Question Bank – Renal (Basic)

The article published in the New England Journal of Medicine in 2014 by Smith-Bindman et al. titled Ultrasonography vs. Computed Tomography for suspected nephrolithiasis drew which conclusion?

To obtain a long axis view of the kidney shown in the image below, which way do you direct the probe?

A 45 year old male presents with acute onset of L flank pain and hematuria.

What finding is present below?

What troubleshooting technique is helpful to better visualize the left kidney?

A 63 year old female presents with a history of chronic low back pain, weight loss, and constipation. Despite being post-menopausal, she continues to occasionally have vaginal bleeding. Her urinalysis shows no hematuria or other signs of infection.

You perform a bedside ultrasound and see the following:

What would be your next step in management?

In the paper titled “Radiological Imaging of Patients with Suspected Urinary Tract Stones: National Trends, Diagnoses, and Predictors” by Westphalen et al., what did these authors conclude?

A 23 year old male with a history of chronic pain presents with left flank pain.  His ultrasound of the left kidney shows the following:

What conclusion can be drawn?

It can be difficult to distinguish mild hydronephrosis.  One of the pitfalls for diagnosing mild hydronephrosis is demonstrated in the image below.

What pitfall is present?

A bedside renal ultrasound was performed in a patient with acute flank pain and hematuria. This was the initial ultrasound.

The ultrasound was repeated 1 hour later and showed the following:

What treatment did the patient receive in the interim that led to this finding?

While the presence of hydronephrosis in a patient with a high clinical suspicion for obstructing kidney stone can decrease the need for unnecessary CT scans, which of the following are indications to obtain a CT of the abdomen/pelvis in a patient with a clinical presentation consistent with obstructing kidney stones?

A 75 year old male with a history of hypertension, COPD, tobacco smoking presents with acute onset of abdominal pain radiating to the back. His BP is 200/110 and his HR is 98. His urinalysis is negative for hematuria, WBC, leukocytes, and nitrites.

His renal ultrasound shows the following:

Given his age, you decide to scan his abdomen and see the following:

What is the patient’s diagnosis?

True or False.  Findings of moderate/severe hydronephrosis increases the specificity for the diagnosis of nephrolithiasis compared to no hydronephrosis.

A 30 year male with acute L flank pain radiating to the groin and hematuria presents to your clinic. Which probe do you select to scan the kidney and why?

A 35 year old male with acute onset of L flank pain radiating to the groin presents to your office. He has had multiple CT scans in the past which have shown ureteral stones. He has never had urological interventions as the stones have always passed on their own. He denies any fevers & chills. You perform a bedside ultrasound which shows the following image. What finding is present?

You perform an ultrasound of the right kidney and visualize hypoechoic area in the renal pelvis.  You suspect the presence of hydronephrosis.

For confirmation, you use color mode and see the following image.

What do these findings suggest?

What structure is highlighted in the image below?

What structure is highlighted in the picture below?

What finding is highlighted in the image below?

What finding is highlighted in the image below?

A 23 year old female with acute onset of left flank pain radiating to the groin presents to clinic.  She has urinalysis with red blood cells.  You perform the ultrasound which shows the image below.

What finding is highlighted in the image below?

A 23 year old male presents to the emergency department with left flank pain.  He has a long history of chronic pain.  He is complaining of pain mostly in his back.  His urinalysis shows no signs of acute infection or hematuria.

A bedside ultrasound of the left kidney shows the following findings.

What conclusion can you draw of the left kidney?

A 65 year old female with a history of hypertension and diabetes presents with flank pain, weight loss, and hematuria. Her vital signs are within normal limits.  Her WBC, creatinine, platelets and hemoglobin are normal.

Her bedside ultrasound shows the following finding of the let kidney.

What is an appropriate next step in management?

A 45 year old female presents with acute flank pain radiating to the groin and hematuria and you suspect an acute ureteral obstruction from a kidney stone.

Which of the following are indications for obtaining further imaging such as a CT scan?

A 35 year old female presents with right flank pain radiating to the groin, nausea, vomiting and hematuria. Your history and physical exam is suspicious for an obstructing kidney stone. Her vitals are within normal limits. She has no tenderness in the RLQ or RUQ. Her gallbladder ultrasound shows no signs of stones or sonographic Murphy’s sign. Her WBC count, CRP, Hg, PLT, Renal Function are all normal. Her urinalysis shows no signs of infection.

Her right and left kidney ultrasound show the following:

What is an appropriate next step in management?

A 63 yo male presents with difficulty urinating, lower abdominal fullness, and pain.  His creatinine is elevated from 0.7 to 3.5.

A bedside ultrasound of his bladder following a void trial shows the following:

What is the more likely diagnosis and what is the most appropriate treatment?

The following clip shows:

The following clip shows an example of the ___ sign, often a sign of a ___

The following clip shows a sign suggestive of a stone at the ___ UVJ.   

The following clip shows a sign suggestive of a stone at the ___ UVJ.

The following clip shows an example of a ___

The following bladder measurement estimates a bladder volume of ___

Pregnancy most commonly results in physiologic hydronephrosis of the ___ kidney. 

The following clip shows ___

 The following image shows (check all that apply) ___

The following clip shows ___(select all that apply)

The following renal ultrasound demonstrates: