Boards: Reproductive, Endocrine

Front 1

Unilateral renal agenesis associations

Back 1

Men: 20% have ipsilateral epididymis/vas deferens absent, or seminal vesicle cyst

Women: Unicornuate uterus (Mayer Rokitansky)

Front 2

What is the Potter Sequence?

Back 2

In-utero insult (ACE inhibitors?), kidneys don't form, no urine, no lungs (pulmonary hypoplasia)

Front 3

What is Mayer-Rokitansky-Kuster-Hauser?

Back 3

Unilateral renal agenesis and absence or atresia of the uterus

Front 4

Pancake adrenal

Back 4

Used to differentiate between surgical vs congenital absent kidney

Front 5

Teel me about Horseshoe kidney

Back 5

Recurrent infections = increase risk of TCC

Increased risk of Wilms (8x higher)

Associated with Turners syndrome

Front 6

Crossed fused renal ectopia

Back 6

More often the left kidney crosses

The ectopic kidney is inferior

Front 7

Calcifications in a fatty renal mass?

Back 7

RCC until proven otherwise

Front 8

Risk factors for RCC?

Back 8

Tobacco, chronic dialysis, family history

Front 9

Medullary RCC is associated with what disease?

Back 9

Sickle cell trait (very aggressive)

Front 10

Chromophobe RCC is associated with what disease?

Back 10

Birt-Hogg-Dube

Front 11

Clear cell RCC is associated with what disease?

Back 11

VHL

Front 12

Papillary RCC is associated with what disease?

Back 12

Hereditary papillary renal carcinoma

Front 13

RCC stage 1?

Back 13

Limited to kidney and <7cm

Front 14

RCC stage 2?

Back 14

Limited to kidney but >7cm

Front 15

RCC stage 3 (a, b and c)?

Back 15

Vein invasion but limited to Gerota's Fascia

A: Renal vein

B: IVC below diaphragm

C: IVC above diaphragm

Front 16

RCC stage 4?

Back 16

Beyond Gerota's fascia

Front 17

ADPKD increased risk for RCC?

Back 17

No, unless the patient is on dialysis

Front 18

What is a benign renal tumor with a central scar?

Back 18

Oncocytoma (spoke wheel on US)

-Associated with Birt-Hogg-Dube

-Treated like RCC until proven otherwise

-Hotter than surrounding renal parenchyma on PET (unlike RCC)

Front 19

Renal macroscopic fatty tumor?

Back 19

Angiomyolipoma

(associated with Tuberous Sclerosis)

(can bleed if >4cm)

(lipid poor if they are T1 dark)

Front 20

Renal mass with non-communicating, fluid filled locules which protrudes into the renal pelvis?

Back 20

Multilocular cystic nephroma

Front 21

Typical occurrence of Multilocular Cystic Nephroma?

Back 21

Bimodal:

4 year old boys

40 year old women

(Michael Jackson)

Front 22

Bosniak?

Simple cyst, no enhancement

Back 22

Class 1

Front 23

Bosniak?

Hyperdense (<3cm), thin calcifications, thin septations

Back 23

Class 2

Front 24

Bosniak?

Hyperdense (>3cm), minimally thickened calcifications

Back 24

Class 2F (5% chance of cancer)

Front 25

Bosniak?

Thick septations, mural nodule

Back 25

Class 3 (50% chance cancer)

Front 26

Bosniak?

Any enhancement

Back 26

Class 4

Front 27

Ddx for a T2 dark renal cyst?

Back 27

Hemorrhagic cyst

Lipid poor AML

Papillary RCC

Front 28

Tell me about ADPKD?

Back 28

Adult

70% get liver cysts

Berry aneurysms

(risk of RCC only if on dialysis)

Front 29

Tell me about ARPKD?

Back 29

Hypertension

Congential hepatic fibrosis

Echogenic kidneys with loss of corticomedullary differenetiation

Could show large abdomen with small chest (pulmonary hypoplasia)

Front 30

Explain VHL?

