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Ch 14 - Bontrager
Urinary System
| Question | Answer |
|---|---|
| The kidneys and ureters are located in the _____ space. A) Intraperitoneal B) Infraperitoneal C) Extraperitoneal D) Retroperitoneal | D) Retroperitoneal |
| The _____ glands are located directly superior to the kidneys. | suprarenal gland (adrenal) |
| Which structures create a 20' angle between the upper pole and lower pole of the kidney? | Psoas major muscles |
| What is the specific name for the mass of fat surrounding each kidney? | Perirenal fat (adipose capsule) |
| What degree of rotation from supine is required to place the kidneys parallel to the IR? | 30' |
| Which two landmarks can be palpated to locate the kidneys? | Xiphoid process and iliac crest |
| Which term describes an abnormal drop of the kidneys when the patient is placed erect? | nephroptosis |
| List the three functions of the urinary system. | 1) remove nitrogenous waste 2) regulate water levels in the body 3) regulate acid/base balance and electrolyte levels of blood |
| A buildup of nitrogenous waste in the blood is called: A) hemotoxicity B) Uremia C) Sepsis D) Renotoxicity | B) Uremia |
| The longitudinal fissure found along the central medial border of the kidney is called _____. | Hilum |
| The peripheral or outer portion of the kidney is called the _____. | Cortex |
| The term that describes the total functioning portion of the kidney is _____. | renal parenchyma |
| The microscopic functional and structural unit of the kidney is _____. | nephron |
| TRUE/FALSE The efferent arterioles carry blood to the glomeruli. | FALSE (afferent) |
| What is another (older) name for the glomerular capsule? | Bowman capsule |
| TRUE/FALSE The glomerular capsule and proximal and distal convoluted tubules are located in the medulla of the kidney. | FALSE (located in the cortex) |
| Which structure of the medulla is made of a collection of tubules that drain into the minor calyx? | Renal pyramids |
| Which two processes move urine through the ureters to the bladder? | 1) Gravity 2) peristalsis |
| Which of the following structures is located most anterior as compared with the others? A) Proximal ureters B) kidneys C) Urinary bladder D) Suprarenal glands | C) Urinary bladder |
| What is the name of the junction found between the distal ureters and urinary bladder? | Ureterovesical junction |
| What is the name of the inner, posterior region of the bladder formed by the two ureters entering and the urethra exiting? | Trigone |
| What is the name of the small gland found just inferior to the male bladder? | Prostate |
| the total capacity of the average adult bladder is _____. | 350-500 mL |
| which of the following structures is considered most posterior? A) Ovaries B) Urethra C) Vagina D) Kidneys | D) Kidneys |
| Intravenous contrast media may be administered either by: _____ or _____ | Bolus injection or Drip infusion |
| TRUE/FALSE The patient (or legal guardian) must sign and informed consent form before a venipuncture procedure. | TRUE |
| For most IVUs, veins in the _____ are recommended for venipuncture. A) Iliac fossa B) anterior, carpal region C) Axillary fossa D) Antecubital fossa | D) Antecubital fossa |
| The most common size of needle used for bolus injections on adults is _____. A) 23 - 25 gauge B) 14 - 16 gauge C) 18 - 22 gauge D) 28 gauge | C) 18 - 22 gauge |
| The two most common types of needles used for bolus injection of contrast media are _____ and _____. | a) butterfly needle; b) over-the-needle catheter |
| In the correct order, list the 6 steps followed during venipuncture procedure as listed and described in the textbook. | 1.Wash hands and put on gloves 2. Apply tourniquet, select site and cleanse the site 3. Initiate puncture 4. Confirm entry and secure needle 5. Prepare and proceed with injection 6. Needle or catheter removal |
| TRUE/FALSE The bevel of the needle must face downward during the actual puncture into the vein. | FALSE (face up) |
| TRUE/FALSE If extravasation occurs during the initial puncture, a new needle should be used during the second attempt. | FALSE (needle should be withdrawn and pressure applied) |
| TRUE/FALSE If unsuccessful during the initial puncture, a new needle should be used during the second attempt. | TRUE |
| TRUE/FALSE The radiologist is responsible for documenting all aspects of the venipuncture procedure in the patient's chart | FALSE (person performing venipuncture is responsible) |
| Which major type of iodinated contrast media used for urography uses a parent compund of benzoic acid? | Ionic |
| Which major type of iodinated contrast media used for uregraphy will not significantly increase the osmolality of the blood plasma? | Nonionic |
