This document appears to be a series of questions and answers from a diagnostic radiology in-training examination. The questions cover topics in genitourinary tract radiology and ask examinees to identify diagnoses, classifications, or characteristics based on provided radiographic images and clinical scenarios. Rationales are given for each answer that provide additional radiologic and clinical details.
Squamous Cell Carcinoma in the Native Kidney of a Renal Transplant Recipient ...Apollo Hospitals
We are reporting a case of squamous cell carcinoma of the native kidney in a renal transplant recipient. A 54-year-old gentleman, a renal transplant recipient for three years, presented with flank pain. On evaluation he was found to have a mass in the upper pole of the left native kidney. Renal angiogram was done which showed a functioning trans-
planted kidney with a large mass arising from the upper pole of the left native kidney. He underwent nephrectomy. The histopathology reported a squamous cell carcinoma. He was given adjuvant radiotherapy to the tumor bed using image guided radiotherapy thereby delivering a differential dose to the high risk areas and preserving the surrounding normal structures. He developed a urethral nodule which was found to be a squamous cell carcinoma. The lesion was excised with clear margins. We present this case because it is rare and to discuss adjuvant management.
Squamous Cell Carcinoma in the Native Kidney of a Renal Transplant Recipient ...Apollo Hospitals
We are reporting a case of squamous cell carcinoma of the native kidney in a renal transplant recipient. A 54-year-old gentleman, a renal transplant recipient for three years, presented with flank pain. On evaluation he was found to have a mass in the upper pole of the left native kidney. Renal angiogram was done which showed a functioning trans-
planted kidney with a large mass arising from the upper pole of the left native kidney. He underwent nephrectomy. The histopathology reported a squamous cell carcinoma. He was given adjuvant radiotherapy to the tumor bed using image guided radiotherapy thereby delivering a differential dose to the high risk areas and preserving the surrounding normal structures. He developed a urethral nodule which was found to be a squamous cell carcinoma. The lesion was excised with clear margins. We present this case because it is rare and to discuss adjuvant management.
"5 Things in 5 Minutes" Series No.4 - "Mr. Banker, 5-Reasons Why the Bank Nee...Arun Cavale Cavale
Traditionally, Banks have feared Cloud, partly due to regulatory reasons, partly due to data security and other reasons. However, as some pioneering banks around the world have shown, there is a way. And as are increasingly discovering, Cloud will not be an option, but an imperative for Banks.
What's driving this? For starters, the changing systems of engagement with customers. Yes, as banking customers, particularly, retail banking customers, start demanding that their banks are available to them 24x7, across a multitude of channels, "on demand" - banks are driven to engage using new channels: mobile, social media. This introduction to the API-engagement models is driving entirely new workloads for the Banks' infrastructure. Cloud is the only way they can cope with this new engagement model.
In this short 5-minute deck, I present 5 reasons why Banks need cloud today.
Welcome To Jackson Systems, Zone Control Made SimpleThomas Jackson
This is a short introduction to Jackson Systems. We manufacturer and distribute controls for the HVAC industry. We specialize in forced air zone control, thermostats and commercial controls.
Abdomen and liver case presentations with Question & answersKurian Joseph
Abdomen and liver case with Question & answers
Chronic decompensated parenchymal liver disease - cirrhosis with portal hypertension probably of alcoholic etiology with no ascites with no features of hepatic encephalopathy and coagulopathy
To rule out malignancy
Choledochal cysts should be considered in the differential diagnosis in all patients with a history of biliary colic, recurrent cholangitis or pancreatitis with associated dilatation of bile duct, particularly if they are <40 years of age. Delay in the diagnosis increases the incidence of associated biliary pathology and suboptimal surgical therapy
A brief anatomical, embryological, patho-physiological and surgical description of the Vermiform Appendix.
Surface Anatomy of Appendix, Appendicectomy, surgical approach, complications, Appendicular lump and abscess, Neoplasia, Carcinoid syndrome, Pseudomyxoma Peritonei, The Alvarado Score
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
23204961
1. 28th Annual
In-Training Examination
for Diagnostic
Radiology Residents
Rationales
Sponsored by:
Commission on Education
Committee on Residency Training in Diagnostic Radiology
February 3, 2005
The American College of Radiology www.acr.org
2. Section VII – Genitourinary Tract Radiology
Figure 1A
Figure 1B
American College of Radiology
3. Section VII – Genitourinary Tract Radiology
170. You are shown a contrast enhanced CT (Figures 1A and 1B) of a 65-year-old woman with diabetes
and intermittent fevers. What is the MOST likely diagnosis?
