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116 Cards in this Set
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Unilateral renal agenesis associations |
Men: 20% have ipsilateral epididymis/vas deferens absent, or seminal vesicle cyst
Women: Unicornuate uterus (Mayer Rokitansky) |
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What is the Potter Sequence? |
In-utero insult (ACE inhibitors?), kidneys don't form, no urine, no lungs (pulmonary hypoplasia) |
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What is Mayer-Rokitansky-Kuster-Hauser? |
Unilateral renal agenesis and absence or atresia of the uterus |
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Pancake adrenal |
Used to differentiate between surgical vs congenital absent kidney |
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Teel me about Horseshoe kidney |
Recurrent infections = increase risk of TCC Increased risk of Wilms (8x higher) Associated with Turners syndrome |
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Crossed fused renal ectopia |
More often the left kidney crosses The ectopic kidney is inferior |
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Calcifications in a fatty renal mass? |
RCC until proven otherwise |
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Risk factors for RCC? |
Tobacco, chronic dialysis, family history |
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Medullary RCC is associated with what disease? |
Sickle cell trait (very aggressive) |
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Chromophobe RCC is associated with what disease? |
Birt-Hogg-Dube |
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Clear cell RCC is associated with what disease? |
VHL |
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Papillary RCC is associated with what disease? |
Hereditary papillary renal carcinoma |
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RCC stage 1? |
Limited to kidney and <7cm |
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RCC stage 2? |
Limited to kidney but >7cm |
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RCC stage 3 (a, b and c)? |
Vein invasion but limited to Gerota's Fascia A: Renal vein B: IVC below diaphragm C: IVC above diaphragm |
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RCC stage 4? |
Beyond Gerota's fascia |
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ADPKD increased risk for RCC? |
No, unless the patient is on dialysis |
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What is a benign renal tumor with a central scar? |
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) |
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Renal macroscopic fatty tumor? |
Angiomyolipoma
(associated with Tuberous Sclerosis) (can bleed if >4cm) (lipid poor if they are T1 dark) |
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Renal mass with non-communicating, fluid filled locules which protrudes into the renal pelvis? |
Multilocular cystic nephroma |
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Typical occurrence of Multilocular Cystic Nephroma? |
Bimodal: 4 year old boys 40 year old women (Michael Jackson) |
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Bosniak? Simple cyst, no enhancement |
Class 1 |
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Bosniak? Hyperdense (<3cm), thin calcifications, thin septations |
Class 2 |
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Bosniak? Hyperdense (>3cm), minimally thickened calcifications |
Class 2F (5% chance of cancer) |
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Bosniak? Thick septations, mural nodule |
Class 3 (50% chance cancer) |
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Bosniak? Any enhancement |
Class 4 |
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Ddx for a T2 dark renal cyst? |
Hemorrhagic cyst Lipid poor AML Papillary RCC |
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Tell me about ADPKD? |
Adult 70% get liver cysts Berry aneurysms (risk of RCC only if on dialysis) |
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Tell me about ARPKD? |
Hypertension Congential hepatic fibrosis Echogenic kidneys with loss of corticomedullary differenetiation
Could show large abdomen with small chest (pulmonary hypoplasia) |
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Explain VHL? |
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 |
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Explain Tuberous Sclerosis? |
Autosomal dominant. Hamartomas everywhere
Renal: AMLs, RCC in younger patients Lung: LAM Cardiac: Rhabdomyosarcoma Brain: SEGA, subcortical tubers, subependymal nodules |
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Bipolar patient with multiple tiny renal cysts? |
Lithium nephropathy |
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Tiny cysts in utero or newborn, oligo? |
MCDK
(Non-communicating cysts, no functional renal tissue)
Dismal prognosis is bilateral Conservative treatment if unilateral |
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Renal cyst originating from the renal sinus and looks like hydro? |
Peripelvic cyst |
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Renal cyst originating from the parenchyma, compresses the collecting system? |
Parapelvic cyst |
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Striated nephrogram ddx? |
Pyelonephritis Medullary sponge kidney Acutely after contusion Acute ureteral obstruction Radiation nephritis Acute renal vein thombosis
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Diabetic patient with echogenic foci and dirty shadowing on US? |
Emphysematous pyelonephritis (really bad!) |
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"Bear paw" sign with staghorn calculus and psoas abscess? |
Xanthogranulomatous pyelonephritis (Struvite calculus) |
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Most common cause of papillary necrosis? |
Diabetes!