| Which major type of iodinated contrast media used for urography incorporates sodium or meglumine to increase solubility of contrast media? | Ionic |
| Which major type of iodinated contrast media used for urography creates a hypertonic condition in the blood plasma? | Ionic |
| Which major type of iodinated contrast media used for urography is more expensive? | nonionic |
| Which major type of iodinated contrast media used for urography produces less severe reaction? | nonionic |
| Which major type of iodinated contrast media used for urography is a near-isotonic solution? | nonionic |
| Which major type of iodinated contrast media used for urography poses a greater risk for disrupting homeostasis? | ionic |
| Which major type of iodinated contrast media used for urography uses a parent compound of an amide or glucose group? | nonionic |
| Which major type of iodinated contrast media used for urography may increase the severity of side effects? | ionic |
| What should the technologist do at first when a patient is experiencing either a moderate or severe level contrast media reaction? | Call for medical assistance |
| What is the primary purpose of the premedication procedure before an iodinated contrast procedure? | To reduce the severity of possible contrast reaction |
| Which of the following drugs is often given to the patient as part of the premedication procedure? A) Epinephrine B) Valium C) Combination of benadryl and prednisone D) Lasix | C) Combo of benadryl and prednisone |
| Which type of patient is a likely candidate for premedication procedure before a contrast media study? A) elderly patient B) Asthmatic patient C) pediatric patient D) Patient with hypertension | B) Asthmatic patient |
| In addition to notifying a nurse or physician when contrast media have extravasated into the soft tissues, what should the technologist do first to increase reabsorbtion? | elevate affected anatomy and apply pressure - alternate heat and cold |
| TRUE/FALSE Tissue inflammation from extravasated contrast media peaks 1 - 2 hours after the incident. | FALSE - peaks 24 - 48 hours after |
| TRUE/FALSE Acute renal failure may occur 48 hrs after an iodinated contrast media procedure. | TRUE |
| List 10 contraindications that may prevent a patient from having a contrast media procedure performed: | 1) hypersensitivity to iodine; 2) Anuria; 3) Multiple myeloma; 4) Diabetes; 5) Severe hepatic/renal disease; 6) Congestive heart failure; 7) Pheochromocytoma; 8) Sickle cell anemia; 9) Metformin//glucophage, etc; 10) Renal failure |
| A trademark name for a diuretic drug _____. | Lasix |
| Why is the term IVP incorrect when describing a radiographic exam of kidneys, ureters and bladder after injection of contrast media? | IVP or Intravenous Pyelography - technically refers to the renal pelvises only (pyelo - renal pelvis) The excretory urogram visualizes more anatomy. |
| What is the correct term/abbreviation for radiographic exam of kidneys, ureters and bladder after injection of contrast media? | IVU - Intravenous Excretory Urogram |
| Which specific aspect of the kidney is visualized during an IVU? | The collecting system of the kidney (minor and major calyces, renal pelvis, proximal ureters) |
| Which of the following conditions is a common pathologic indication for an IVU? A) sickle cell anemia B) Multiple myeloma C) Hematuria D) Anuria | C) Hematuria |
| What condition is described as a tumor of the adrenal gland? | Pheochromocytoma |
| Name the urinary pathologic condition passage of a large volume of urine. | Polyuria |
| Name the urinary pathologic condition presence of glucose in urine. | Glucosuria |
| Name the urinary pathologic condition excess urea and creatinine in the blood. | Uremia |
| Name the urinary pathologic condition diminished amount of urine being excreted. | Oliguria |
| Name the urinary pathologic condition presence of gas in urine. | Pneumouria |
| Name the urinary pathologic condition indicated by the presence of uremia, oliguria, or anuria. | Acute renal failure |
| Name the urinary pathologic condition constant or frequent involuntary passage of urine. | Urinary incontinence |
| Name the urinary pathologic condition backward return flow of urine. | Urinary reflux |
| Name the urinary pathologic condition absence of functioning kidney. | Renal agenesis |
| Name the urinary pathologic condition complete cessation of urinary secretion. | Anuria |
| Name the urinary pathologic condition act of voiding. | Micturition |
| Name the urinary pathologic condition inability to void. | retention |
| Name the urinary disorder enlargement of the prostate. | Benign prostatic hyperplasia |