A. Acute pyelonephritis
B. Xanthogranulomatous pyelonephritis
C. Acute left ureteral obstruction
D. Multilocular cystic nephroma
Question #170
Findings:
Images demonstrate left cortical thinning, dilated collecting system, infiltration of the fat adjacent to the left
kidney, and calcifications in the left renal collecting system.
Rationales:
A. Incorrect. In early acute pyelonephritis, the kidney may actually appear within normal limits on CT,
particularly on noncontrast scanning, but in more advanced cases, after intravenous contrast may
demonstrate striated nephrogram or focal wedge-like areas of abnormally decreased enhancement. Although
the infiltration of fat seen around the kidney in this case could be seen with acute pyelonephritis, the
obstructing stone, cortical thinning, and dilated, fluid-filled collecting system suggests a more chronically
obstructed, infected system.
B. Correct. Xanthogranulomatous pyelonephritis is a chronic suppurative granulomatous infection in the
setting of chronic obstruction. Common organisms are Proteus mirabilis and E Coli. Histologically there
is diffuse infiltration by plasma cells and lipid-laden macrophages. Symptoms are generally of long duration,
and the affected kidney is nonfunctioning. The kidney is diffusely enlarged, but maintains its reniform
shape, with one or more relatively large calculi typically seen. The renal pelvis is typically poorly defined
or normal in size, as in this case.
C. Incorrect. While acute obstruction could result in hydronephrosis and perinephric stranding, it would not
account for the cortical thinning seen here, and with acute obstruction, one would expect to see dilatation
of the renal pelvis.
D. Incorrect. Multilocular cystic nephroma is an uncommon renal neoplasm containing many cysts of varying
sizes, surrounded by a thick fibrous capsule. Calcifications may rarely be seen, but are usually only in the
cyst walls or intervening stroma. It would not account for the significant infiltration of the adjacent
perinephric fat seen in this case.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Diagnostic In-Training Exam 2005
4. Section VII – Genitourinary Tract Radiology
Figure 2A
Figure 2B
American College of Radiology
5. Section VII – Genitourinary Tract Radiology
171. You are shown an axial image (Figure 2A) and a coronal reconstructed image (Figure 2B) from an
abdominal CT of a 25-year-old African American man with sickle cell trait, flank pain and
hematuria. What is the MOST likely diagnosis?
A. Non-Hodgkin’s lymphoma
B. Angiomyolipoma
C. Renal medullary carcinoma
D. Transitional cell carcinoma
Question #171
Findings:
A large infiltrative mass is present in the right kidney with extension of mass into the renal pelvic fat, the right
renal vein and IVC. There is also retroperitoneal lymphadenopathy and splenomegaly.
Rationales:
A. Incorrect. Non-Hodgkin’s lymphoma can involve the kidney but is seen on presentation in only 5.8% of
cases. Although it can involve the kidney as a single mass, renal lymphoma most commonly presents as
multiple lymphomatous masses.
Additionally, renal vein and IVC invasion would be distinctly unusual for lymphoma.
B. Incorrect. Angiomyolipoma is a benign tumor of the kidney that is characterized by regions of macroscopic
fat (seen in 95% of cases). No areas of fat density are seen in the images provided with this case.
Additionally, renal vein and IVC invasion and lymphadenopathy would not be a characteristic of this
benign tumor.
C. Correct. Renal medullary carcinoma is an unusual tumor that almost always occurs in young patients with
sickle cell trait. No cases have been reported in patients with sickle cell disease. The tumor arises from the
calyceal epithelium and grows in an infiltrative pattern. It is a very aggressive tumor with early metastases to
lymph nodes and vascular invasion.
D. Incorrect. Transitional cell carcinoma can fill the renal pelvis and diffusely infiltrate the kidney as in this
case. However, transitional cell carcinomas typically affect older individuals and would be rare to affect
someone of this age. Also, transitional cell carcinomas would not demonstrate vascular invasion as in this
case.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Lowe LH, Isuani BH, Heller RM, et al. Pediatric renal masses: Wilms tumor and beyond. Radiographics.
2000;20:1585-1603.
Diagnostic In-Training Exam 2005
6. Section VII – Genitourinary Tract Radiology
Figure 3
172. You are shown an abdominal CT image of a 39-year-old woman (Figure 3). What is the MOST
likely diagnosis?
