the Glomeruli
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What happens to the vessels and tubules with glomerulonephritis
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vessels and tubules become infected
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What is the appearance of the kidneys with glomerulonephritis
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enlarged and poorly functioning
|
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what is the appearance of acute glomerulonephritis?
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normal and asymtomatic
|
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As glomerulonephritis turns chronic what is the appearance of the cortex
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becomes hyperechoic
|
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What are the clinical symptoms of glomerulonephritis
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hematuria
hypertension no urine output (urea gets reabsorbed back into the body) |
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what is another name for fungus balls
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Mycetoma
|
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what is a fungus ball
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an echogenic , non shadowing mass within the kidney caused by candida
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What type of patient usually gets fungus balls
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patients with low resistance to disease, (malignancy, diabetes and neonates)
|
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What is the sonographic appearance of a fungus ball?
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looks like stone but does not shadow
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what are three types of perinephric fluid collections
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renal abscess
lymphocele urinoma |
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what is a renal abscess?
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infection inside or outside the kidney, usually due to inflammation, stone reflux, neurogenic bladder and diabetes
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what is the appearance of a renal abscess?
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complex mass with possible septations, dirty shadows, thick-irregular wall with enhancement
|
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what are the symtoms of a renal abscess?
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flank pain, fever , chills, elevated WBC
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Lymphocele
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largest fluid collection of the lymphatic fluid caused by renal damage/leakage
|
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what is a lymphocele often confused with
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a cyst
|
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What is the appearance of a lymphocele
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well defined cystic area with or without septations
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when would a lymphocele contain echos
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when it is hemorrhagic
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a lymphocele is usually ________ in size than a abscess or urinoma
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larger
|
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what is a urinoma
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encapsulated collection of anachoic extravasated urine
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How does a urinoma occur?
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urine escapes from vessels and leaks into surrounding tissues outside of kidney
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where are urinomas usually located
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near lower pole of kidney
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what are causes of urinomas
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renal injuries, transplants, tumor, calculus erosion, ureteral obstruction
|
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What are three benign solid renal masses?
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adenoma
oncocytoma angiomyolipoma |
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Adenoma
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a benign vascular tumor that attenuates sound
|
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what is the typical size of an adenoma
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<3cm
|
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how is an adenoma usually found
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usually incidental finding
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What are the clinical symptoms of an adenoma
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painless hematuria; but usually asymptomatic
|
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Adenomas are believed to be the benign counterpart to...
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renal cell CA
|
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What is the us appearance of and renal adenoma?
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highly vascular, internal echos, attenuating sound
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Where is the renal adenoma ususally located
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cortex
|
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What is the most common benign kidney mass
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a renal adenoma
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what is oncocytoma
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large vascular adenomas that grow very fast
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A oncocytoma cannot be distinquished from __________?
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Renal cell CA
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What are the clinical symptoms of oncocytomas?
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usually asymtomatic but if large can have pain and hematuria
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Are Oncocytomas more common in men or women?
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men
|
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what is the us appearance of an oncocytoma?
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well defined
smooth homogenious stallate scar (central necrosis) |
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What is angiomyolipoma
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benign tumor primarily composed of fat cells intermixed with smooth muscle and blood vessels
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What is another name for angiomyolipomas
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renal hamartoma
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Where is a angiomyolipoma usually found?
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renal cortex
|
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is the angiomyolipoma hypoechoic or hyperechoic
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hyperechoic due to fat content
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What aged person is most likely to get angiomyolipoma
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mid aged women
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what does a angiomyolipoma look like on US
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hemangioma of kidney
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What are three types of malignant solid renal masses?
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renal Cell CA
transitional cell CA Nephroblastoma |
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What is another name for Renal cell CA
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hypernephroma or adenocarcinoma
|
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Waht is the most common primary malignant tumor of the kidney
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renal cell CA
|
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Where on the kidney is renal cell CA usually found?
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cortical tumor
|
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At what age are you most likely to develop renal cell CA
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over 50
|
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Is renal cell CA unilateral or bilateral?
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unilateral
|
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What are symptoms of Renal Cell CA
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gross hematuria and pain when large
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What are us characteristics of Renal cell CA
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very vascular with calcification
area of necrosis, hemorrhage or degeneration well delineated (encapsulated) no enhancement can be hyper, hypo or isoechoic to renal tissue fast growing |
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what is the pattern of metastisis in renal cell CA
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spreads by way of renal vein, most likely to spread to lungs
lymph nodes---lungs---bone---liver---brain |
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How many stages are there of renal cell ca
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4
|
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Stage 1 renal cell CA is described as
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confined within capsule
|
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stage 2 renal cell CA is described as
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invasion into the perinephric fat
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involvment into lymph nodes or venous structures (IVC and RV) decribes what stages of renal call CA
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stage 3
|
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Stage 4 renal cell CA is described as
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invasion into adjacent organs or distant metastiasis
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What is transitional cell CA
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malignant tumor of the renal collecting system
|
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what is the average age of someone developing tranisitonal cell CA
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males 61 or older
|
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What is the appearance for transitional cell CA
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multiple, bilateral and hypoechoic
|
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Where is transitional cell ca usually found?