| Name the urinary disorder fusion of the lower poles of the kidneys during the development of the fetus. | Horseshoe kidney |
| Name the urinary disorder inflammation of the capillary loops of the glomeruli of the kidneys. | Glomerulonephritis |
| Name the urinary disorder artificial opening between urinary bladder and aspects of large intestine. | vesicorectal fistula |
| Name the urinary disorder a large stone that grows and completely fills the renal pelvis. | Staghorn calculus |
| Name the urinary disorder increased blood pressure to the kidneys resulting from atherosclerosis. | Renal hypertension |
| Name the urinary disorder normal kidney that fails to ascend into the abdomen but remains in the pelvis. | ectopic kidney |
| Name the urinary disorder multiple cysts in one or both kidneys. | Polycystic kidney disease |
| Describe the radiographic appearance of malrotation. | abnormal rotation of kidney |
| Describe the radiographic appearance of vesicorectal fistula. | signs of abnormal fluid collections |
| Describe the radiographic appearance of renal cell carcinoma. | irregular appearance of renal parenchyma or collecting system |
| Describe the radiographic appearance of BPH. | Elevated or indented floor of bladder |
| Describe the radiographic appearance of renal hypertension. | rapid excretion of contrast media |
| Describe the radiographic appearance of renal calculi. | signs of obstruction of urinary system |
| Describe the radiographic appearance of cystitis. | mucosal changes within bladder |
| Describe the radiographic appearance of Chronic Bright Disease. | Nephritis - bilateral, small kidneys with blunted calyces |
| A condition characterized by regions or areas of subcutaneous swelling caused by an allergic reaction to food or drugs is termed _____. | angioedema |
| Contraction of muscles within the walls of the bronchi and bronchioles, producing a restriction of air passing through them is a condition called _____. | bronchospasm |
| Loss of consciousness resulting from reduced cerebral blood flow is termed _____ | syncope |
| An eruption of wheals (hives), often caused by a hypersensitivity to food or drugs, is a condition called _____. | Urticaria |
| What type of renal calculi is often associated with chronic urinary tract infections? | Staghorn calculi |
| TRUE/FALSE The patient should void before an IVU to prevent possible rupture of the bladder if compression is applied. | TRUE |
| What is the primary purpose of ureteric compression? | To enhance filling of renal pelvic-calyceal system and proximal ureters with contrast media |
| List six conditions that contraindicate use of ureteric compression. | 1) possible ureteric stones 2) abdominal mass 3) abdominal aortic aneurysm 4) recent abdominal surgery 5) severe abdominal pain 6) acute abdominal trauma |
| When does timing for an IVU exam start? | At the start of the injection of contrast media |
| List the routine five step imaging sequence for a routine IVU: | 1) 1 min nephrotomogram 2) 5 min full KUB 3) 10-15 min full KUB 4) 20 min posterior R/L obliques 5) Postvoid (PA prone or erect AP) |
| What is the primary difference between a standard and hypertensive IVU? | hypertensive IVU requires a shorter time span between projections |
| In which department are most retrograde urograms performed? | Surgery (in-patient or out-patient) |
| TRUE/FALSE A retrograde urogram examines the anatomy and function of the pelvicaliceal system. | FALSE (non functional exam) |
| TRUE/FALSE A Brodney clamp is used for male and female retrograde cystourethrograms. | FALSE (used for males only) |
| Which of the following involves a direct introduction of the contrast media into the structure being studied? A) retrograde urogram B) retrograde cystogram C) retrograde urethrogram D) all of the above | D) all of the above |
| Which of the following alternative imaging modalities is not routinely used to diagnose renal calculi? A) nuclear medicine B) sonography C) magnetic resonance imaging D) CT | C) MRI |
| TRUE/FALSE Urinary studies on pediatric patients should be scheduled early in the morning to minimize the risk for dehydration. | TRUE |
| TRUE/FALSE The number of retrograde urography procedures for urethral calculi has been reduced as a result of the increased use of CT. | TRUE |
| Exposure factors used during CT procedure can be adjusted to compensate for a decrease or increase in body size according to _____ and _____. | height and weight |
| TRUE/FALSE A patient does not require extensive bowel preparation before a CT scan for renal calculi. | TRUE |
| Which imaging modality is used to detect subtle tissue changes following a renal transplant? A) MRI B) CT C) Radiography - IVU D) nuclear medicine | A) MRI |