A. Adenoma
B. Lymphangioma
C. Metastasis
D. Myelolipoma
American College of Radiology
7. Section VII – Genitourinary Tract Radiology
Question #172
Findings:
Left adrenal mass containing gross fat and a small amount of coarse calcium.
Rationales:
A. Incorrect. Adenomas rarely calcify. Although 80% do contain fat, it is intracytoplasmic, and is usually not
grossly fatty as in this case.
B. Incorrect.Lymphangioma should be water density and not fatty.
C. Incorrect. The adrenal glands are a common site of metastatic disease, but adrenal metastases are typically
soft tissue density. Larger metastases to the adrenals may have central necrosis or areas of hemorrhage, but
would not have a fatty component.
D. Correct. Myelolipomas are uncommon benign tumors of the adrenal gland comprised of mature adipose
cells and hematopoietic tissue. They are functionally inactive and usually are detected as incidental
findings. A grossly fatty adrenal mass is virtually diagnostic of a myelolipoma.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Diagnostic In-Training Exam 2005
8. Section VII – Genitourinary Tract Radiology
Figure 4
173. You are shown an image from a hysterosalpingogram (Figure 4) of a 34-year-old woman with
infertility. Which one of the following is the MOST likely diagnosis?
A. Salpingitis isthmica nodosa
B. Adhesions of fallopian tube
C. Hydrosalpinx
D. Contrast intravasation
American College of Radiology
9. Section VII – Genitourinary Tract Radiology
Question #173
Rationales:
A. Incorrect. Salpingitis isthmica nodosa involves the isthmic portion of the fallopian tube. Hysterosalpingogram
will reveal small outpouchings of contrast outside the expected lumen of the tube. It is seen in 4% of infertility
cases. It indicates scarring and is associated with an increased incidence of ectopic pregnancy.
B. Incorrect. Adhesions or clumping of a fallopian tube cause convolution of the tube but not the appearance
of multiple serpentine structures in the expected location of the isthmic portion of the tube.
C. Incorrect. A hydrosalpinx is a dilated, fluid-filled fallopian tube. Usually the ampullary portion of the tube
is dilated. The fallopian tube may or may not be obstructed.
D. Correct. Contrast intravasation into the uterine wall causes multiple serpentine venous structures to fill
adjacent to the uterus. The contrast-filled veins often mimic the appearance of the fallopian tube. Often
venous intravasation occurs when the fallopian tube is blocked, as in this case. Confirmation occurs after
waiting 2-3 minutes, in which time the contrast dissipates from the veins. Contrast in a fallopian tube would
not change in density in that time. Unfortunately, once venous intravasation occurs, further attempts to
visualize the tube are futile since the intravasation usually occurs again with the next immediate injection.
Citations:
Ubeda B, Paraira M, Alert E, Abuin RA. Hysterosalpingography: Spectrum of normal variants and nonpathologic
findings. AJR 2001;177:131-135.
Diagnostic In-Training Exam 2005
10. Section VII – Genitourinary Tract Radiology
Figure 5A
Figure 5B
American College of Radiology
11. Section VII – Genitourinary Tract Radiology
174. You are shown images from an IVU (Figure 5A) and a CT (Figure 5B) of a 35-year-old woman with
frequent urinary tract infections. Which one of the following is the MOST likely diagnosis?
A. Focal renal infarct with scar
B. Focal acute pyelonephritis
C. Obstructive uropathy
D. Reflux nephropathy
Question #174
Findings:
IVU demonstrates complete duplication of both the right and left collecting systems. There is dilatation of
both lower pole-collecting systems, right more than left. The right lower pole calyces are blunted. The CT
image demonstrates cortical thinning of the lower pole of the right kidney overlying a dilated calyx that shows
a contrast-urine level confirming it is a dilated calyx. The combination of cortical scarring overlying a dilated
calyx is typical of reflux nephropathy.
Rationales:
A. Incorrect. A focal renal infarct may produce a cortical scar in the chronic stage, but generally there is not
underlying calyceal dilatation.
B. Incorrect. Focal, acute pyelonephritis can produce a region of decreased enhancement or low density in the
kidney after IV contrast. However, the focal inflammatory process should not demonstrate a cystic nature
that was seen on this exam as confirmed by the fluid-contrast level.