Back 30

Autosomal dominant

50-75% have renal cysts

25-50% develop RCC (clear cell)

Pancreas: cysts, neuroendocrine tumors, serous microcystic adenomas

Adrenal: Pheochromocytomas

CNS: Hemangioblastomas, endolymphatic sac tumors

Epididymal cystadenomas

Front 31

Explain Tuberous Sclerosis?

Back 31

Autosomal dominant. Hamartomas everywhere

Renal: AMLs, RCC in younger patients

Lung: LAM

Cardiac: Rhabdomyosarcoma

Brain: SEGA, subcortical tubers, subependymal nodules

Front 32

Bipolar patient with multiple tiny renal cysts?

Back 32

Lithium nephropathy

Front 33

Tiny cysts in utero or newborn, oligo?

Back 33

MCDK

(Non-communicating cysts, no functional renal tissue)

Dismal prognosis is bilateral

Conservative treatment if unilateral

Front 34

Renal cyst originating from the renal sinus and looks like hydro?

Back 34

Peripelvic cyst

Front 35

Renal cyst originating from the parenchyma, compresses the collecting system?

Back 35

Parapelvic cyst

Front 36

Striated nephrogram ddx?

Back 36

Pyelonephritis

Medullary sponge kidney

Acutely after contusion

Acute ureteral obstruction

Radiation nephritis

Acute renal vein thombosis

Front 37

Diabetic patient with echogenic foci and dirty shadowing on US?

Back 37

Emphysematous pyelonephritis

(really bad!)

Front 38

"Bear paw" sign with staghorn calculus and psoas abscess?

Back 38

Xanthogranulomatous pyelonephritis

(Struvite calculus)

Front 39

Most common cause of papillary necrosis?

Back 39

Diabetes!

Others:

Pyelonephritis, sickle cell (analgesic use), TB, cirrhosis

Front 40

Shrunken calcified kidney with cavitary lung mass?

Back 40

Renal TB

Front 41

Prepuberty uterus and streaky ovaries?

Back 41

Turner Syndrome

(also coarctation and horseshoe kidney)

Front 42

Mullerian agenesis with renal agenesis or ectopia?

Back 42

Mayer-Rokitansky-Kuster-Hauser

Front 43

Back 43

Uterus Didelphys

(complete uterine duplication

Front 44

Back 44

Bicornus

(unicollis or bicollis)

(separation of uterus by deep myometrial cleft)

Front 45

Back 45

Septate

(two endometrial canals separated by muscular or fibrous septum)

(has a higher fundal apex contour)

Front 46

Back 46

Arcuate uterus

(normal variant)

Front 47

Back 47

T-shaped

(DES related, vaginal clear cell carcinoma)

Front 48

Infertile patient with multiple diverticula involving the fallopian tube?

Back 48

Salpingitis isthmica nodosa

Front 49

High velocity serpiginous structure in myometrium in a patient with prior D&C (or abortion, c-section, multiple pregnancies)?

Back 49

Uterine AVM

Front 50

Intrauterine filling defects on HSG, or T2 dark bands on MRI in infertile patient?

Back 50

Ashermans or endometrial synechia

(due to D&C, surgery, pregnancy, or infection...TB)

Front 51

Order of fibroids (by location)?

Back 51

Intramural, subserosal, submucosal

Front 52

Fibroid without enhancement, T2 dark?

Back 52

Hyaline degeneration

Front 53

Fibroid without enhancement with peripheral rim of T1 high signal, pregnant woman?

Back 53

Red (carneous) degeneration

(due to venous thrombosis)

Front 54

Fibroid with minimal gradual enhancement, T2 bright?

Back 54

Myxoid degeneration

Front 55

thickening of the junctional zone, thickened posterior wall, foci of T2 high signal in uterus?

Back 55

Uterine adenomyosis

Front 56

HNPCC causes increased risk of what cancer other than colon?