| TRUE/FALSE Nuclear Medicine is highly effective in demonstrating signs of vesicorectural reflux. | TRUE |
| How will an enlarged prostate gland appear on a postvoid radiograph taken during an IVU? | the floor of the bladder will appear elevated or indented |
| Where should the pneumatic paddle be placed for a ureteric compression phase of an IVU? | medial to ASIS and lateral to spine (over outer pelvic brim) |
| What can be done to enhance filling of the calyces of the kidney if ureteric compression is contraindicated? | Place patient in 15' Trendelenberg position |
| A retrograde pyelogram is primarily a nonfunctional study of _____. | the renal pelvis, major and minor calyces |
| What are 4 reasons a scout projection is taken before the injection of contrast media for an IVU? | 1) determine acceptable exposure factors 2) verify patient prep 3) Verify positioning 4) Detect any abnormal calcifications |
| What specific anatomy is examined during a retrograde ureterogram? A) primarily the ureters B) Primarily the renal pelvis and calyces C) entire urinary system D) urinary bladder | A) primarily the ureters |
| Which specific position is recommended for a male patient during a voiding cystourethrogram? | 30' RPO |
| What kV range is recommended for IVU? | 80 (+/-5) kV |
| TRUE/FALSE There is a change in SID recommendations when placing a patient erect versus supine for an IVU AP projection. | FALSE (both are recommended at 40") |
| TRUE/FALSE Male and female patients should have the gonads shielded for an AP scout projection. | FALSE (would obscure female pertinent anatomy) |
| TRUE/FALSE Nephrotomograms produced during an IVU most commonly use an exposure angle of less than or equal to 10' | TRUE |
| How many tomograms (focal levels) are usually produced during a routine IVU? | 3 tomograms or focal levels |
| At what stage of IVU is the renal parenchyma best seen? A) 5 min post injection B) 10 min post injection C) after postvoid D) within 1 min post injection | D) within 1 min after injection |
| Where is the CR centered for a nephrotomogram? A) at the xiphoid process B) Midway between the xiphoid process and the iliac crest C) At the iliac crest D) At the axillary costal margin | B) Midway between the xiphoid process and the iliac crest |
| Which specific position, taken during an IVU, places the left kidney parallel to IR? | RPO |
| How much obliquity is required for LPO/RPO projections taken during an IVU? | 30' |
| Which position best demonstrates possible nephroptosis? | Erect |
| What CR angle is used for the AP projection taken during a cystogram? | 10 -15' caudad |
| TRUE/FALSE Contrast media should never be injected into the bladder under pressure but should be allowed to fill slowly by gravity in the presence of an attendant. | TRUE |
| What are the routine projections for IVU? | Excretory Urography - *AP (Scout and series) *nephrotomogram, *RPO/LPO 30', *AP postvoid |
| Describe an AP Scout for IVU. | 14x17; 40" SID; 80-85 kV; CR - perpendicular to IR; center to level of iliac crest and MSP; Patient supine with no rotation; visualize entire urinary system (KUB) including upper border of symphysis pubis |
| Describe nephrotomogram (procedure technique) | 11x14; 40" SID; 80-85 kV; CR - 10' caudal to IR; center midway between xiphoid process and iliac crest and MSP; Patient supine with no rotation; visualize entire renal parenchyma with some filling of collecting system with contrast |
| Describe RPO and LPO for IVU. | 14x17 portrait or 11x14 landscape; 40" SID; 80-85 kV; CR - perpendicular to IR; center to level of iliac crest and MSP; Patient supine with 30' rotation, elevated arm across upper chest; visualize elevated kidney parallel to IR and downside ureter. |
| Describe AP postvoid for IVU. | 14x17; 40" SID; 80-85 kV; CR - perpendicular to IR; center to level of iliac crest and MSP; Patient erect (or prone) with no rotation; visualize entire urinary system (KUB) including upper border of symphysis pubis with only residual contrast visible |
| Describe AP ureteric compression for IVU | 11x14; 40" SID; 80-85 kV; CR - perpendicular to IR; center midway between xiphoid process and iliac crests and MSP; Patient supine w/no rotation, compression device in place; visualize entire urinary system, enhanced pelvic calyceal filling |
| Describe the optional Lateral position for IVU. | 14x17 portrait; 40" SID; 80-85 kV; CR - perpendicular to IR; center 2" superior/posterior to symphysis pubis; Patient in true lateral with no rotation; visualize distal ureters, bladder, proximal urethra (male) |
