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22 Cards in this Set

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Leriche
Absent femoral pulses


Buttock and hip claudication


Impotence
Leriche collateral
SMA to enlarged marginal artery of Drummond to IMA, to internal iliacs to CFA
Bear-paw sign
Fragmented staghorn calculus. Fragmentation occurs due to infection. There is replacement of the parenchyma by hypodense material within which is contained calcified stone bodies. The whole thing looks like a bear's paw and represents XGP.
Stone with long spikes
JACK STONE = Calcium oxalate stone. Easy to lithotripse.
Most common cause of cortical nephrocalcinosis
Cortical necrosis due to major vascular insult
Next 3 most common causes of cortical nephrocalcinosis
Chronic glomerulonephritis


Oxalosis


Alports


Mnemonic == too much "coac" gives you cortical necrosis from major vascular insult.

Cortical necrosis
Oxalosis
Alports
Chronic glomerulonephritis
Most common causes of medullary nephrocalcinosis
Medullary sponge


RTA, distal, Type 1


Hyperparathyroidism (or any cause of hypercalcemia and/or hypercalciuria)
Hypodense kidney with renal artery contrast filled right up to margin of kidney
ARTERIAL CUT-OFF sign


= Renal artery thrombosis
Rim of perfusion at edge of kidney
Rim sign = evidence of renal artery thrombosis
Edge of kidney hypodense, while medullary portion enhances
Reverse rim sign


Evidence of CORTICAL NECROSIS with preservation of medullary bloodflow. If the patient survives the vascular catastrophe, she will develop cortical nephrocalcinosis.
Enlarged central hypodensity with thin rim of enhancement
Hydronephrotic rim sign
Early image from XU with patches of enhancement, then on delayed nephrogram, patches become big and septations between the spots are seen
Spotted nephrogram

=

Polyarteritis nodosa

Scleroderma

Hypertensive nephrosclerosis


ON CT, THIS LOOKS LIKE A STRIATED NEPHROGRAM
Dilated collecting system with cortical enhancement and thin line of dense enhancement directly adjacent to the calyx in the deepest portion of the medulla.
CRESCENT SIGN


Caused by re-orientation of tubules from perpendicular to the calyx to horizontal, following the calyx. THIS INDICATES RECOVERABILITY OF FUNCTION, even if creatinine is chronically elevated, and means decompression of the collecting system should be performed.

It has a much more positive connotation than does rim sign of hydronephrosis
XU with dialated collecting system. The ureter is seen exiting the pelvis from a more inferior than normal position
BALLOON on a STRING appearance = UPJ obstruction


LOOK FOR CROSSING VESSEL AS CAUSE, as always, ESPECIALLY in adults, as more than 1/2 are due to this.
Renal hematoma
LOOK FOR THE CAUSE


1) Renal cell CA


2) AML


3) Aneurysm


4) Trauma
Thin fluid collection surrounding kidney
KIDNEY SWEAT


Seen in acute renal failure
Horseshoe kidney
LOOK FOR VERTEBRAL, ANORECTAL, TRACHEAL, AND ESOPHAGEAL ANOMALIES (VACTERL ASSOCIATION) as this can be part of the anomaly
What does horseshoe kidney as well as pelvic kidney have
Anomalous blood supply from the aorta, since it didn't ascend, picking up new vessels along the way.
Indications for tips
intractable ascites and refractory variceal bleeding.
Goal of tips
portal systemic gradient less than 12.
Sign of acute vascular embolism
meniscus sign, lack of collaterals,. Clinical syndrome of cold painful leg with pallor cyanosis or paresthesias.
Rare cause of arterial embolus
left heart tumor