Back 56

Endometrial

Front 57

What ovarian tumor secretes estrogen and can cause a thickened endometrial stripe?

Back 57

Granulosa Cell tumor

Front 58

Limit for post-menopausal endometrial stripe on and not on Tamoxifen?

Back 58

4mm in a normal patient

8mm with Tamoxifen use

Front 59

Cervical cancer Stage IIA?

Back 59

Spread beyond cervix but NO parametrial invasion

Surgery only

Front 60

Cervical cancer Stage IIB?

Back 60

Parametrial involvement but NO pelvic sidewall extent.

Chemo/Radiation and Surgery

Front 61

Main type of cervical cancer?

Back 61

Squamous cell

Front 62

Vaginal mass with a history of mom using DES?

Back 62

Clear cell adenocarcinoma

(plus a T-shaped uterus)

Front 63

Most common vaginal cancer in children?

Back 63

Rhabdomyosarcoma

(age 2-6 and 14-18)

Front 64

A met to the anterior wall upper 1/3 vagina came from where?

Back 64

Genital tract

Front 65

A met to the posterior wall lower 1/3 vaginal came from where?

Back 65

GI tract

Front 66

Cyst in the cervix?

Back 66

Nabothian

Front 67

Cyst in anterior lateral wall of upper vagina?

Back 67

Gartner duct cyst

Front 68

Cyst in vagina below pubic symphysis?

Back 68

Bartholin gland cyst

Front 69

Most common cause of genital ambiguity in females?

Back 69

Congenital adrenal hyperplasia

Front 70

Patient with meningitis and adrenal hemorrhage?

Back 70

Waterhouse-Friderichsen Syndrome

Front 71

What is the organ of Zuckerkandl?

Back 71

An area of extra adrenal tissue located near the origin of the IMA. A pheochromocytoma can present here.

Front 72

What is the "Rule of 10s" for pheochromocytomas? (5)

Back 72

10% are extra-adrenal

10% are bilateral

10% are in children

10% are hereditary

10% are NOT active

Front 73

What conditions are associated with pheochromocytomas?

Back 73

VHL

MEN IIa and IIb

NF-1

Sturge Weber

Tuberous Sclerosis

Carney Triad

Front 74

Whats the difference between the Carney Triad and the Carney Complex?

Back 74

Carney Triad: Extra-adrenal pheo, GIST, pulmonary chondroma

Carney Complex: Cardiac myxoma, skin pigmentation

Front 75

Common mets to adrenal gland?

Back 75

Lung, breast, melanoma

Front 76

What are the adrenal washout equations?

Back 76

Absolute:

E-D

----- x 100 >60% is Adenoma

E-U

Relative:

E-D

----- x 100 >40% is Adenoma

E

Front 77

Bilateral enlarged calcified adrenal glands with hepatosplenomegaly?

Back 77

Wolman Disease

Front 78

MEN?

Pituitary adenoma, parathyroid hyperplasia, pancreas (gastrinoma)

Back 78

MEN I

(PiParPanc)

Front 79

MEN?

Medullary thyroid cancer, parathyroid hyperplasia, pheochromocytoma

Back 79

MEN IIa

(PMP)

Front 80

MEN?

Medullary thyroid cancer, marfanoid habitus/mucosal neuroma, pheochromocytoma

Back 80

MEN IIb

(PMMM)

Front 81

Carcinoid syndrome implies mets to where?

Back 81

Liver

Front 82

What type of thyroid cancer contains microcalcifications?

Back 82

Papillary

Front 83

Enhancing nodule in a thyroglossal duct cyst?

Back 83

Papillary thyroid cancer

Front 84

Most common location for ectopic thyroid tissue?

Back 84

Lingual thyroid

Front 85

Most common cause of hyperthyroidism and goiter?

Back 85

Graves (autoimmune disease, antibody against TSH receptor)

Front 86

Increased uptake of I-123 with %RAIU 50-80%?