C. Incorrect. Ureteral obstruction could produce similar findings of cortical atrophy and dilated collecting
system. However, in cases with completely duplicated collecting systems, the lower pole moiety more
commonly is complicated by reflux than by obstruction. Also, the focal cortical thinning over the calyces
(as opposed to dilated system with generalized cortical thinning) favors reflux.
D. Correct. Completely duplicated collecting systems often have renal complications associated with the
ureteral duplication. The ureter draining the lower pole moiety typically enters the bladder slightly above
and more lateral to the normal position on the trigone and this predisposes that ureter to reflux. The upper
pole moiety enters the bladder inferiorly and medially (Meyer-Weigert Law) and can be complicated by
obstruction. The upper pole moiety ureter can also insert ectopically outside of the bladder and this is also
typically associated with obstruction.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Diagnostic In-Training Exam 2005
12. Section VII – Genitourinary Tract Radiology
175. Which one of the following BEST characterizes an adrenal lesion as a benign adenoma?
A. Attenuation less than 10 HU on non-contrast CT
B. Enhancement washout less than 50% on delayed contrast-enhanced CT
C. Increase in signal on out-of-phase images using chemical shift MRI technique
D. Attenuation greater than 50 HU on delayed contrast-enhanced CT
Question #175
Rationales:
A. Correct. Approximately 80% of benign adrenal adenomas contain adequate intracellular lipid to give HU
less than 10 on noncontrast CT. This is generally accepted as definitive evidence of benignity.
B. Incorrect. A small percentage of benign adenomas do not have adequate intracellular lipid to give attenuation
values less than 10 on noncontrast CT. In these cases, intravenous contrast can be given and washout
characteristics studied. Metastases tend to “hold” onto contrast longer than benign adrenal adenomas.
Thus, adenomas have greater enhancement washout {[(E-D)/(E-U)]x100}, where E is enhanced attenuation
value, D is delayed enhancement value, and U is the unenhanced attenuation value, and the accepted
threshold value for a benign adrenal adenoma is greater than 60% washout. Washout less than 60% would
be indeterminate and other lesions such as metastases would have to be considered. If unenhanced CT has
not been performed, a relative enhancement washout can be calculated {[(E-D)/E]x100}, and greater than
40%-50% indicates benign adenoma.
C. Incorrect. Chemical shift MRI imaging uses the same physiological principles as noncontrast CT in
evaluating an adrenal nodule. Intracytoplasmic lipid in a benign adenoma results in cancellation or loss
of signal on out-of-phase images rather than no change or increase in signal intensity.
D. Incorrect. Attenuation values of 30-40 HU or less on delayed, contrast-enhanced CT images almost always
indicate a benign adenoma. An attenuation value of greater than 50 HU would be indeterminate.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Dunnick NR, Korobkin M. Imaging of adrenal incidentalomas: Current status. AJR. 2002:179.
American College of Radiology
13. Section VII – Genitourinary Tract Radiology
176. What is the classification of a renal cyst with complex septations and dense calcification?
A. Bosniak I
B. Bosniak II
C. Bosniak III
D. Bosniak IV
Question #176
Rationales:
A. Incorrect. Bosniak I cysts are simple cysts and have no septations or calcifications. These require no further
evaluation.
B. Incorrect. Bosniak II cysts have some atypical features, but are most likely benign. This group of cysts can
have thin septations or calcifications but not complex septations or dense calcifications. Some lesions in
this group are followed (subgroup IIF). Hyperdense, nonenhancing cysts are included in the Bosniak II
category.
C. Correct. Bosniak III cysts can have dense calcifications, complex septations, and multiloculated cysts. This
group cannot be distinguished from malignancy, and often these lesions require surgical exploration.
D. Incorrect. Bosniak IV cystic masses have features which strongly suggest malignancy, such as an enhancing
solid component or thick irregular walls. Lesions in this category are treated as presumed renal carcinomas.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Diagnostic In-Training Exam 2005
14. Section VII – Genitourinary Tract Radiology
177. Concerning congenital ureteropelvic junction (UPJ) obstruction, which one of the following is
TRUE?