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within the bladder
|
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What are the symptoms of Transitional cell CA
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same as Renal Cell CA (gross hematuria)
|
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Is it easy to detect transitional cell CA on US
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no, too small
|
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If transitional cell ca is seen on us what is the appearance?
|
solid mass centered in renal sinus
|
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What is another name form Nephroblastoma
|
wilms tumor
|
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What is the most common solid kidney or abdominal tumor found in children
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nephroblastoma
|
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what is the peak age of identification for nephroblastsoma
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3-4 years old
|
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a nephroblastoma is commonly associated wtih...
|
beckwith wiedemann syndrome
|
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where does nephroblastoma metastasize too
|
nodes liver and lungs
|
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what is the usual secondary CA to nephroblastoma
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lungs, breast then other kidney
|
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what are the clinical symptoms of nephroblastoma
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pain, fever, malaise, weight loss, possibly palpable, possible hematuria and hypertension
|
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What is the us appearance of nephroblastoma
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well defined smooth echogenic mass
inhomogenious with age necrosis and calcifications hydronephrosis |
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What are the renal lab values
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creatinine, BUN, UA-urinalyisis, urine Ph, hematuria
|
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What is the standard long term treatment for end stage chronic renal failure
|
renal transplant
|
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Why have the survival rates improved for renal transplants
|
immunology
therapy more favorable selection of a donor |
|
What is a sign of renal faillure on us
|
if the renal cortex is more hyperechoic than the liver.
|
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Where is the donor kidney placed in the recipient?
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they are placed in the retroperitoneum within the iliac fossa (anterior to fossas and iliac veins)
|
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Why is the donor kidney placed "inverted" or backwards in the recipient
|
to bring the vessels closer to the bladder
|
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the RA is Anastomased to the __________________,
|
external iliac artery
|
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the ________ is anastomosed to the internal iliac vein
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RV
|
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The ureter is anasomosed to the ___________
|
bladder
|
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T/F
in a transplant they remove the old kidney |
false
|
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Is it normal or abnormal to have ascites with a transplant?
|
normal
|
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What is the role of US in a renal transplant?
|
1. Look for fluid collections around kidney
2. scan bladder full/empty 3. get doppler of RA, RV and thru out renal cortex 4. measure size and doc position 5. check for obstruction |
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When is first us usually completed after transplant
|
within 48 hours
|
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What will a transplanted kidney look like initially?
|
initially it will be small then within a few weeks will be at it's normal size
|
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What are some complications of renal transplant
|
fever
increased creatinine levels fluid collections rejection drug toxicity infection obstruction risk of malignancy acute tubular necrosis |
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what are some signs of rejections
|
enlargement and decreased echo
hyperechoic cortex distortion of renal outline patchy sonolucent areas with in the cortex and medulla |
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What is acute tubular necrosis?
|
occurs when there is a loss of blood volume to the transplant tissues
|
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ATN causes what 4 things
|
decrease in renal blood pressure
acute renal shut down renal parenchyma is unchanged kidney shut down if blood volume is not resored quickly enough |
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What is the most common cause of renal failure
|
Acute tubular necrosis (ATN)
|
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What are Bladder Calculi
|
develop from upper UT and pass into bladder can be caused from prolonged use of catheter
|
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What are the symptoms of Bladder Calculi?
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Asymptomatic unless they obstruct the bladder neck
|
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US appearance of bladder calculi
|
mobile
may not shadow |
|
what is the normal msmt of the bladder wall fully distended
|
3 mm
|
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what is the normal bladder msmt of a bladder wall not distended
|
5-6mm
|
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What are the three areas of the bladder
|
apex, base and trigone
|
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Do all stones originate in bladder
|
no. they can develop in the bladder or can develop in the kidney and migrate to bladder
|
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what is cystictis?
|
infection or inflammation of the bladder
|
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What are the causes of cystitis?
|
females: pregnancy, coital trauma and ascending UTI
Males: Prostate disease |
|
what are the clinical symptoms of cystitis
|
freq. disurea, lower abd. pain in bladder region
|
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On US you see a pouchlike invaginantion of the bladder wall or urine filled outpouching from bladder what would he dx most likely be?
|
bladder diverticulum
|
|
On US you note the appearance of thickened bladder wall fluid/fluid level
|
cystitis
|
|
Post Uretheral valve PUV
|
dilitation of the uretheral due to an obstruction
|
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What is the most common cause of obstruction in male infants
|
PUV
|
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On US you note the "keyhole sign", a thickened bladder wall, hydronephrosis, hydroureter. You are most likely seeing....
|
PUV
|
|
What is a neurogenic bladder
|
losing the ability to control voiding due to a disturbance in the neural passage to bladder
|
|
the following are causes of:
congenital anomaly systemic disease infection trauma brain and spinal tumor |
neurogenic blader
|
|
When are bladder neoplasms usually found?
|
usually not detected until advanced stages
|
|
What is a papilloma
|
a benign, rare bladder tumor attached to the bladder wall by a stalk
|
|
Are papillomas usually large or small
|
small
|
|
Name the most aggresive malignant bladder tumor
|
squamous cell CA
|
|
which is larger, squamous cell or transitional cell tumors
|
squamous cell
|
|
What is transitional cell CA
|
bladder CA that arises from the transitional epithelium that lines the renal pelvis, ureter and bladder
|