Others: Pyelonephritis, sickle cell (analgesic use), TB, cirrhosis |
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Shrunken calcified kidney with cavitary lung mass? |
Renal TB |
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Prepuberty uterus and streaky ovaries? |
Turner Syndrome
(also coarctation and horseshoe kidney) |
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Mullerian agenesis with renal agenesis or ectopia? |
Mayer-Rokitansky-Kuster-Hauser |
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Uterus Didelphys (complete uterine duplication |
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Bicornus
(unicollis or bicollis) (separation of uterus by deep myometrial cleft) |
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Septate
(two endometrial canals separated by muscular or fibrous septum) (has a higher fundal apex contour) |
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Arcuate uterus
(normal variant) |
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T-shaped
(DES related, vaginal clear cell carcinoma) |
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Infertile patient with multiple diverticula involving the fallopian tube? |
Salpingitis isthmica nodosa |
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High velocity serpiginous structure in myometrium in a patient with prior D&C (or abortion, c-section, multiple pregnancies)? |
Uterine AVM |
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Intrauterine filling defects on HSG, or T2 dark bands on MRI in infertile patient? |
Ashermans or endometrial synechia
(due to D&C, surgery, pregnancy, or infection...TB) |
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Order of fibroids (by location)? |
Intramural, subserosal, submucosal |
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Fibroid without enhancement, T2 dark? |
Hyaline degeneration |
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Fibroid without enhancement with peripheral rim of T1 high signal, pregnant woman? |
Red (carneous) degeneration
(due to venous thrombosis) |
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Fibroid with minimal gradual enhancement, T2 bright? |
Myxoid degeneration |
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thickening of the junctional zone, thickened posterior wall, foci of T2 high signal in uterus? |
Uterine adenomyosis |
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HNPCC causes increased risk of what cancer other than colon? |
Endometrial |
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What ovarian tumor secretes estrogen and can cause a thickened endometrial stripe? |
Granulosa Cell tumor |
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Limit for post-menopausal endometrial stripe on and not on Tamoxifen? |
4mm in a normal patient 8mm with Tamoxifen use |
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Cervical cancer Stage IIA? |
Spread beyond cervix but NO parametrial invasion
Surgery only |
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Cervical cancer Stage IIB? |
Parametrial involvement but NO pelvic sidewall extent.
Chemo/Radiation and Surgery |
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Main type of cervical cancer? |
Squamous cell |
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Vaginal mass with a history of mom using DES? |
Clear cell adenocarcinoma
(plus a T-shaped uterus) |
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Most common vaginal cancer in children? |
Rhabdomyosarcoma (age 2-6 and 14-18) |
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A met to the anterior wall upper 1/3 vagina came from where? |
Genital tract |
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A met to the posterior wall lower 1/3 vaginal came from where? |
GI tract |
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Cyst in the cervix? |
Nabothian |
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Cyst in anterior lateral wall of upper vagina? |
Gartner duct cyst |
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Cyst in vagina below pubic symphysis? |
Bartholin gland cyst |
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Most common cause of genital ambiguity in females? |
Congenital adrenal hyperplasia |
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Patient with meningitis and adrenal hemorrhage? |
Waterhouse-Friderichsen Syndrome |
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What is the organ of Zuckerkandl? |
An area of extra adrenal tissue located near the origin of the IMA. A pheochromocytoma can present here. |
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What is the "Rule of 10s" for pheochromocytomas? (5) |
10% are extra-adrenal 10% are bilateral 10% are in children 10% are hereditary 10% are NOT active |
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What conditions are associated with pheochromocytomas? |
VHL MEN IIa and IIb NF-1 Sturge Weber Tuberous Sclerosis Carney Triad |
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Whats the difference between the Carney Triad and the Carney Complex? |
Carney Triad: Extra-adrenal pheo, GIST, pulmonary chondroma
Carney Complex: Cardiac myxoma, skin pigmentation |
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Common mets to adrenal gland? |
Lung, breast, melanoma |
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What are the adrenal washout equations? |
Absolute: E-D ----- x 100 >60% is Adenoma E-U
Relative: E-D ----- x 100 >40% is Adenoma E |
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Bilateral enlarged calcified adrenal glands with hepatosplenomegaly? |
Wolman Disease |