A. It is an uncommon cause of hydronephrosis in children.
B. Urinary tract infection is the most common presentation.
C. Females and males are affected equally.
D. The presence of crossing vessels decreases the success rate of pyeloplasty.
Question #177
Rationales:
A. Incorrect. It is the MOST common cause of hydronephrosis in children.
B. Incorrect. UPJ obstruction is being discovered increasingly in the prenatal period due to frequent use of
obstetric ultrasound. When detected due to symptoms or signs, congenital ureteropelvic junction obstruction
most often presents in infancy or childhood with an abdominal mass, flank or abdominal pain, failure to
thrive, or nonspecific gastrointestinal complaints. Infection, hypertension, hematuria, and stone formation
less commonly are the cause for the child to come to medical attention. In a significant number of cases, the
disorder is clinically silent into adulthood, when hematuria, flank pain, fever, or rarely, hypertension, are the
presenting clinical symptoms. Pain in adults is often episodic and in some cases may only present by high
urine flow rates such as those produced by beer drinking.
C. Incorrect. Males are affected more than females by 2:1.
D. Correct. Crossing vessels are seen in only 15%-20% of cases but significantly reduce the success of
pyeloplasty. Thus, many advocate the use of CT for preoperative planning.
Citations:
Davidson AJ, Hartman DS, eds. Radiology of the Kidney and Urinary Tract. Philadelphia, PA: W.B. Saunders,
1984.
Herts BR. Helical CT and CT angiography for the identification of crossing vessels at the ureteropelvic junction.
Urol Clin North Am. 1998;25(2):259-269.
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
American College of Radiology
15. Section VII – Genitourinary Tract Radiology
178. Regarding intravaginal testicular torsion, which one of the following is TRUE?
A. Color Doppler is more sensitive than power Doppler for detecting flow.
B. It is associated with an abnormal mesenteric attachment bilaterally.
C. It accounts for 70 % of cases of acute scrotal pain in adolescents.
D. Symmetric homogeneous echogenicity of the testes excludes the diagnosis.
Question #178
Rationales:
A. Incorrect. Power Doppler is more sensitive than color Doppler for detecting flow, especially in neonates
and young boys. Power Doppler shows superiority in demonstrating intratesticular vessels. Power Doppler
is limited somewhat by being more sensitive to patient motion than color Doppler.
B. Correct. Cases of intravaginal torsion are caused by a bell-clapper deformity of attachment of the
mesentery to the testis. The abnormality is bilateral in nearly all cases.
C. Incorrect. Testicular torsion only accounts for 30% of cases of scrotal pain in boys age 12-18. Epididymo-
orchitis or torsion of an appendix testis/epididymis are much more common causes of scrotal pain.
D. Incorrect. In early torsion (when most critical to detect torsion to permit salvaging the testicle), testes may
have normally preserved gray-scale appearance. Later gray-scale ultrasound may demonstrate decreased
echogenicity of the testis, testicular swelling or reactive hydrocele. Early on, the sonographic diagnosis of
testicular torsion relies on the demonstration of decreased or absent flow in the torsed testis on color or
power Doppler.
Citations:
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology. 2003;227(1):18-36.
Diagnostic In-Training Exam 2005
16. Section VII – Genitourinary Tract Radiology
179. Concerning blunt trauma to the bladder, which one of the following is TRUE?
A. Intraperitoneal rupture accounts for the majority of cases.
B. Less than 20% of extraperitoneal ruptures have pelvic fractures.
C. Intraperitoneal rupture is typically treated with surgical repair.
D. CT with intravenous contrast can exclude major bladder injury.
Question #179
Rationales:
A. Incorrect. Extraperitoneal bladder ruptures account for 80%-90% of major bladder injuries.
Intraperitoneal ruptures account for 10%-20% of major bladder injuries.
B. Incorrect. Extraperitoneal bladder ruptures are almost always associated with pelvic fractures and
many are thought to be due to bladder laceration by the fracture fragments. (Although other causes of
extraperitoneal bladder injury have also been suggested, such as stress applied to the puboprostatic
ligaments causing the bladder wall to tear.)
C. Correct. Intraperitoneal bladder rupture is typically treated with surgical repair of the tear and diverting
vesicostomy.
D. Incorrect. Even delayed images of the bladder with CT and intravenous contrast are not adequate to
exclude major bladder injury. This is because there is inadequate distension of the bladder. At least 300 ml
of fluid is required to adequately distend the bladder and evaluate for extravasation.
Citations:
Dunnick NR, Sandler CM, Newhouse JH, Amis Jr SE. Textbook of Uroradiology. 3rd ed. Philadelphia, PA:
Lippincott, Williams, & Wilkins; 2001.
Vaccaro JP, Brody JM. CT cystography in the evaluation of major bladder trauma. Radiographics.
2000;20:1373-1381.
American College of Radiology