| Describe the voiding cystourethrography. | 10x12; 40" SID; 80-85 kV; CR - perpendicular to IR; center to level of symphysis and MSP; Patient (female) supine/erect with no rotation separate legs, Patient (male) 30' RPO; visualize contrast filled urinary bladder and urethra |
| What are the Routine projections for IVU (Intravenous Urography) Excretory? | AP (Scout and Series), Nephrotomogram, RPO and LPO 30', AP Postvoid erect or recumbent |
| Describe the Intravenous (excretory) Urography: AP (scout and series). | SID-40"; IR-14x17/11x14 (nephrogram); 80-85kV; Pt position: supine, bladder empty; Part position: no rotation, include KUB; CR - perp IR, iliac crest and MSP; Nephrogram - center to midway between xiphoid and iliac crest; expose suspend expiration |
| Describe the Intravenous (excretory) Urography: Nephrotomography and nephrography. | SID-40"; IR-11x14; 80-85kV; Pt position: supine; Part position: no rotation; CR - Caudad, 10' for larger section of tissue in focus, 40' thinner sections of tissue in focus, center to midway btwn xiphoid process/iliac crest; expose suspend expiration |
| Describe the Intravenous (excretory) Urography: RPO and LPO | SID-40"; IR-14x17; 80-85kV; Pt position: RPO or LPO 30'; Part position: upside knee flexed, arm across chest; CR - perp to IR, center iliac crest and MSP; expose suspended expiration |
| Describe the Intravenous (excretory) Urography: AP Postvoid. | SID-40"; IR-14x17; 80-85kV; postvoid marker Pt position: erect or (optional PA) prone, bladder empty; Part position: no rotation, include KUB; CR - perp IR, iliac crest and MSP; expose suspended expiration |
| Describe the SPECIAL Intravenous (excretory) Urography: AP Ureteric Compression. | SID-40"; IR-11x14; 80-85kV; Pt position: supine, device placed, knees flexed; Part position: no rotation, upper edge paddles to iliac crest, just lateral to spine; CR - perp IR,Center to midway btwn xiphoid/iliac crest; expose suspended expiration |
| What is the anatomy demonstrated with IVU: AP | Entire urinary system from upper renal shadows to distal urinary bladder, including upper margin of symphysis. |
| What anatomy is demonstrated with IVU: Nephrotomography and nephrography? | Entire renal parenchyma, with some filling of collecting system with contrast |
| What anatomy is visualized with IVU: RPO and LPO? | Kidney on elevated side is placed in profile or parallel to IR best demonstrated with each oblique. Downside ureter is projected away from spine |
| What anatomy is best visualized with IVU: Postvoid? | Entire urinary system with only residual contrast visible - all of symphysis pubis (including prostate in males) |
| What anatomy is visualized with IVU: Ureteric Compression? | Entire urinary system visualized, with enhanced pelvic calyceal filling |
| What are the routine projections for Cystography? | AP (10 to 15' Caudad), Both obliques (45 - 60') and optional Left Lateral |
| Describe the Cystography: AP | SID-40"; IR-11x14(child)14x17(adult); 80-85kV; Pt position: supine; Part position: no rotation; CR - Caudad 10-15', 2" superior to symphysis and MSP, or to Demo urinary reflux, center at level of iliac crest; expose suspended expiration |
| Describe the Cystography: LPO and RPO | SID-40"; IR-11x14(child)14x17(adult); 80-85kV; Pt position: 45-60' body rotation, down leg flexed; Part position: CR - Perp, 2" superior to symphysis, 2" medial to upside ASIS, demo reflux, center to iliac crest; expose susp expiration |
| Describe the Cystography: Lateral | SID-40"; IR-11x14(child)14x17(adult); 80-85kV; Pt position: Left lateral, knees flexed; Part position: true lateral, no rotation; CR - Perp, 2" superior and posterior to symphysis; expose suspended expiration |
| What anatomy is demonstrated for Cystography? | Distal ureters, urinary bladder, proximal urethra on males; AP - no superimposition of pubis, OBLs - no superimposition of legs, Lateral - Hips and femurs should be superimposed INCLUDE PROSTATE distal to pubis |
| What are the routine projections for Voiding Cystourethrography? | Male - RPO (30') Female - AP |
| Describe the Voiding Cystourethrography: AP | SID-40"; IR-10x12; 80-85kV; Pt position: supine or erect; Part position: no rotation, legs extended and slightly separated; CR - Perp to IR and symphysis/MSP; expose suspended expiration |
| Describe the Voiding Cystourethrography: RPO | SID-40"; IR-10x12; 80-85kV; Pt position: Oblique 30'; Part position: RPO, superimpose urethra over soft tissue of right leg; CR - Perp to IR and symphysis/MSP; expose suspended expiration |
| What anatomy is visible on Voiding Cystourethrography? | contrast filled urinary bladder and urethra; females - urethra is visible inferior to pubis; males - urethra over soft tissue of rt leg |
Created by:
Larobbins
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