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MEN? Pituitary adenoma, parathyroid hyperplasia, pancreas (gastrinoma) |
MEN I (PiParPanc) |
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MEN? Medullary thyroid cancer, parathyroid hyperplasia, pheochromocytoma |
MEN IIa (PMP) |
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MEN? Medullary thyroid cancer, marfanoid habitus/mucosal neuroma, pheochromocytoma |
MEN IIb (PMMM) |
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Carcinoid syndrome implies mets to where? |
Liver |
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What type of thyroid cancer contains microcalcifications? |
Papillary |
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Enhancing nodule in a thyroglossal duct cyst? |
Papillary thyroid cancer |
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Most common location for ectopic thyroid tissue? |
Lingual thyroid |
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Most common cause of hyperthyroidism and goiter? |
Graves (autoimmune disease, antibody against TSH receptor) |
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Increased uptake of I-123 with %RAIU 50-80%? |
Graves |
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Most common cause of hypothyroidism and goiter? |
Hasimotos |
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Woman with a painful thyroid gland after an upper respiratory infection? |
Subacute thyroiditis |
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%RAIU during acute phase of subacute thyroiditis? |
Low |
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What are the IgG4 associated diseases? |
Reidels thyroiditis Orbital pseudotumor Retroperitoneal fibrosis Sclerosing cholangitis |
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Where could the infection have started in a child that has acute suppurative thyroiditis? |
4th brachial cleft anomaly via a pyriform fistula |
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Comet artifact on thyroid US? |
Colloid nodule |
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Type of thyroid cancer that produces calcitonin? |
Medullary |
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What types of thyroid cancer do NOT respond to I-131? |
Medullary, Anaplastic and Hurthle cell |
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What types of thyroid cancer respond well to I-131? |
Papillary and Follicular |
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What is the classic pattern of thyroid cancer mets to the lungs? |
Miliary |
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Risk of treating metastatic thyroid cancer to the lung with I-131? |
Pulmonary fibrosis |
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What factors does sestamibi parathyroid imaging depend on? |
Mitochondrial density and blood flow |
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What is the cumulus oophorus? |
Collection of cells in a mature dominant follicle, signals imminent ovulation |
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Ovary with multilocular "spoke-wheel" appearance? |
Theca lutein cysts, related to overstimulation by bHCG.
1. Multifetal pregnancy 2. Molar pregnancy 3. Ovarian hyperstimulation syndrome |
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Patient with theca lutein cysts, ascites, and pleural effusions? |
Ovarian hyperstimulation syndrome |
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Best time to perform a PET scan on a woman in regards to menstrual cycle? |
First 7-10 days of the cycle |
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Size cutoff of a postmenopausal woman with ovarian cyst who needs further workup? |
7cm needs MRI or surgical evaluation |
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Round mass with homogenous low-level echoes and increased through transmission? (Uterus) |
Endometrioma |
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Risk factor for an endometrioma for turning into a cancer? |
1. Size > 6-9cm 2. Age > 45 years old |
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How to differentiate between an endometrioma and a hemorrhagic cyst? |
Re-image in 1-2 menstrual cycles, the cyst will get smaller or go away |
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Most likely diagnosis for a large, simple-appearing, unilocular cyst in a postmenopausal woman |
Serous ovarian cystadenoma |
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Psuedomyxoma peritonei comes from what? |
Ruptured mucinous tumors: 1. Appendiceal mucinous adenocarcinoma 2. Mucinous ovarian cystadenocarcinoma |
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What is Meigs syndrome? |
Pleural effusion, ascites and benign ovarian tumor (usually fibroma) |
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What is a Krukenberg tumor? |
Mets to the ovary that secrete mucin, usually from GI source |
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Benign ovarian tumor with calcification? |
Brenner tumor |
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Osteochondrosis of the tarsal navicular? |
Kohler |
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Osteochondrosis of the 2nd metatarsal head? |
Freiberg infraction |
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Most common carpal coalition? |
Lunotriquetral |
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Management for simple adnexal cyst >5 and <7cm? |
Almost certainly benign, annual follow up ultrasound |
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Management for simple adnexal cyst >7cm? |
Not definitively benign, MRI or surgical consult follow up |