Back 86

Graves

Front 87

Most common cause of hypothyroidism and goiter?

Back 87

Hasimotos

Front 88

Woman with a painful thyroid gland after an upper respiratory infection?

Back 88

Subacute thyroiditis

Front 89

%RAIU during acute phase of subacute thyroiditis?

Back 89

Low

Front 90

What are the IgG4 associated diseases?

Back 90

Reidels thyroiditis

Orbital pseudotumor

Retroperitoneal fibrosis

Sclerosing cholangitis

Front 91

Where could the infection have started in a child that has acute suppurative thyroiditis?

Back 91

4th brachial cleft anomaly via a pyriform fistula

Front 92

Comet artifact on thyroid US?

Back 92

Colloid nodule

Front 93

Type of thyroid cancer that produces calcitonin?

Back 93

Medullary

Front 94

What types of thyroid cancer do NOT respond to I-131?

Back 94

Medullary, Anaplastic and Hurthle cell

Front 95

What types of thyroid cancer respond well to I-131?

Back 95

Papillary and Follicular

Front 96

What is the classic pattern of thyroid cancer mets to the lungs?

Back 96

Miliary

Front 97

Risk of treating metastatic thyroid cancer to the lung with I-131?

Back 97

Pulmonary fibrosis

Front 98

What factors does sestamibi parathyroid imaging depend on?

Back 98

Mitochondrial density and blood flow

Front 99

What is the cumulus oophorus?

Back 99

Collection of cells in a mature dominant follicle, signals imminent ovulation

Front 100

Ovary with multilocular "spoke-wheel" appearance?

Back 100

Theca lutein cysts, related to overstimulation by bHCG.

1. Multifetal pregnancy

2. Molar pregnancy

3. Ovarian hyperstimulation syndrome

Front 101

Patient with theca lutein cysts, ascites, and pleural effusions?

Back 101

Ovarian hyperstimulation syndrome

Front 102

Best time to perform a PET scan on a woman in regards to menstrual cycle?

Back 102

First 7-10 days of the cycle

Front 103

Size cutoff of a postmenopausal woman with ovarian cyst who needs further workup?

Back 103

7cm

needs MRI or surgical evaluation

Front 104

Round mass with homogenous low-level echoes and increased through transmission? (Uterus)

Back 104

Endometrioma

Front 105

Risk factor for an endometrioma for turning into a cancer?

Back 105

1. Size > 6-9cm

2. Age > 45 years old

Front 106

How to differentiate between an endometrioma and a hemorrhagic cyst?

Back 106

Re-image in 1-2 menstrual cycles, the cyst will get smaller or go away

Front 107

Most likely diagnosis for a large, simple-appearing, unilocular cyst in a postmenopausal woman

Back 107

Serous ovarian cystadenoma

Front 108

Psuedomyxoma peritonei comes from what?

Back 108

Ruptured mucinous tumors:

1. Appendiceal mucinous adenocarcinoma

2. Mucinous ovarian cystadenocarcinoma

Front 109

What is Meigs syndrome?

Back 109

Pleural effusion, ascites and benign ovarian tumor (usually fibroma)

Front 110

What is a Krukenberg tumor?

Back 110

Mets to the ovary that secrete mucin, usually from GI source

Front 111

Benign ovarian tumor with calcification?

Back 111

Brenner tumor

Front 112

Osteochondrosis of the tarsal navicular?

Back 112

Kohler

Front 113

Osteochondrosis of the 2nd metatarsal head?

Back 113

Freiberg infraction

Front 114

Most common carpal coalition?

Back 114

Lunotriquetral

Front 115

Management for simple adnexal cyst >5 and <7cm?

Back 115

Almost certainly benign, annual follow up ultrasound

Front 116

Management for simple adnexal cyst >7cm?

Back 116

Not definitively benign, MRI or surgical consult follow up